目标性监测中集束化干预措施对降低呼吸机相关性肺炎发生率的研究

Application of bundle interventions in targeted surveillance to reduce incidence of ventilator-associated pneumonia

目的探讨集束化干预对ICU预防呼吸机相关性肺炎(VAP)的影响,有效降低VAP的发生率。方法目标性监测ICU 2011年1月-2012年12月入院后使用机械通气>48h患者,以2011年1-12月为干预前,2012年1-12月为干预组后,采用集束化干预方法,比较两组呼吸机相关性肺炎发生率。结果通过集束化干预后,床头抬高30～45度、声门下吸引、手卫生、呼吸机管路的清洁消毒是有效预防呼吸机相关性肺炎的措施;干预前发生呼吸机相关性肺炎19例,呼吸机相关性肺炎发生率25.40‰,干预后发生呼吸机相关性肺炎10例,呼吸机相关性肺炎发生率10.68‰,经卡方检验,干预前后呼吸机相关性肺炎发生率差异有统计学意义(P<0.05)。结论集束化干预措施可以有效预防呼吸机相关性肺炎的发生。

OBJECTIVE To study the effect of bundle interventions on prevention of the ventilator-associated pneumonia （VAP） in ICU so as to reduce the incidence of VAP. METHODS The targeted surveillance was performed for the patients who underwent mechanical ventilation for more than 48 hours from Jan 2011 to Dec 2012. The patients from Jan 2011 to Dec 2011 were subjected into the intervention group, and patients from Jan 2012 to Dec 2012 were subjected as the control group, the bundle interventions were adopted, and the incidence of VAP was compared between the two groups. RESULTS After the implementation of bundle interventions , the bed head elevated for 30-45 degrees, subglottic suction, hand hygiene, and cleaning and disinfection of pipelines were the effective measures to prevent VAP. There were 10 cases with VAP in the intervention group with the incidence of 10. 68% and 19 cases in the control group with the incidence of 25. 40‰, and the chi-square test showed that the difference in the incidence of VAP was statistically significant （P〈0.05）. CONCLUSION The bundle interventions can effectively prevent the incidence of VAP.