| Objective:This study investigated two tumor groups to analyze the risk factors for bacterial colonization of PICC punctures and the colonization bacteria, in order to take corresponding measures to prevent local skin infection, reduce catheter related infections and medical costs. This stuty also studyed the risk factors of these two groups, to provide evidences for effective prevention of PICC catheter related infections.Methods:1. Cross-sectional investigation:(1) Puncture point samples of 472 patients admitted to maintenance center from November to December in 2015 were bacteriologically cultured and observed. 243 males and 229 females; age 48.89119.82 years old; PICC indwelling time was 98.44±78.21 day. Adopt the self-designed questionnaire to collect data, and sample the puncture point bacteria, divided the patients into positive group and negative group, compared two groups'data, find out the factors that influence tumor patients at home.(2) Puncture point samples of 112 elderly patients admitted to maintenance center from October 2015to January in 2016 were bacteriologically cultured and observed. 65male and 47 female cases; age 67.60±7.64 years old. Adopt the self-designed questionnaire to collect data, and sample the puncture point bacteria, divided the patients into positive group and negative group, compared two groups'data, find outthe risk factors in elderly tumor patients.2. Randomized controlled research:34 patients were selected from August 2016 to December 2016 in our hospital, The left venipuncture 26 cases, 8 right venipunctures. The patients were divided into observation group and control group randomly, observation group of 18 patients and control group of 16 patients. Observe group: exposed length cut for 3?4 cm. Control group: exposed length cut for 5 ?6 cm. Two groups were covered with IV3000 transparent patches.Alcohol and iodine are disinfections. Investigators collect samples and record datas after 9 days, 16 days, 23 days before disinfection, and observate bacteria colonization, catheter movement rate and mobile length difference and the incidence of phlebitis.Results:1. Analysis the risk factors and the distribution of bacteria of PICC1.1 Tumor patients at homeSkin bacteriology cultivation in 141 patients (29.9%) were positive, 331 patients (70.1%)were negative. The Logistic analysis showed that gender, maintenance period , curling dressing, dirty skin,unable to function independently, hyperplasia of puncture point and the exposed length were the risk factors of tumor patients at home. Odds ratios were 2.451?0.090?4.077?1.694?2.210?2.612 and 0.529, respectively.1.2 Inpatients:32 inpatients (28.57%) microbial cultures result is positive, 80 inpatients (71.43%),microorganism culture results were negative. The Logistic analysis showed that gender,hyperplasia, exposed length > 4 cm, and the platelet count is of the risk factors of elderly patients with tumor, Odds ratios were 6.044, 0.214, 0.262 and 7.593, respectively.1.3 Compare the bacteria species on skin(1) The rate of bacteria of two groups have no significant difference (29.9%,28.57%).(2) The bacterial species of home and hospitalized patients are predominantly gram positive bacteria. A total of 197 bacterial strains pathogenic bacteria isolated from specimens of patients at home, of which were 189 strains of the gram-positive bacteria(95.93%), 8 strains of gram-negative bacteria (4.06%). A total of 40 bacterial strains isolated from specimens of inpatients, including 32 strains of gram-positive bacteria(80%), 5 strains of gram negative bacteria (12.5%) and fungi strains (7.5%). The percentage of gram positive bacteria of home patients was higher than that of hospitalized patients, and hospitalized patients of gram-negative bacteria and fungi percentage is higher than the patients at home.2.The most appropriate exposed length of PICCLogistic analysis shows: the exposed length > 4 cm was the common influence factors,and now there are few studies of the exposed length. Based on this, the exposed length of PICC was studies. Now the results are as follows.2.1 The bacterial positive rates of two groups have no defference on 9 day, 16 day, 23 day(P > 0.05).2.2 Exposed tube mobility of observation group is higher than that of control group on 9day,16 day and 23 day ( x 2 = 4.636, P = 0.031; x 2 = 4.250, P = 0.039; x 2 = 5.673, P =0.017).The leakage length has no statistically significant difference on 9 day, 16 day and 23day (t=1.848, P = 1.848, t = 0.496, P = 0.623, t = 0.438, P = 0.664).2.3 Local phlebitis incidence of obseriation group was higher than that of control group on 16 day and 23 day (t = 6.595, p = 0.010; t = 3.848, p = 0.050).Conclusion:1. The related factors contributing to the bacterial colonization of patients at home included: gender, maintenance period, dressing edge range, the surrounding skin cleanness, hyperplasia of the puncture point, and leakage length > 4 cm.2. The related factors contributing to the bacterial colonization of inpatients included:gender, hyperplasia, exposed length > 4 cm and the platelet count.3. Primary colonization bacteria were Gram-positive bacteria. Coagulase negative staphylococcus aureus had the highest percentage.4. Bacterial positive rates between two group have no significant diffidence. Patients at home have higher percentage of Gram-positive bacteria colonization than that of inpatients, but lower percentage of Gram-negative bacteria and fungi colonization.5. The bacterial colonized rate between two groups have no difference, but the longer leakage length increased the occurrence of phlebitis and catheter translocation. |
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