综合干预措施对呼吸机相关性肺炎发病率的影响

Effectiveness of Bundle for Incidence of Ventilator-associated Pneumonia

目的了解中山医院ICU内呼吸机相关性肺炎(VAP)的发病率趋势,评价干预措施对VAP发病率的影响。方法 2004年9月-2009年12月对中山医院6个ICU进行前瞻性监测,感染控制人员在各ICU收集入住ICU的病例资料≥2次/周,实施了不同的干预措施,包括宣教和培训、氯己定口腔护理、严格的手卫生措施、床头抬高30度等;统计分析和比较VAP的季度发病率。结果共监测28 533例ICU病例,入住ICU为122 098 d,呼吸机使用率0.32%,发生VAP 481例;VAP发病率平均为12.16例/1000通气日,VAP的死亡率为8.32%,平均延长ICU住院时间14.2 d;通过综合干预措施,VAP发病率从24.57例/1000通气日(2004年10月-2005年9月)下降至5.34例/1000通气日(2009年1-12月)。结论虽然医院VAP发病率仍高于美国,但是近年来采取的综合干预措施已使VAP发病率显著下降。

OBJECTIVE To investigate the trends in ventilator-associated pneumonia （VAP） rates in ICUs and to assess the impact of the combined interventions to improve respiratory infection control practices. METHODS Prospective surveillance from 9/2004 to 12/2009 of VAP in ICUs was conducted. The trained infection control professionals collected the data regarding to pneumonia and related information at least twice per week. The diagnosis criteria for VAP were issued by MOH of China in 2001. The rates of VAP were evaluated quarterly. During the surveillance, different infection controls were implemented： include education and training, oral care, hand hygiene and head- of-bed elevated to 30%. RESULTS Prospective data from 28 533 patients hospitalized in ICUs were collected for an aggregate of 122 098 days, the utilization rate of ventilator was 0.32%. The aver age rate of VAP was 12. 16 cases per 1000 ventilator-days. VAP was associated with a crude mortality that was 8.32% and with increased ICU LOS of 14.2 d. As the results of the interventions, the rate of VAP decreased from 24.57/1000 （10/2004--9/2005） to 5.34/1000 （1/2009--12/2009）. CONCLUSIONS The rate of VAP in our ICU is higher than the rate in American ICUs and is associated with a significant decrease after interventions.