Wang Jianwen, Zhang Hao, Liu Jun, Zhang Ke, Yi Bin, Liu Yan, Liu Jishi, Zhang Xianming, Ji Ying
Department of Nephropathy, Third Xiangya Hospital of Central South University , Changsha, Hunan Province , China.
Ren Fail. 2014 Aug;36(7):1029-32. doi: 10.3109/0886022X.2014.927771. Epub 2014 Jun 18.
To investigate the causes of peritonitis in patients with peritoneal dialysis (PD) using continuous quality improvement (CQI) to develop effective interventions and reduce the occurrence of peritonitis.
A quality control team consisting of 10 members, including the department head, four nephrologists and four nurses, all specialized in PD care, and the head nurse, was established at the Peritoneal Dialysis Center of the Third Xiangya Hospital of Central South University. All patients with peritonitis occurring between 1 July 2010 and 31 December 2011 (pre-CQI period) were analyzed and compared with data obtained between January 2012 (implementation of CQI) and March 2013 to investigate possible causes of peritonitis and to develop corresponding interventions. Fishbone analysis, including laboratory parameters, was carried out monthly.
Gastrointestinal tract dysfunction, nonstandard procedures and malnutrition were found to be the top three risk factors for peritonitis. Gastrointestinal tract dysfunction was the likely cause of peritonitis in 42.8% of the subjects before CQI and 36.0% after CQI (p<0.05). Nonstandard procedures were the cause of peritonitis in 33.3% of the subjects before CQI and 24.0% after CQI (p<0.05). The overall incidence of peritonitis reduced from once every 40.1 patient months before the CQI to once every 70.8 patient months after CQI (p<0.05). The incidence of Gram-positive bacteria peritonitis reduced from once every 96.9 patients per month before CQI to once every 209.1 patient months after CQI (p<0.05), whereas the incidence of Gram-negative bacteria peritonitis reduced from once every 234.2 patient months before CQI to once every 292.8 patient months after CQI.
CQI can effectively reduce the occurrence of PD-related peritonitis.
通过持续质量改进（CQI）调查腹膜透析（PD）患者腹膜炎的病因，制定有效的干预措施并减少腹膜炎的发生。
中南大学湘雅三医院腹膜透析中心成立了一个由10名成员组成的质量控制小组，包括科室主任、4名肾病科医生、4名专门从事腹膜透析护理的护士以及护士长。对2010年7月1日至2011年12月31日（CQI实施前阶段）期间发生腹膜炎的所有患者进行分析，并与2012年1月（CQI实施）至2013年3月期间获得的数据进行比较，以调查腹膜炎的可能病因并制定相应的干预措施。每月进行包括实验室参数在内的鱼骨分析。
发现胃肠道功能障碍、操作不规范和营养不良是腹膜炎的三大危险因素。胃肠道功能障碍在CQI实施前是42.8%的患者发生腹膜炎的可能原因，CQI实施后为36.0%（p<0.05）。操作不规范在CQI实施前是33.3%的患者发生腹膜炎的原因，CQI实施后为24.0%（p<0.05）。腹膜炎的总体发生率从CQI实施前每40.1个患者月发生一次降至CQI实施后每70.8个患者月发生一次（p<0.05）。革兰氏阳性菌腹膜炎的发生率从CQI实施前每月每96.9名患者发生一次降至CQI实施后每209.1个患者月发生一次（p<0.05），而革兰氏阴性菌腹膜炎的发生率从CQI实施前每234.2个患者月发生一次降至CQI实施后每292.8个患者月发生一次。
CQI可有效降低PD相关腹膜炎的发生。
