集束预防策略对导管相关性血流感染发生率影响的多因素分析

】目的探讨集束预防策略对导管相关性血流感染（CRBSI）发生率的影响。方法选取入住ICU并行中心静脉置管的患者1405例为研究对象,根据是否发生CRBSI,分为感染组117例和未感染组1288例。对每例患者实施集束预防策略,每日进行评估。分析集束预防策略中的各项措施与CRBSI发生率的关系。结果本研究患者总置管天数17317d,导管平均留置时间12．85d,感染发生率为6．8／1000导管留置日。两组患者性别、年龄、肤贴种类、更换肤贴时间和是否输入TPN差异均无统计学意义（P〉0．05）;感染组患者APACHEII评分〉20分占78．63％、住ICU时间〉30d占38．46％、紧急插管占17．95％、接受倾人性操作频次〉4次占83．76％、导管留置时间〉7d占78．63％均高于非感染组（51．86％,15．53％,7．84％,35．02％,31．13％）,差异均具有统计学意义（X2值分别为8．071,23．750,10．781,36．56,44．886;P〈0．05）;感染组患者操作时提供最大无菌屏障的合格率占45．30％、操作中接头消毒的合格率占68．38％、锁骨下静脉置管占40．17％均低于非感染组（75．93％,94．33％,59．94％）,差异均具有统计学意义（x2值分别为9．303,4．604,5．076;P〈0．05）;多元回归分析显示操作中接头消毒的合格率是影响CRBSI发生的独立因素（OR=4．992,P〈0．01）。结论实行集束化预防策略,加强导管接头消毒管理可以降低CRBSI的发生率。

Multi-factor analysis on prevention strategies of bundle on catheter-related bloodstream infection rates

Objective To explore the impact of bundle prevention strategies on the CRBSI incidence. Methods Patients admitted to ICU with central venous catheter were given daily assessment and target monitor from 2008.2 to 2010.2, and divided into infected （117 cases） and non-infected （1 288 cases） group according to whether there was CRBSI. Analysis the relationship between the measures of bundle prevention strategies and the incidence of CRBSI, all data applications SPSS 10.0 for windows statistical software package for statistical analysis. Results In the study, 1 405 cases were collected, and 117 eases were infected while 1 288 cases were non-infected. The total number of catheter day was 17 317 days, and the average was 12.85 d. Infection rate was 6.8 per 1 000 catheter days. Sex, age, type of skin plaster and time of changing skin plaster and infusion TPN were not different between the two groups （P 〉 0. 05 ）. The single variable analysis has shown that the in the infection group, severity of clinical patients （APACHE II 〉 20 points） was 78.63% , ICU stay time（ 〉 30 days） was 38.46%, emergency intubation method was 17.95%, patients received the frequency of invasive procedures（ 〉4 times） was 83.76% , catheter day longer than 7 days was 78.63% were higher than those in the non-infection group （51.86%, 15.53%, 7.84%, 35.02% and 31.13%, respectively） and the difference was significant （ X2 = 8. 071, 23. 750, 10. 781, 36.56, 44. 886, respectively; P 〈 0. 05 ） ; the pass rate of maximum sterile barrier （45.30%）, the timeliness of joint disinfection on normal operation （68.38%） and catheterization in subclavian vein （40.17%） in infection group were lower than non-infection group （75.93%, 94.33% and 59.94%, respectively） and the difference was significant （ X2 = 9.303, 4.604,5. 076, respectively; P 〈 0. 05 ）. Multiple regression analysis showed that the joint disinfection timeliness on normal operation was the independence factor of affecting CRBSI incidence （ OR = 4. 992, P 〈 0. 01 ）. Conclusions The implementation of bundle prevention strategies and strengthening the management of catheter connector can reduce the incidence of CRBSI.