持续质量改进在预防维持性血液透析患者中心静脉导管相关感染中的应用

目的探讨应用持续质量改进（CQI）的方法降低血液透析患者静脉导管相关血流感染（CRBSI）的效果。方法选择北京大学人民医院CQI前维持性透析患者（68例）分析导管相关的血流感染发生情况，采用PDCA四步法，设计并实施改善留置导管血液透析患者导管相关血流感染的防治措施，与CQI后次年同期76例中心静脉留置导管的患者导管相关血流感染发生情况比较。结果持续质量改进后，无论是非隧道式或隧道式中心静脉导管的CRBSI发生率均有不同程度降低。非隧道式中心静脉导管总体CRBSI发生率降低68％（8．1例次／1000导管日VS2．6例次／1000导管日，其中股静脉置管的CRBSI发生率由14．8例次／1000导管日降至4．1例次／1000导管日，颈内静脉置管CRBSI发生率2．6例次／1000导管日降至0．7例次／1000导管日。隧道式中心静脉置管CRBSI发生率降低了77％（5．2例／1000导管日VS0．7例／1000导管日），其中颈内静脉置管CRBSI发生率由CQI前的2．6例次／1000导管日下降至0．7例次／1000导管日。结论持续质量改进的方法可以降低维持性血液透析患者的中心静脉导管相关血流感染。

Effect of continuous quality improvement on central venous catheter-related bloodstream infections in hemodialysis pafients

Objective To study the continuous quality improvement （CQI） program for the control of central venous catheter-related bloodstream infections （CRBSI） in hemodialysis patients. Methods We first analyzed CRBSI incidence in 68 hemodialysis patients before CQI, and carried out CQI for the prevention of CRBSI. The procedures of CQI included four steps： planning, doing, checking and acting （PDCA）. We then compared the CRBSI incidence in 76 hemodialysis patients with central venous catheter and receiving CQI. Results For patients with untunneled central venous catheterization, total CRBSI incidence was 8.1 times/1000 catheterization days in those without CQI, and the incidence reduced to 2.6 times/1 000 catheterization days in those receiving CQI during the same period. For patients with tunneled central venous catheterization, CRBSI incidence decreased from 2.6 times/1000 catheterization days in those without CQI to 0.7 times/1 000 catheterization days in those receiving CQI. Conclusion CQI program reduces CRBSI incidence in hemodialysis patients.