183所三级医院ICU中心静脉导管相关血流感染防控护理实践的调查

doi:10.3761/j.issn.0254-1769.2022.11.014

摘要/Abstract

摘要：

目的了解国内三级医院ICU中心静脉导管相关血流感染防控实践现况,评估护理实践的薄弱环节,为制订相应的干预措施提供依据。方法自行设计调查问卷,共3个部分、29个条目。采用便利抽样法,于2021年9月1日—15日对26个省（自治区、直辖市）183所三级医院336名ICU护士进行调查。结果共回收336份有效问卷,有效问卷回收率为100%。其中,294名（87.50%）ICU护士填写了中心静脉导管相关血流感染发生率,其发生率为0~20.01‰,中位数为0.77‰。在置管环节,275个（81.85%）ICU有置管核查员,77个（22.92%）ICU使用无菌巾覆盖患者全身,48个（14.29%）ICU使用思乐扣固定导管,52个（15.48%）ICU使用洗必泰醇消毒皮肤,仅23个（6.85%）ICU有消毒范围规范。在导管维护环节,分别有148个（44.05%）、123个（36.61%）ICU使用预冲式导管冲洗液冲管、封管,71个（21.13%）ICU对患者进行洗必泰擦浴,253个（75.30%）ICU有输液接头使用操作规范,162个（48.21%）ICU使用酒精棉片进行输液接头消毒,195个（58.04%）ICU输液接头消毒擦拭的时间≥15 s。不同类型ICU在是否有置管督查表、导管维护集束化措施核查表等方面,差异具有统计学意义（P<0.05）。结论目前,预防中心静脉导管相关血流感染的制度和流程已趋于完善,但在置管、维护、输液接头使用等环节的防控措施有待进一步细化和同质化,建议进一步加强相关培训,并制订具体措施促进指南的落实。

关键词: 重症监护病房, 中心静脉导管相关血流感染, 现况研究, 护理

Abstract:

Objective To understand the clinical practice of prevention and control of ICU central line-associated bloodstream infections（CLABSI） of tertiary hospitals in China,to evaluate the weakness in nursing practice and explore the common problems. Methods From September 1st to 15th,2021,the convenience sampling method was adopted,and the self-designed “Questionnaire on current status of nursing practice for prevention and control of CLABSI” was used in 183 tertiary hospitals in 26 provinces/autonomous regions/municipalities to select ICU nurses in the hospitals. The questionnaire consists of 3 parts and 29 items. Results A total of 336 questionnaires were collected,with an effective rate of 100%. Among them,294（87.50%） ICUs filled in the incidence of CLABSI,and the incidence ranged from 0 to 20.01‰ with a median of 0.77‰. In the central vascular catheterization process,275（81.85%） ICUs had catheterization inspectors;77（22.92%） ICUs used the sterile towel to cover the whole body during the puncture;48（14.29%） ICUs used Statlock to fix the catheter;52（15.48%） ICUs selected chlorhexidine alcohol as skin disinfectant;only 23（6.85%） departments had the standard of disinfection scope during catheterization. In the central line maintenance process,148（44.05%） used pre-flushing catheter flushing fluid to flush the tube;123（36.61%） used pre-flushing catheter flushing fluid to seal the tube;71（21.13%） ICUs adopted chlorhexidine for sponge bath;253（75.30%） ICUs have procedures for using infusion connectors;162（48.21%） ICUs wiped the infusion connectors with an alcohol cotton pad;195（58.04%） ICUs wipe time is more than or equal to 15 s. Different ICUs have great differences in the implementation of key process with statistically significant differences. Conclusion At present,the relevant systems and procedures to prevent CLABSI have been improved,but the prevention and control measures in the aspects of central line catheterization,maintenance,and the use of infusion joints need to be further detailed. It is recommended to further strengthen and implement the training related to the guidelines,and to formulate specific measures to promote the implementation of the guidelines.

Key words: Intensive Care Units, Central Line-Associated Bloodstream Infection, Cross-Sectional Study, Nursing Care

王霞, 邵欣, 旷璐, 孙众, 刘晨霞, 刘聚源, 蔡虻. 183所三级医院ICU中心静脉导管相关血流感染防控护理实践的调查[J]. 中华护理杂志, 2022, 57(11): 1371-1376.

WANG Xia, SHAO Xin, KUANG Lu, SUN Zhong, LIU Chenxia, LIU Juyuan, CAI Meng. Investigation of nursing prevention and control practice of central line-associated bloodstream infections in ICU of 183 tertiary hospitals[J]. Chinese Journal of Nursing, 2022, 57(11): 1371-1376.

图/表 3

表1 各ICU所属地区的分布情况（n=336）

Table 1 Regional distribution of ICUs（n=336）

表2 各ICU中心静脉导管相关血流感染防控护理实践现状（n=336）

Table 2 The survey results of nursing practice status of prevention and control of central line-associated blood stream infections in ICUs（n=336）

表3 不同类型ICU中心静脉导管相关血流感染防控护理实践现状比较[n=336,个（百分率,%）]

Table 3 Comparison of nursing practice status of prevention and control of central line-associated blood stream infections in different types of ICUs[n=336,case（percentage,%）]

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