重症监护病房呼吸机相关肺炎的集束干预效果观察

Ef ect of Bundle Interventions on Ventilator-associated Pneumonia in Intensive Care Unit

目的观察集束干预措施对于重症监护病房(ICU)呼吸机相关肺炎(VAP)发病率的影响。方法选取2011年6月-8月ICU使用呼吸机的患者作为基线调查对象,2011年9月-2012年5月实施集束干预措施后每3个月评估1次VAP发病率。结果呼吸机使用率由干预前的26.5%降至干预实施6个月后的24.6%和9个月后的22.6%,VAP发病率由61.2‰降至34.9‰、22.7‰,速干手消毒剂的用量由每床日32.6 mL增至58.8、54.4 mL。结论集束干预措施对于预防VAP效果明显,人员培训、床旁督导及监测反馈能有效促进干预措施执行。

Objective To observe the effect of bundle interventions on ventilator-associated pneumonia （VAP） in Intensive Care Unit （ICU）. Methods Baseline survey among the patients undergoing mechanical ventilation was conducted during June 2011 to August 2011. During September 2011 to May 2012, the rate of VAP was monitored every three months after taking bundle measures, which included oral care, elevation of the head of the bed, daily assessment of readiness to extubation, optimizing process of devices disinfection and hand hygiene. Results Through carrying out the bundle interventions, the VAP rate decreased from 61.2‰ to 34.9%o after six months and 22.7‰ after nine months, and the ventilator utilization ratio decreased from 26.5% to 24.6% after six months and 22.6% after nine months. The alcohol-based hand disinfectant dosage was increased from 32.6 mL to 58.8 mL and 54.4 mL for each patient bed in ICU. Conclusions The bundle intervention has been proved to be effective. Measures such as staff education, bedside supervision and monitoring data feedback can help implement bundle interventions.