门诊血液透析感染事件监测系统的开发与应用

白易; 马茹; 邵红琳; 苏春燕; 王少利; 赵心田; 袁晓宁; 邢燕; 张会芝

doi:10.16462/j.cnki.zhjbkz.2025.08.019

门诊血液透析感染事件监测系统的开发与应用

doi: 10.16462/j.cnki.zhjbkz.2025.08.019

1.
北京大学第三医院医院感染管理处，北京 100191
2.
北京大学第三医院信息管理与大数据中心，北京 100191
3.
北京大学第三医院肾内科，北京 100191

基金项目:

国家卫生健康委医院管理研究所“感·动中国”医疗机构感染预防与控制科研项目 GY20230023

北京市卫生健康委员会首都卫生发展科研专项 2024-2G-40916

详细信息

通讯作者:
张会芝，E-mail: zhihui1002@qq.com

中图分类号: R692.5
计量
- 文章访问数: 3
- HTML全文浏览量: 3
- PDF下载量: 0
- 被引次数: 0
出版历程
- 收稿日期: 2024-10-28
- 修回日期: 2025-05-27
- 刊出日期: 2025-08-10

Development and application of outpatient dialysis event monitoring system

1.
Department of Nosocomial Infection Management, Peking University Third Hospital, Beijing 100191, China
2.
Information Management and Big Data Center, Peking University Third Hospital, Beijing 100191, China
3.
The Department of Neurology, Peking University Third Hospital, Beijing 100191, China

Funds:

"Infection and Action, China" Research Project on Infection Prevention and Control in Medical Institutions, National Institute of Hospital Administration, National Health Commission GY20230023

Capital′s Funds for Health Improvement and Research, Beijing Municipal Health Commission 2024-2G-40916

More Information

Corresponding author: ZHANG Huizhi, E-mail: zhihui1002@qq.com

摘要

摘要: 目的为满足精准防控需求，开发并应用门诊血液透析感染事件(dialysis event, DE)监测系统，借助信息化手段实现对门诊血液透析相关感染的风险监控、实时预警和数据驱动决策。方法围绕监测技术要点及原则，构建监测系统，并依托自主研发的信息化监测系统，于2024年对某三级甲等医院门诊血液透析患者开展为期1年的主动监测，针对DE发生率、血液透析相关感染发生率、系统预测性能等主要指标进行描述。结果建立了门诊DE监测系统，2024年利用该系统共监测到587名血液透析患者，累计完成40 253例次透析治疗。经临床确认，累计发生DE 423例次，DE发生率为1.05%；发生血液透析相关感染1例，相关感染发生率为0.17%。上述研究结果与同步开展的传统监测结果一致，与传统方法相比，主动监测系统的及时性和主动报告率分别提高了57.97%和21.40%。结论门诊DE监测系统作为标准化监测工具，对推动门诊血液透析感染管理的数字化转型具有重要实践价值。其生成的连续监测数据不仅为建立感染基线数据提供技术支撑，还为进一步提升门诊DE监测与防控水平提供借鉴。
- 门诊血液透析感染事件 /
- 信息化 /
- 监测系统 /
- 数字化管理
Abstract: Objective To meet the need for precise prevention and control, this study established and applied a surveillance system for dialysis event (DE) in outpatient settings, enabling risk monitoring, real-time alerts, and data-driven decision support based on health information technology. Methods The surveillance system was developed based on the designed key technical information and principles. The self-developed platform was implemented in a tertiary care hospital hemodialysis unit for a 12-month prospective surveillance in 2024. We described three-tier metrics: (1) DE incidence (2) Hemodialysis-associated infection incidence (3) System performance indicators. Results The system monitored 587 patients undergoing 40 253 hemodialysis sessions through automated data extraction. It recognized and reported 423 DEs (incidence: 1.05%), and one hemodialysis-associated infection (incidence: 0.17%). These findings were consistent with results from parallel traditional manual surveillance. Compared to the conventional methods, the timeliness and proactive reporting rate of the active monitoring system had increased by 57.97% and 21.40% respectively. Conclusions As a standardized monitoring tool, this system has important practical value in promoting the digital transformation of infection management in outpatient hemodialysis. The real-time surveillance data generated not only provides technical support for establishing infection baseline data, but also provides reference and inspiration for further improving the level of infection monitoring and prevention in outpatient hemodialysis.
- Outpatient dialysis event /
- Informatization /
- Monitoring system /
- Digital management

HTML全文

表 1 2024年门诊血液透析室不同血管通路类型血液透析治疗情况

Table 1. Outpatient hemodialysis treatments by vascular access type in 2024

月份 Month	患者人数 Number of patients	门诊血液透析例次数 Number of hemodialysis sessions
月份 Month	患者人数 Number of patients	AVF	AVG	TCC	ECC
1	294	2 719	154	382	133
2	291	2 490	98	367	153
3	303	2 741	124	357	124
4	302	2 727	125	350	111
5	297	2 883	133	347	93
6	294	2 642	100	356	76
7	293	2 860	94	423	49
8	304	2 899	115	402	56
9	297	2 709	106	352	40
10	300	2 886	118	425	68
11	311	2 796	123	413	125
12	297	2 787	131	425	66
注：AVF，自体动静脉内瘘；AVG, 移植血管内瘘；TCC，隧道式中央导管；ECC, 非隧道式中央导管。 Note：AVF, arteriovenous fistul; AVG, arteriovenous graft; TCC, tunneled-cuffed catheter; ECC, external central catheter.

下载: 导出CSV

表 2 2024年门诊血液透析患者透析感染事件发生情况

Table 2. Incidence of outpatient dialysis events in 2024

月份 Month	门诊血液透析例次数 Number of hemodialysis sessions	血液透析感染事件发生例次数 Number of dialysis events				发生率 Occurrence rate/%
月份 Month	门诊血液透析例次数 Number of hemodialysis sessions	抗菌药物使用 Use of antimicrobials	血培养阳性 Positive blood culture	血管通路部位出现脓液、发红或肿胀加剧 Pus, redness, or increased swelling at the vascular access site	合计 Total	发生率 Occurrence rate/%
1	3 388	47	0	3	50	1.48
2	3 108	32	0	3	35	1.13
3	3 346	36	0	1	37	1.11
4	3 313	38	0	2	40	1.21
5	3 456	29	0	1	30	0.87
6	3 174	31	0	0	31	0.98
7	3 426	26	1	0	26	0.76
8	3 472	31	0	1	32	0.92
9	3 207	44	0	1	45	1.40
10	3 497	31	0	1	32	0.92
11	3 457	27	0	1	28	0.81
12	3 409	37	0	0	37	1.09
合计 Total	40 253	409	1	14	423	1.05

下载: 导出CSV

参考文献(13)

[1]	《中国腹膜透析管理现状白皮书》项目组. 中国腹膜透析管理现状白皮书[J]. 中华肾脏病杂志, 2022, 38(12): 1076-1104. DOI: 10.3760/cma.j.cn441217-20220418-00158. Project group of "White paper on the status of peritoneal dialysis management in China". White paper on the current status of peritoneal dialysis management in China[J]. Chin J Nephrol, 2022, 38(12): 1076-1104. DOI: 10.3760/cma.j.cn441217-20220418-00158.
[2]	Htay H, Bello AK, Levin A, et al. Hemodialysis use and practice patterns: an international survey study[J]. Am J Kidney Dis, 2021, 77(3): 326-335. e1. DOI: 10.1053/j.ajkd.2020.05.030.
[3]	Zhang H, Li LY, Jia HX, et al. Surveillance of Dialysis Events: one-year experience at 33 outpatient hemodialysis centers in China[J]. Sci Rep, 2017, 7(1): 249. DOI: 10.1038/s41598-017-00302-9.
[4]	门海燕, 苏春燕. 血液透析中心静脉导管相关血流感染研究进展[J]. 护士进修杂志, 2020, 35(12): 1116-1120. DOI: 10.16821/j.cnki.hsjx.2020.12.014. Men HY, Su CY. Advances in research on bloodstream infections associated with central venous catheters in hemodialysis[J]. J Nurs Train, 2020, 35(12): 1116-1120. DOI: 10.16821/j.cnki.hsjx.2020.12.014.
[5]	Fisher M, Golestaneh L, Allon M, et al. Prevention of bloodstream infections in patients undergoing hemodialysis[J]. Clin J Am Soc Nephrol, 2020, 15(1): 132-151. DOI: 10.2215/cjn.06820619.
[6]	中华人民共和国国家卫生健康委员会. 血管导管相关感染预防与控制指南(2021年版)[EB/OL]. (2021-03-17)[2024-10-28]. https://www.nhc.gov.cn/yzygj/c100068/202103/feb9ec8a985048f896226e8b59a6f76d/files/1732871567392_31004.pdf.
[7]	中华人民共和国国家卫生健康委员会. 医院感染监测标准WS/T 312-2023[EB/OL]. (2023-08-20)[2024-10-28]. https://www.nhc.gov.cn/cms-search/downFiles/5f37d8384be746aeaec21ab14cf0a5ea.pdf.
[8]	中华人民共和国国家卫生健康委员会. 国家卫健委医院感染管理医疗质量控制指标(2024年版)[EB/OL]. (2024-04-30)[2024-10-28]. https://www.nhc.gov.cn/yzygj/c100068/202405/7d1d82090e8b44d2af3339d7ee8c7cca/files/1733999833111_26793.pdf.
[9]	Weikert B, Kramer TS, Schwab F, et al. Implementation of a new surveillance system for dialysis-associated infection events in outpatient dialysis facilities in Germany[J]. J Hosp Infect, 2023, 142: 67-73. DOI: 10.1016/j.jhin.2023.08.024.
[10]	赵心田, 袁晓宁, 白易, 等. 基于德尔菲法门诊血液透析感染事件监测指标体系的构建[J]. 中华医院感染学杂志, 2025, 35(7): 1090-1095. DOI: 10.11816/cn.ni.2025-241707. Zhao XT, Yuan XN, Bai Y, et al. Construction of monitoring indicators system for infection events in outpatient hemodialysis based on Delphi method[J]. Chin J Nosocomiol, 2025, 35(7): 1090-1095. DOI: 10.11816/cn.ni.2025-241707.
[11]	尹剑斌, 吴文妍. 公共卫生数据共享中的风险预防原则及其适用[J]. 中华医院管理杂志, 2023, 39(10): 728-732. DOI: 10.3760/cma.j.cn111325-20230619-00484. Yin JB, Wu WY. Risk prevention principle of public health data sharing and its application[J]. Chin J Hosp Admin, 2023, 39(10): 728-732. DOI: 10.3760/cma.j.cn111325-20230619-00484.
[12]	Liu J, Zhang HX, Diao ZL, et al. Epidemiological analysis of death among patients on maintenance hemodialysis: results from the Beijing blood purification quality control and improvement center[J]. BMC Nephrol, 2023, 24(1): 236. DOI: 10.1186/s12882-023-03271-6.
[13]	Keenan J, Barbre KA, Dollard P, et al. A six-year follow-up of bloodstream infections in hemodialysis facilities in the United States, national healthcare safety network, 2020[J]. Clin J Am Soc Nephrol, 2024, 19(8): 978-983. DOI: 10.2215/CJN.0000000000000476.