摘要
目的探讨集成化临床信息系统(ICIS)在重症医学科(ICU)院内感染管理中的应用价值。方法采用前瞻性前后对照研究方法,选取上海健康医学院附属周浦医院于2017年7月至2018年6月入住ICU的所有患者作为实施ICIS后组,利用ICIS智能预警,每日执行核查单,实行过程质量控制;选取2016年4月至2017年3月收治的重症患者作为实施ICIS前组,未实施ICIS,只进行常规护理与查房。纵向比较两组患者ICU导管相关性感染(CAI)、呼吸机相关性肺炎(VAP)、中心静脉导管相关血流感染(CLABSI)、导尿管相关泌尿系感染(CAUTI)发生率及临床预后的变化。结果两组患者基线资料比较差异均无统计学意义(P>0.05)。实施ICIS前组CAI发生率为8.97%(35/390),实施ICIS后组为3.53%(14/397),两组比较差异有统计学意义(RR:0.393,95%CI:0.211~0.730,P=0.003);实施ICIS前后VAP发生率分别为10.92例/1000机械通气日和4.90例/1000机械通气日,两组差异有统计学意义(RR:0.449,95%CI:0.215~0.939,P=0.033);两组CLABSI和CAUTI发生率比较差异均无统计学意义(P>0.05)。实施ICIS后,ICU住院时间由7.0(3.5~12.5)d降至5.0(3.0~10.0)d,差异有统计学意义(P=0.006);实施ICIS后,ICU病死率虽有下降趋势,但差异无统计学意义(P>0.05)。结论利用ICIS实行过程质量控制,可有效降低ICU患者CAI和VAP的发生率,缩短ICU住院时间。
Objective To investigate the application value of the integrated clinical information system(ICIS)in the nosocomial infection management of the intensive care unit(ICU).Methods A prospective pre-and post-control study method was adopted.All inpatients admitted to ICU of this hospital from July 2017 to June 2018 were enrolled as the post-ICIS group.The post-ICIS group used the ICIS intelligent warning,executed the check list daily and implemented the process quality control.The critical patients without implementing ICIS from April 2016 to March 2017 served as the pre-ICIS group,the pre-ICIS group did not implement ICIS,only conducted the routine nursing and ward round.The incidence rates of ICU catheter-associated infection(CAI),ventilator-associated pneumonia(VAP),central line-associated bloodstream infection(CLABSI),catheter-associated urinary tract infection(CAUTI)and the clinical prognosis changes were vertically compared between the two groups.Results There was no statistically significant difference in the baseline data between the two groups.The incidence rate of CAI in the pre-ICIS group was 8.97%(35/390),which in the post-ICIS group was 3.53%(14/397),the difference between the two groups was statistically significant(RR:0.393,95%CI:0.211-0.730,P=0.003);before and after implementing ICIS,the VAP incidence rates were 10.92 cases/1000 mechanical ventilator days and 4.90 cases/1000 mechanical ventilator days respectively,and the difference between the two groups was statistically significant(RR:0.449,95%CI:0.215-0.939,P=0.033).However,the incidence rate of CLABSI and CAUTI had no statistical difference between the two groups(P>0.05).After implementing ICIS,the hospitalization time of ICU was decreased from 7.0(3.5-12.5)d to 5.0(3.0-10.0)d,and the difference was statistically significant(P=0.006).After implementing ICIS,although the ICU mortality rate had the decreasing trend,but the difference had no statistical significance(P>0.05).Conclusion Implementing the process quality control by using ICIS can effect
作者
许东伟
邱泽亮
沈侃
周丽红
戴华
张倩
XU Dongwei;QIU Zeliang;SHEN Kan;ZHOU Lihong;DAI Hua;ZHANG Qian(Department of Critical Care Medicine,Affiliated Zhoupu Hospital,Shanghai University of Medicine&Health Sciences,Shanghai 201318,China;Department of Nosocomial Infection Control,Affiliated Zhoupu Hospital,Shanghai University of Medicine&Health Sciences,Shanghai 201318,China)
出处
《检验医学与临床》
CAS
2022年第4期443-446,450,共5页
Laboratory Medicine and Clinic
基金
上海市浦东新区卫生系统学科带头人人才培养计划项目(PWRd2016-08)
上海市浦东新区科委面上项目(PKJ2019-Y26)。
关键词
集成化临床信息系统
ICU导管相关性感染
呼吸机相关性肺炎
中心静脉导管相关性血流感染
导尿管相关性感染
integrated clinical information system
ICU catheter-associated infection
ventilator-associated pneumonia
central line-associated bloodstream infection
catheter-associated urinary tract infection
