无菌治疗巾包裹导管接头对中心静脉导管相关血流感染发病率的影响
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唐志红

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R181.3+2

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四川省健康委员会项目(18PJ230)


Effect of sterile therapeutic towel wrapping catheter connectors on incidence of central line-associated bloodstream infection
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    摘要:

    目的 探讨无菌治疗巾包裹中心静脉导管接头及三通对降低重症监护病房(ICU)患者中心静脉导管相关血流感染(CLABSI)发病率的作用。方法 选取四川省某三甲医院外科ICU收治的中心静脉置管患者作为研究对象,以2017年5—10月收治的患者为对照组,2018年5—10月收治的患者为试验组。对照组实施常规的深静脉置管护理措施,试验组在实施常规护理措施基础上,采用无菌治疗巾对导管及三通进行包裹,每8 h更换一次。比较两组患者CLABSI发病情况,并在措施实施半年后采用自行设计的调查问卷调查临床护士的使用感受。结果 共纳入患者对照组188例,试验组166例。对照组中7例发生CLABSI,CLABSI发病率为3.72%,中心静脉置管总日数为1 233 d,千日发病率为5.68‰;试验组中5例发生CLABSI,CLABSI发病率为3.01%,中心静脉置管总日数为 1 098 d,千日发病率为4.55‰;两组患者CLABSI发病率比较,差异无统计学意义(χ2=0.136,P=0.712)。共调查65名护士对采用无菌治疗巾包裹导管接头及三通的临床使用感受,结果显示,98.46%的护士认为加药时需要打开、包扎治疗巾,操作不方便,93.85%的护士认为不利于观察导管连接情况,66.15%的护士在工作中遇到过因无菌治疗巾包裹导致导管连接处松动、液体渗出时观察不及时的问题,53.85%的护士认为包裹无菌治疗巾平均每例患者约花费2~3 min时间。结论 尚不能证明无菌治疗巾包裹导管接头及三通能降低CLABSI发病率,且同时大量增加临床护理工作量,减少护士直接照护患者的时间,增加临床护理风险。

    Abstract:

    Objective To investigate effect of sterile therapeutic towel wrapping connector and three-way tube of central venous catheter(CVC) on reducing incidence of central line-associated bloodstream infection (CLABSI) in intensive care unit (ICU) patients. Methods Patients with central vein catheterization in surgical ICU of a tertiary first-class hospital in Sichuan Province were selected as the study objects, patients who were admitted to ICU from May to October 2017 were as control group, those from May to October 2018 were as trial group. In control group, routine nursing measures of deep vein catheterization were carried out, in trial group, on the basis of routine nursing measures, CVC and three-way tube were wrapped with sterile therapeutic towel and replaced every 8 hours. Incidence of CLABSI was compared between two groups of patients, self-designed questionnaire was used to investigate the feeling of clinical nurses half a year after the implementation of measures. Results 188 patients in control group and 166 patients in trial group were included in study. In control group, 7 patients developed CLABSI, incidence of CLABSI was 3.72%, central vein catheterization days was 1 233 days, incidence was 5.68 per 1 000 catheter days; in trial group, 5 patients developed CLABSI, incidence of CLABSI was 3.01%, central vein catheterization days was 1 098 days, incidence was 4.55 per 1 000 catheter days; there was no significant difference in the incidence of CLABSI between two groups of patients(χ2=0.136,P=0.712). A total of 65 nurses were investigated about their feelings of clinical use of sterile therapeutic towel wrapping connector and three-way tube of CVC, 98.46% of nurses thought it was inconvenient to open and bandage the sterile therapeutic towel when adding medicine, 93.85% thought it was not conducive to observing the connection of catheter, 66.15% encountered the problems of untimely observation when catheter connection was loose and liquid was oozing out due to the wrapping of sterile therapeutic towel, 53.85% thought that it took about 2-3 minutes to wrap the sterile therapeutic towel for each patient. Conclusion It can not be proved that sterile therapeutic towel wrapping collector and three-way tube can reduce the incidence of CLABSI, while greatly increase the clinical nursing workload, reduce the time of nurses to directly care for patients, and increase the risk of clinical nursing.

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李思宇, 唐志红, 李娜.无菌治疗巾包裹导管接头对中心静脉导管相关血流感染发病率的影响[J]. 中国感染控制杂志,2020,19(4):365-369. DOI:10.12138/j. issn.1671-9638.20205414.
LI Si-yu, TANG Zhi-hong, LI Na. Effect of sterile therapeutic towel wrapping catheter connectors on incidence of central line-associated bloodstream infection[J]. Chin J Infect Control, 2020,19(4):365-369. DOI:10.12138/j. issn.1671-9638.20205414.

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  • 收稿日期:2019-05-17
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  • 在线发布日期: 2020-04-28
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