ICU呼吸机相关性肺炎感染控制的干预对策

Intervention measures for control of ventilator-associated pneumonia in ICU

目的通过采取有效的干预措施,降低ICU机械通气患者呼吸机相关性肺炎(VAP)发生率。方法从2011年开始对入住ICU使用呼吸机>48h患者采取目标性监测,1-6月份采用常规护理措施,不进行实地干预,7-12月份通过对VAP高发原因分析后采用跟班督导的方式,按照制定的VAP预防控制措施进行干预。结果采用跟班督导等一系列有效的护理干预措施后,ICU机械通气患者在机械通气例数增加的情况下,VAP千日感染率从干预前的61.7‰下降至干预后的38.6‰,干预前后感染率比较,差异有统计学意义(P<0.01)。结论 ICU机械通气患者通过加强对医务人员预防控制知识的教育培训、抬高病床头、声门下分泌物吸引、加强医务人员手卫生以及设备的管理,能有效降低VAP感染率,保证患者安全。

OBJECTIVE To take effective intervention measures to reduce the incidence of ventilator-associated pneumonia （VAP） in the ICU patients undergoing mechanical ventilation. METHODS The targeted monitoring was conducted for the ICU patients who underwent the mechanical ventilation for 48 hours in 2011, then the con- ventional nursing measures were adopted from Jan to Jun, without any field intervention measure implemented; while the attendant supervision was conducted from Jul to Dec after the analysis of high-risk causes of VAP, and the inventions were taken according to the formulated prevention and control measures for VAP. RESULTS After the implementation of a series of effective nursing interventions including the attendant supervision, under the in- crease in the number of the ICU patients undergoing the mechanical ventilation, the thousand-day rate of VAP de- creased from 61.7‰ before the implementation of the interventions to 38.6‰ after the implementation of the in- terventions, the difference was statistically significant （P〈 0. 01）. CONCLUSION It is an effective way to strengthen the training of knowledge of prevention and control of VAP, raise the bed head, attract subglottic se- cretions, and enhance the hand hygiene of medical staff and the management of equipments so as to reduce the inci- dence of VAP in the ICU patients and ensure the safety of the patients.