呼吸机清洗消毒方法对呼吸机相关性肺炎的影响

Impact of cleaning and disinfection methods of ventilator on ventilator-associated pneumonia

目的探讨安全有效的呼吸机清洗消毒方法,降低呼吸机相关性肺炎(VAP)的发病率。方法在2009年11月-2010年2月VAP目标性监测基础上,对胸心外科ICU呼吸机清洗消毒方法进行干预:制定并落实"呼吸机清洗消毒暂行办法",观察干预后2年内各季度VAP千日感染率的变化,并比较两年间对应季度VAP发病率的差异以及干预前、中、后VAP发病率的差异。结果在呼吸机使用率相对稳定的前提下,干预中VAP千日感染率51.72‰,与次年相同季度9.57‰比较差异有统计学意义(P<0.05);干预后VAP发病率稳定在一个较低水平,干预前、中、后VAP发病率比较差异均有统计学意义(P<0.01)。结论呼吸机外置管路清洗后环氧乙烷灭菌及其配件的清洗消毒灭菌,并按规定时间更换等措施显著降低了呼吸机相关肺炎发病率。

OBJECTIVE To explore safe and effective measures for cleaning and disinfection of ventilator so as to re- duce the morbidity of ventilator-associated pneumonia （VAP）. METHODS From Nov 2009 to Feb 2010, the inter- ventions were taken to the cleaning and disinfection of the ventilators in ICUs of cardiothoracic surgery department on the basis of targeted surveillance, then the interim measures for cleaning and disinfection of ventilators were developed and implemented, the change of thousand-day infection rate of VAP was observed in each quarter within two years after the interventions, and the incidence of VAP between the corresponding quarters and the incidence of VAP before, during , and after the intervention were compared. RESULTS With the relatively stable utilization rate of ventilator, the thousand-day infection rate of VAP was 51.72‰ during the intervention, as compared with 9.57‰ of the same quarter in the following year, the difference was significant （P〈0.05）. After the interven- tion, the incidence of VAP maintain a low level, and the difference in the incidence of VAP between before, during, and after the intervention was significant （P〈0.01）. CONCLUSION The ethylene oxide sterilization of external pipelines of ventilator, cleaning and disinfection of their accessories, and regular change can significantly reduce the incidence of VAP.