论文部分内容阅读
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。
Objective: To investigate the effect of central line bundle (CLB) on catheter related bloodstream infection (CRBSI) in patients with hematologic malignancies. Methods: To develop a cluster intervention for CRBSI with reference to the Centralized Prevention Strategy for Central Venous Catheter-Related Blood Infection by the Institution for Healthcare Improvement (IHI) Central venous catheter routine care of 252 cases of hematological malignancies as a control group, randomly selected during the same period in our hospital central catheterization catheterization cluster intervention strategy of 271 cases of hematological malignancies as the experimental group, conventional nursing and cluster intervention Strategy after the comparative analysis of the effect. Results: The average incidence of GRBSI in femoral vein of control group was the highest (26.1%). The average incidence of GRBSI in femoral vein after cluster intervention was 7.4 ‰. The average incidence of GRBSI in femoral vein of control group was significantly lower than that in experimental group P <0.01). The average incidence of GRBSI in the control group was no significant difference compared with the experimental group (P> 0.05). The incidence of CRBSI in control group and experimental group were 13.5 ‰, 6.1 ‰. The CRBSI rate (‰), CRBSI onset time, days of indwelling, length of hospital stay, and expense of hand disinfectant in the experimental group were significantly different from those in the control group (P <0.01) after the cluster intervention strategy. Gram-positive bacteria were the main CRBSI, and there was no significant difference in the constituent ratio of pathogens between the experimental group and the control group after the cluster intervention strategy (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 the hospitalization time, reduce hospitalization costs, reduce the economic burden of patients and improve the survival rate and quality of life of patients with hematologic malignancies .