摘要
目的探讨新生儿PICC导管相关感染的发生情况和危险因素，为预防导管相关感染的发生提供护理参考。方法2015年9月-2017年6月对深圳市7家医院811例留置PICC导管的新生儿实施前瞻l生研究，观察导管相关感染的发生情况，对导管相关感染的相关因素进行单因素和多因素非条件Logistic回归分析。结果811例新生儿中，770例（94．9％）未出现导管相关感染，41例发生导管相关感染，发生率5．1％（1．95／1000导管日），其中出口部位感染20例，导管相关血行感染（CRBSI）21例。CRBSI的病原菌前3位为表皮葡萄球菌、真菌和肺炎克雷伯菌。单因素分析结果显示，感染组和无感染组新生儿胎龄、出生体重、输液接头的消毒方法、导管维护过程中的无菌防护屏障比较，差异均有统计学意义（x。值分别为4．026、4．964、4．369、7．463；P〈0．05）。多因素非条件Logistic回归分析结果显示，出生体重〈1200g是危险因素（OR=2．099，95％CI：1．103～3．996，P〈0．05），导管维护过程中的无菌防护是保护因素（OR=0．393，95％CI：0．206～0．749，P〈0．01）。结论出生体重〈1200g、导管维护过程中的无菌防护是新生儿PICC导管相关感染发生的影响因素，建议新生儿PICC导管维护时使用无菌防护屏障包括戴无菌口罩、圆帽、使用无菌包、戴无菌手套进行导管维护；对出生体重〈1200g的早产儿更应注意置管及导管维护过程中严格的无菌操作。
Objective To explore the situation and risk factors of peripherally inserted central catheter （PICC）-related infections among neonate so as to provide a nursing reference for preventing catheter-related infections. Methods From September 2015 to June 2017, a prospective study was carried out to 811 neonates with PICC from 7 hospitals in Shenzhen City to observe the incidence of catheter-related infections. Simple correlation and multiple factors unconditional Logistic regression was used to analyze the correlative factors of catheter-related infections. Results Among 811 neonates, there were 770 （94.9%） without and 41 （5.1%, 1.95/1000 catheter days） with catheter-related infections along with 20 cases with exit-site infection and 21 cases with catheter related bloodstream infections （CRBSI）. Top three pathogens of CRBSI included Staphylococcus epidermidis, fungus and klebsiella pneumonia. Simple correlation showed that there were statistical differences in gestational age, birth weight of the neonate, disinfection methods of infusion connector, sterile protective barrier during maintenance of catheter between infection group and non-infection group （ X^2=4.026, 4.964, 4.369, 7.463; P〈0.05）. Multiple factors unconditional Logistic regression revealed that the risk factor contained birth weight 〈 1200 g （OR=2.099, 95%CI： 1.103-3.996, P〈0.05）, and the protective factors consisted of sterile protective barrier during maintenance of catheter （OR=0.393, 95%CI： 0.206-0.749 ,P〈0.01）. Conclusions Birth weight 〈1200 g, sterile protection during maintenance of catheter are the influencing factors of neonatal PICC catheter-related infections. Sterile protective barrier during maintenance of PICC for neonate should include wearing sterile mask, round hat, using aseptic packets and wearing sterile gloving to maintain the catheter. Aseptic technique should be paid more attention to during indwelling catheter and maintaining catheter for premature with birth weight 〈1 200 g.
作者
林真珠
熊小云
何少玲
吕元红
金丽
孙莉
方小燕
贺万香
Lin Zhenzhu;Xiong Xiaoyun;He Shaoling;Lyu Yuanhong;Jin Li;Sun Li;Fang Xiaoyan;He Wanxiang(Department of Neonatology,Shenzhen People＇s Hospital,the Second Clinical Medical College of Ji＇nan University,Shenzhen 518020,China;Department of Neonatology,Shenzhen Maternity ＆ Child Healtheare Hospital,the Affiliated Hospital of Southern Medical University,Shenzhen 518028,China;Department of Neonatology,Shenzhen Baoan Maternal and Child Health Hospital,the Affiliated Hospital of Ji＇nan University Faculty of Medical Science,Shenzhen 518133,China;Department of Neonatology,Shenzhen Children＇s Hospital,Shenzhen 518038,Chin;Department of Neonatology,Shenzhen Nanshan Maternal and Child Health Hospital,Shenzhen 518000,China;Department of Neonatology,Shenzhen Luohu People＇s Hospital,Shenzhen 518001,Chin;Department of Neonatology,Peking University Shenzhen Hospital,Shenzhen 518036,China)
出处
《中华现代护理杂志》
2018年第28期3371-3376,共6页
Chinese Journal of Modern Nursing
基金
深圳市科技计划项目（JCYJ20150403101146319）
关键词
婴儿
新生
多中心研究
导管插入术
外周
导管相关感染
危险因素
Infant
newborn
Multicenter study
Catheterization
peripheral
Catheter-related infections
Risk factors
