目的 评价综合安全项目（comprehensive unit-based safety program,CUSP）协同行动策略对降低ICU患者中心静脉导管相关血流感染（central line associated blood stream infection,CLABSI）发生率的效果。方法 通过明确ICU发生CLABSI的现存问题,制订以降低CLABSI发生率为目标的CUSP协同行动策略干预方案,于2019年7月—2021年6月在浙江省某三级甲等医院ICU应用并动态调整该方案。比较干预前（2017年7月—2019年6月）、干预后（2019年7月—2021年6月）CLABSI发生率、护士CLABSI知信行得分、中心静脉导管维护项目执行率及手卫生依从性的差异。结果 干预前共14 681导管日CLABSI发生率为0.82‰,干预后共15 055导管日发生率为0.27‰（χ2=4.202,P<0.05）;干预前ICU护士CLABSI知信行得分为（96.84±8.00）分,干预后得分为（99.35±7.96）分（t=-2.016,P<0.05）;干预前ICU护士中心静脉导管维护项目执行率为82.73%,干预后为92.74%（χ2=4.735,P<0.05）;干预前ICU护士手卫生依从率为51.21%,干预后为85.33%（χ2=26.563,P<0.05）,差异均具有统计学意义。结论 采用CUSP协同行动策略有助于降低ICU患者CLABSI发生率,同时提高ICU护士CLABSI知信行水平、中心静脉导管维护项目执行率及手卫生依从性。
Objective To evaluate the effect of comprehensive unit-based safety program（CUSP） coordinated with action strategy on reducing the incidence of central line associated blood stream infection（CLABSI） in ICU patients. Methods The CUSP coordinated with action strategy intervention program was developed to reduce CLABSI by identifying the existing problems related to the incidence of CLABSI in ICU. The program was continuously applied in ICU and the intervention measures were dynamically adjusted during the application process from July 2019 to June 2021. The incidence of CLABSI,nurses' knowledge and practice of CLABSI,the implementation rate of central venous catheter-related maintenance items and hand hygiene compliance were compared before（July 2017 to June 2019） and after the intervention（July 2019 to June 2021）. Results The incidence of CLABSI in 14 681 catheter days before intervention was 0.82‰,while the incidence of CLABSI in 15 055 catheter days after intervention was 0.27‰,with statistical significance（P<0.05）. Before the intervention the ICU nurses' knowledge,attitude and practice score of CLABSI was （96.84±8.00）,and the score was （99.35±7.96） after the intervention,the difference was statistically significant（t=-2.016,P<0.05）. The implementation rate of central intravenous catheter maintenance was 82.73% before intervention and 92.74% after intervention（ χ2=4.735,P<0.05）. The hand hygiene compliance rate was 51.21% before the intervention and 85.33% after the intervention（ χ2=26.563,P<0.05）. Conclusion The adoption of comprehensive unit-based safety program coordinated with action strategy can reduce the incidence of CLABSI,improve the knowledge and practice of CLABSI,the implementation rate of central venous catheter maintenance and hand hygiene compliance of ICU nurses.
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