中国血液净化

›› 2008, Vol. 7 ›› Issue (4): 188-191.

• 论著 • 上一篇    下一篇

持续质量改进在预防维持性血液透析患者中心静脉导管相关感染中的应用

王磊 孟宪华 檀敏   

  1. 北京大学人民医院 肾内科 北京大学人民医院 肾内科
  • 收稿日期:2008-03-12 修回日期:1900-01-01 出版日期:2008-04-12 发布日期:2008-04-12

Effect of continuous quality improvement on central venous catheter-related bloodstream infections in hemodialysis patients

WANG Lei, MENG Xian-hua, TAN Min, YANG Jing-hua, FAN Xiao-zhi, SHAO Lin, CAI Mei-shun, WANG Mei.
  

  1. Department of Nephrology, Peking University People抯 Hospital, Beijing 100044, China
  • Received:2008-03-12 Revised:1900-01-01 Online:2008-04-12 Published:2008-04-12

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摘要： 目的　探讨应用持续质量改进（CQI）的方法降低血液透析患者静脉导管相关血流感染（CRBSI）的效果。方法　分析CQI前维持性透析病人（68例）导管相关的血流感染发生情况，采用PDCA四步法,设计并实施改善留置导管血液透析患者导管相关血流感染的防治措施，与CQI后次年同期76例中心静脉留置导管的病人导管相关血流感染发生情况比较。结果　持续质量改进后,无论是非隧道式或隧道式中心静脉导管的CRBSI发生率均有不同程度降低。非隧道式中心静脉导管总体CRBSI发生率降低68%(8.1例次/1000导管日 VS 2.6例次/1000导管日，其中股静脉置管的CRBSI发生率由14.8例次/1000导管日 降至4.1例次/1000导管日，颈内静脉置管CRBSI发生率2.6例次/1000导管日降至0.7例次/1000导管日。隧道式中心静脉置管CRBSI发生率降低了77％（5.2例/1000导管日 vs 0.7例/1000导管日）,其中颈内静脉置管CRBSI发生率由CQI前的2.6例次/1000导管日下降至0.7例次/1000导管日。结论　持续质量改进的方法可以降低维持性血透患者的中心静脉导管相关血流感染

关键词: 中心静脉导管相关血流感染, 持续质量改进, 血液透析

Abstract: Objective　To analyze the incidence for central venous catheter-related bloodstream infections (CRBSI) in hemodialysis patients and improve catheter-related bloodstream infections management using continuous quality improvement (CQI). Methods Analyzing the incidence of central venous catheter-related bloodstream infections (CRBSI) in 68 hemodialysis patients pre-CQI and using CQI to prophylaxis CRBSI. The CQI team was driven by a four-step process called PDCA cycle: plan, do, check and act. Compared the incidence for CRBSI in 76 hemodialysis patients with central venous catheter post-CQI Results　 For untunneled CVCs, The incidence of the total CRBSI is 8.1episodes /1000 catheter-days pre-CQI, and which reduced to 2.6 episodes/1000 catheter-days during the same period post-CQI(decreased 68%).For tunneled CVCs, the incidence of CRBSI dropped from 2.6 episodes /1000 catheter-days pre-CQI to 0.7 episodes /1000 catheter-days post-CQI. Conclusion　Continuous quality improvement program can improve the management of CRBSI in hemodialysis patients.

Key words: Continuous quality improvement, Hemodialysis

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