PDCA循环在导尿管相关性泌尿道感染控制中的应用

目的了解规范留置导尿及其护理流程，对降低导尿管相关性泌尿道感染（CAUTI）的影响。方法 运用PDCA循环管理留置导尿管的住院患者，通过分析CAUTI相关危险因素，制定留置导尿管的标准操作流程，加强培训、指导、考核与检查，及时发现问题，提出改进措施，并进行持续质量改进。结果应用PDCA循环管理1年后，尿道口、导尿管与集尿袋接口、集尿袋放尿口的日常护理达标率及尿管的外固定与标识的执行率分别为98.59%（70/71）、95.77%（68/71）、95.77%（68/71）、100.00%（71/71），显著高于管理前的34.92%（22/63）、28.57%（18/63）、17.46%（11/63）、0.00%（0/63）；2011年脑外科住院患者的CAUTI发生率，第1-4季度分别为1.86‰、1.63‰、1.10‰、0.95‰，呈逐步下降趋势（χ2=3.951，P=0.047）。结论采用PDCA循环模式，充分发挥监控部门的管理功能，能降低CAUTI的发生率。

Application of PDCA cycle in the control of catheter associated urinary tract infection

ObjectiveTo study the effect of standard indwelling urinary catheterization and nursing procedures on reducing the incidence of catheter associated urinary tract infection（CAUTI）.MethodsPlane do check act（PDCA） cycle model was used to manage the inpatients with indwelling urinary catheterization, standard manipulation procedures of indwelling urinary catheterization were formulated by analyzing the risk factors of CAUTI, the training, guidance, assessment and check were strengthened to find out the problems and propose improvement measures timely,and the continuous quality improvement was performed.ResultsThrough one year implementation of PDCA cycle management, the qualified rates of routine care for urinary meatus, connection between urinary catheter and urine collection bags, and outlets of urine collection bags, as well as implementation rate of external fixation and signs of catheters were significantly higher than those before PDCA management respectively （98.59%70/71] vs 34.92%22/63];95.77%68/71] vs 28.57% 18/63];95.77%68/71] vs 17.46%11/63]; 100.00%71/71] vs 0.00%0/63]）; the incidence of CAUTI in neurosurgery patients from quarter 1 to 4 of 2011 was 1.86‰,1.63‰,1.10‰ and 0.95‰ respectively,there was a decreased tendency（X2=3.951,P=0.047）.Conclusion The implementation of PDCA cycle model can bring the function of surveillance system into full play, and effectively reduce the incidence of CAUTI.