目标性监测结合集束化干预对ICU相关器械感染的预防作用研究

目的分析目标性监测结合集束化干预在重症监护室(intensive care unit,ICU)导管相关血流感染(catheter-related bloodstream infection,CRBSI),导管相关泌尿系统感染(catheter associated urinary tract infections,CAUTZ)及呼吸机相关性肺炎(ventilator-associated pneumonia,VAP)预防中的作用,为临床诊疗提供一些借鉴。方法选取2018年4~9月在浙江医院ICU没有进行目标监测与集束化干预患者作为对照组,选取2018年10月至2019年3月在浙江医院ICU行目标监测与集束化患者作为观察组,对照组行常规管理,观察组行目标性监测结合集束化干预,观察其VAP、CRBSI、CAUTI医院感染率、例次感染率、器械使用率、医院千日感染率及例次千日感染率。结果观察组CRBSI感染率(0.62%)、CRBSI例次感染率(0.86%)、千日感染率(0.11%)及例次千日感染率(0.15%)均低于对照组(1.13%、1.43%、0.19%、0.24%),差异有统计学意义(P均<0.05);观察组VAP感染率(5.06%)、VAP例次感染率(5.60%)、千日感染率(0.94%)及例次千日感染率(1.04%)均低于对照组(9.56%、10.39%、1.88%、2.05%),差异有统计学意义(P均<0.05);观察组CAUTI感染率(2.18%)、CAUTI例次感染率(2.49%)、千日感染率(0.41%)及例次千日感染率(0.46%)均低于对照组(4.29%、4.59%、0.85%、0.90%),差异有统计学意义(P均<0.05)。结论目标性监测结合集束化干预可有效降低ICU中VAP、CRBSI及CAUTI感染率。

The impact of targeted surveillance along with bundles of care on the prevention of device-associated infection in ICU

Objective To describe the impact of targeted surveillance along with bundles of care on the prevention of device-associated infections such as catheter-related bloodstream infection(CRBSI),catheter-associated urinary tract infection(CAUTI)and ventilator-associated pneumonia(VAP)in ICU.Methods Patients who received targeted monitoring along with bundles of care in ICU in Zhejiang hospital from October 2018to March 2019were recruited into the intervention group of our study,while patients who received regular management in ICU from April to September 2018were enrolled as controls.The rates of VAP,CRBSI,CAUTI nosocomial infection,infection rate per case,device utilization rate,in fection rate per 1000ICU-days as well as infection rate per case per 1000ICU-days were recorded and compared between the two groups.Results The overall CRBSI rate,CRBSI rate per patient,CRBSI rate per 1000catheter-days and CRBSI rate per patient per 1000catheter-days were all significantly lower in the intervention group compared to the control group(0.62%vs 1.13%;0.86%vs 1.43%;0.11%vs 0.19%;0.15%vs 0.24%;P<0.05).Meanwhile,the overall VAP rate,VAP rate per patient,VAP rate per 1000ventilator-days and VAP rate per patient per 1000ventilator-days were all significantly lower in the intervention group compared to the control group(5.06%vs 9.56%;5.60%vs 10.39%;0.94%vs 1.88%;1.04%vs 2.05%,P<0.05).At the same time,the overall CAUTI rate,CAUTI rate per patient,CAUTI rate per 1000catheter-days and CAUTI rate per patient per 1000catheter-days were also lower in the intervention group compared to the control group(2.18%vs 4.29%;2.49%vs 4.59%;0.41%vs 0.85%;0.46%vs 0.90%),the differences were statistically significant(P<0.05).Conclusions Targeted surveillance together with bundles of care can effectively reduce the infection rate of VAP,CRBSI and CAUTI in ICU.