组合干预措施对ICU中呼吸机相关性肺炎发病率影响的研究

Impact of bundle interventions on incidence of ventilator-associated pneumonia

目的评价组合干预措施对上海市二、三级医院重症监护病房(ICU)患者呼吸机相关性肺炎(VAP)发病率的影响。方法于2007年1月-2012年6月对上海市67所二、三级医院176个ICU中发生VAP患者进行干预前、后对照研究,分为3个阶段:基线调查、过渡期和干预期,VAP组合干预措施包括加强手卫生、半卧位、采用消毒剂进行口腔护理以及对医护人员的宣教和督查,由医院感染控制专职人员收集ICU出入院患者例数、基本信息、住院天数、接受机械通气天数(VDs)和VAP发病等资料,比较干预前、后VAP发病率,评价组合干预措施效果。结果共收集患者资料463 208例,监测ICU住院天数为2 535 917d,累计使用机械通气日695 185d;基线调查阶段,VAP发病率为每千VDs 23.4例,实施组合干预后,VAP发病率明显下降,2009-2012年为每千VDs 14.3例,RR=0.61(95%CI0.59～0.64),RD=9.1(95%CI8.3～9.9)。结论在ICU中施行VAP组合干预措施,可显著降低患者VAP发病率。

OBJECTIVE To evaluate the effect of a multidimensional infection control bundle on the incidence of ventilator-associated pneumonia （VAP） in 176 intensive care units （ICUs） in Shanghai. METHODS The trial was designed as a before-after study in 176 ICUs of 67 two-A and three-A hospitals in Shanghai from Jan 2007 to Jun 2012, which was divided into the baseline, transition and intervention periods. The interventions of the VAP group included the hand hygiene, recumbent bed position, and oral care with antiseptic, as well as education and supervision for the medical personnel. The number of the discharged cases, general information, length of ICU stay, duration of mechanical ventilation, and the incidence of VAP were collected by the infection control person- nel. The incidence of VAP was compared before and after the interventions, and the effects of the bundle were e- valuated. RESULTS Of totally 463 208 patients whose clinical data were collected in this study, there were 2 535 917 days of ICU stay were monitored and 695 185 days （VDs） The incidence of VAP during the baseline investiga- tion period was 23.4 per 1000 VDs and was significantly decreased after the implementation of the bundle interven tions, the incidence of VAP during 2009-2012 was 14.3 per 1000 VDs, RR=0. 61 （95% CI, 0. 59-0. 64）, RD =9.1（95%CI, 8.3-9.9）. CONCLUSION To implement the bundle interventions to the VAP in the ICUs can significantly reduce the incidence of VAP.