摘要
目的探讨基于失效模式与效应分析(FMEA)的导管信息化平台在预防ICU中心静脉导管相关血流感染(CRBSI)中的应用效果,以改善CRBSI目前的现状。方法本研究为回顾性队列研究,采用目的抽样法,将2021年8—12月北京大学深圳医院ICU收治的140例留置中心静脉导管的患者设为对照组,将2022年1—5月ICU收治的140例留置中心静脉导管的患者设为观察组。对照组给予CRBSI集束化护理措施后在床边使用电子表单记录与管理,观察组在给予CRBSI集束化护理措施后使用基于FMEA构建的重症系统导管信息化平台对导管评估及维护过程等进行信息化管理。比较2组ICU护士CRBSI集束化护理措施的执行率(6项)、执行时间、合格率及ICU患者CRBSI发生率情况。结果观察组的ICU护士CRBSI集束化护理措施执行率中护士严格执行手卫生为87%(122/140)、穿刺时最大无菌屏障为97%(136/140)、导管维护时无菌操作为91%(128/140)、75%乙醇消毒接头为84%(118/140)、24 h更换输液管路为95%(133/140)、及时更换贴膜/敷料为89%(125/140),均大于对照组的70%(98/140)、87%(122/140)、71%(100/140)、61%(86/140)、71%(99/140)、69%(96/140),差异均有统计学意义(χ^(2)值为9.67~29.07,均P<0.05);观察组的ICU护士CRBSI集束化护理措施执行时间、合格率分别为(9.11±2.83)min、91.4%(128/140),对照组分别为(10.00±2.84)min、60.7%(85/140),差异均有统计学意义(t=-2.64,χ^(2)=36.28,均P<0.05)。结论基于FMEA的导管信息化平台有助于增强ICU护士CRBSI集束化护理措施执行效率,提高护理质量,进而减少CRBSI的发生,临床推广具有一定的可行性。
Objective To investigate the effect of failure mode and effect analysis(FMEA)based catheter information platform in preventing catheter-related bloodstream infection(CRBSI)in intensive care unit to improve the current status of CRBSI.Methods In this study,a retrospective cohort study was conducted using the purposive sampling method,and 140 patients with indwelling central venous catheters admitted to the ICU of Peking University Shenzhen Hospital from August to December 2021 were set as the control group;the 140 patients with indwelling central venous catheters admitted to the ICU from January to May 2022 were set as the observation group.The control group used electronic forms to record and manage at the bedside after CRBSI cluster nursing measures were given,and the observation group used the catheter information platform based on FMEA to conduct information management on catheter evaluation and maintenance process after CRBSI cluster nursing measures were given.Compared the implementation rate(6 items),implementation time,qualification rate,and incidence of CRBSI in ICU patients between two groups of ICU nurses.Results The implementation rate of CRBSI cluster nursing measures among ICU nurses in the observation group:strict hand hygiene by nurses was 87%(122/140),maximum aseptic barrier during puncture was 97%(136/140),aseptic operation during catheter maintenance was 91%(128/140),75%alcohol disinfection of connectors was 84%(118/140),24-hour change of infusion lines was 95%(133/140),and timely change of patches/dressings was 89%(125/140),they were greater than those in the control group 70%(98/140),87%(122/140),71%(100/140),61%(86/140),71%(99/140),69%(96/140),the differences were statistically significant(χ^(2)values were 9.67 to 29.07,all P<0.05);the execution time and qualification rate among ICU nurses in the observation group were(9.11±2.83)minutes and 91.4%(128/140),the control group were(10.00±2.84)minutes and 60.7%(85/140),with statistically significant differences(t value was-2.64,χ^(2)values was 36.28,all P<0.05).Conclusions The FMEA-based catheterization information platform can help enhance the efficiency of the implementation of CRBSI clustering nursing measures by ICU nurses,improve the quality of care,and thus reduce the occurrence of CRBSI,and the feasibility of clinical promotion is high.
作者
徐佳卿
莫敏华
高莹莹
张文婷
李圣芳
赖文娟
丁小容
Xu Jiaqing;Mo Minhua;Gao Yingying;Zhang Wenting;Li Shengfang;Lai Wenjuan;Ding Xiaorong(Department of Intensive Care Unit,Peking University Shenzhen Hospital,Shenzhen 518000,China;Department of Nursing,Peking University Shenzhen Hospital,Shenzhen 518000,China)
出处
《中国实用护理杂志》
2023年第24期1846-1852,共7页
Chinese Journal of Practical Nursing
基金
深圳市医学重点学科(2020-2024年)建设经费资助(SZXK056)。
关键词
中心静脉导管
导管信息化
失效模式与效应分析
预防感染
Central venous catheter
Catheter informatization
Failure mode and effect analysis
Prevention of infection
