加强手卫生对呼吸机相关性肺炎发病率影响的荟萃分析

A Meta analysis of the effect of enhanced hand hygiene on the morbidity of ventilator-associated pneumonia

目的 观察加强手卫生对呼吸机相关性肺炎（VAP）发病率的影响.方法 计算机检索和手工检索中、英文数据库1992年7月至2013年6月发表的加强手卫生对VAP发病率影响的临床研究,按纳入与排除标准选择文献,提取资料,采用RevMan 5.0软件对数据进行荟萃分析（Meta分析）.结果 共纳入6篇文献,均为前后对照研究,加强手卫生前后机械通气日分别为28 461和32 428,VAP发病率分别为39.5/1 000个机械通气日和19.5/1 000个机械通气日.加强手卫生的具体措施包括提供便捷的手卫生清洁装置,长期的教育、监督与反馈,以及积极提高手卫生的依从性.6篇文献均显示加强手卫生可降低VAP发病率,降低程度29.8％～65.5％,平均50.6％.Meta分析显示,加强手卫生对VAP有明显的保护作用[优势比（OR）1.43 ～ 5.82,合并OR为2.23,95％可信区间（95％CI）为1.62 ～ 3.07,P＜ 0.000 01].漏斗图显示,文章发表偏倚不大.结论 加强手卫生对VAP具有保护作用,可以降低VAP的发病率,然而研究文献的低质量限制了结论的可信度.

Objective To determine the effect of enhanced hand hygiene on the morbidity of ventilator-associated pneumonia （VAP）.Methods Clinical studies which were related to enhanced hand cleansing to the risk of VAP,which were published between July 1992 and June 2013 in English or Chinese were retrieved via computer and manual screening.Data were extracted according to appropriate inclusion and exclusion criteria and analyzed with RevMan 5.0 software.Results A total of 6 studies,all of which were performed with well controlled protocol,involving 28 461 mechanical ventilator days and 32 428 mechanical ventilator days were analyzed.The morbidity of VAP was 39.5 days per 1 000 mechanical ventilator days and 19.5 days per 1 000 mechanical ventilator days before and after enhanced hand cleaning,respectively.The methods of enhancing hand hygiene included feasible hand hygiene apparatus,long-term education,supervision and feedback,as well as increased hand cleaning compliance.All 6 eligible studies reported that enhanced hand washing lowered the risk of VAP,with risk reduction ranging from 29.8％ to 65.5％ with a mean reduction value of 50.6％.Meta analysis showed that enhanced hand cleaning could protect patients from VAP with odds ratio （OR） varying from 1.43 to 5.82 [pooled OR=2.23,95％ confidence interval （95％CI） 1.62-3.07,P＜0.000 01].It was showed in funnel chart that bias in the published articles was not significant.Conclusions Enhanced hand hygiene has an effect of prevention of VAP morbidity and is associated with lowered morbidity of VAP.However,the reliability of this conclusion is questionable because of poor quality of these studies.