北京市医疗机构ICU连续性肾脏替代治疗相关医院感染防控现状调查

Investigation on current status of prevention and control for hospital-associated infection related to continuous renal replacement therapy in ICUs of medical institutions in Beijing

  • 摘要:
    目的 对北京市属22所医疗机构连续性肾脏替代治疗(CRRT)开展现状及对《连续性肾脏替代治疗医院感染防控专家共识》核心建议依从性进行调查, 为制定精准化CRRT医院感染防控质量提升策略提供循证依据。
    方法 采用多中心横断面调查, 通过结构化问卷回收各机构重症医学病区(ICU)基本情况、制度建设、人员管理、感控措施等数据。运用Epidata 3.1建立数据库, SPSS 19.0进行统计学分析。
    结果 16所医疗机构的ICU常规开展CRRT治疗, 平均置管日6.29日;整体医院感染发生率为4.37%;其中CRRT导管相关血流感染发生率为0.73%(千日感染发生率为1.39‰)。调查显示:CRRT专项感控制度建设, 专业人才培养建设明显不足。医疗机构对CRRT共识核心建议的总体依从性较高;依从率与ICU床旁血滤设备配置数量存在正相关关系(r=0.476, P=0.021)。超声引导静脉穿刺(50.00%)和氯己定乙醇消毒剂应用(56.25%)两项关键措施依从率亟待改善。
    结论 通过构建基于区域实际的CRRT专项医院感染防控制度体系、人才培养机制及质控标准, 系统性提升医疗机构对共识建议的依从水平非常必要且具有切实可行性。

     

    Abstract:
    OBJECTIVE To investigate the current status of continuous renal replacement therapy (CRRT) in 22 medical institutions under the jurisdiction of Beijing and their compliance with the core recommendations of the "Expert Consensus on Prevention Control of Hospital-associated Infection in Continuous Renal Replacement Therapy", providing evidence-based support for formulating targeted strategies to improve the quality of prevention and control for hospital-associated infection of CRRT.
    METHODS A multi-center cross-sectional survey was conducted, data on the basic situation, institutional development, personnel management and infection control measures of intensive care unit (ICU) were collected by structured questionnaires. A database was established based on Epidata 3.1, and statistical analysis was performed with SPSS 19.0.
    RESULTS CRRT was routinely provided in ICUs of 16 medical institutions, with an average catheterization duration of 6.29 days. The overall hospital-associated infection rate was 4.37%, and the incidence rate of CRRT catheter-related bloodstream infection was 0.73% (incidence rate per 1 000 catheter-days was 1.39‰). The investigation revealed significant deficiencies in the development of specialized infection control institutions and professional talent cultivation for CRRT. Medical institutions demonstrated high overall compliance with the core recommendations of the CRRT consensus. Compliance was positively correlated with the number of bedside haemofiltration apparatus in ICUs (r=0.476, P=0.021). The compliance rates for two key measures, ultrasound-guided venous puncture (50.00%) and the use of chlorhexidine-alcohol disinfectants (56.25%), urgently need improvement.
    CONCLUSIONS It is both necessary and feasible to systematically enhance medical institutions′ compliance with consensus recommendations by establishing a specialized hospital-associated infection prevention and control institution, talent cultivation mechanism and quality control standards for CRRT based on regional realities.

     

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