集束化干预对恶性血液病患者导管相关性血流感染的效果分析

目的:探讨中心静脉导管集束化干预策略(central line bundle,CLB)对恶性血液病患者导管相关性血流感染(catheter related bloodstream infection,CRBSI)的影响效果。方法:参照美国健康促进会(Institution for Healthcare Improvement,IHI)中心静脉导管相关血流感染预防的集束化干预策略,制定CRBSI集束化干预办法,选择2010年1月至2015年1月在本院留置中心静脉导管行常规护理的252例恶性血液病患者作为对照组,随机选取同期在我院留置中心静脉导管行集束化干预策略的271例恶性血液病患者作为实验组,对常规护理与集束化干预策略后的效果进行比较性分析。结果:对照组股静脉GRBSI平均发生率最高,达26.1‰,集束化干预策略后股静脉置管GRBSI平均发生率7.4‰,对照组股静脉GRBSI平均发生率较实验组比较差异有统计学意义(P<0.01),对照组颈内静脉、锁骨下静脉置管GRBSI平均发生率较实验组比较差异无统计学意义(P>0.05);对照组与实验组的CRBSI发生率分别为13.5‰、6.1‰,集束化干预策略后实验组的CRBSI率(‰)、CRBSI起始时间、留置天数、住院时间和费用及手消毒剂消耗量与对照组比较差异均有统计学意义(P<0.01);CRBSI以革兰阳性菌为主,集束化干预策略后实验组与对照组的病原菌构成比比较差异无统计学意义(P>0.05)。结论:采用集束干预策略可有效降低恶性血液病患者中心静脉导管相关性血流感染发生率,缩短患者住院时间,降低住院费用,减轻患者经济负担,提高了恶性血液病患者的生存率和生活质量。

Effect of cluster intervention strategy on catheter-related bloodstream infections in patients with hematologic malignancies

Objective:To explore the effect of central venous catheter cluster intervention strategy (central line bundle,CLB) on catheter-related bloodstream infections in patients with hematologic malignancies (catheter related bloodstream infection,CRBSI).Methods:According to the United States of central venous catheter related blood stream infection prevention Institution for Healthcare Improvement(IHI),cluster intervention strategy of CRBSI cluster change intervention measures were set.252 patients with hematologic malignancies in our hospital from January 2010 to January 2010 were set as control group and treated with central venous catheter indwelling routine nursing,at the same time randomly selected 271 patients with hematologic malignancies as experimental group and treated with cluster intervention strategy.The effects of two groups were compared.Results:The incidence rate of femoral vein GRBSI was 26.1‰ in contrast group,average 7.4‰ in control group and the difference was statistically significant (P<0.01).The incidence of internal jugular vein,subclavian venipuncture GRBSI in experimental group had no statistically significant difference (P>0.05).The incidence of CRBSI in two groups were 13.5‰,6.1‰ respectively,and the CRBSI rate (per),CRBSI starting time,retention days,length of hospital stay,cost and consumption of hand disinfectant were significantly different (P<0.01) compared with control group.Gram-positive bacteria were the main cause of CRBSI,and pathogenic constituent ratio has no significant difference after intervention strategy between experimental group and control group (P>0.05).Conclusion: The cluster intervention strategy can effectively reduce the incidence of central venous catheter related bloodstream infections in patients with hematologic malignancies,shorten their hospital stay,reduce hospitalization expenses,and improve their survival rate and quality of life.