集束化干预措施依从性对降低呼吸机相关性肺炎的管理

Cluster Change Interventions Adherence to Reduce the Management of the Ventilator Associated Pneumonia

目的:通过集束化干预措施的执行情况,了解其对呼吸机相关肺炎(Ventilator associated pneumonia,VAP)发生率的影响,掌握干预措施依从性,为基层医疗机构在VAP的预防与控制方面提供参考。方法:对2012-2013年连续使用呼吸机48 h以上的91例患者进行研究,以2012年未实施集束化干预措施的48例患者为对照组,2013年实施集束化干预措施的43例患者为实验组,掌握干预措施依从性,对比VAP发生率的变化,了解集束化干预措施效果。结果:实施集束化干预措施后呼吸机相关肺炎发生显著降低。VAP发生人次数由2012年23例降到2013年10例,VAP每千床日数发生率由2012年40.00‰降到2013年17.48‰。连续使用呼吸机48 h以上患者感染率由2012年47.92%降低到2013年23.26%。结论:集束化干预措施的充分执行能有效降低ICU内VAP的发生,其依从性对结果有直接影响。措施的执行情况是影响其干预效果的核心,采取相应措施提高临床医务人员对干预措施的依从性,才是院感科降低VAP目标管理工作的重点。

Objective：To study the effect of bundle interventions on prevention of the ventilator-associated pneumonia （VAP） in primary hospital so as to provide reference.Method：A total of 91 patients who underwent mechanical ventilation for more than 48 hours from 2012 to 2013 were enrolled in the study and divided into two groups.43 patients were subjected into the interventions group,and 48 patients were subjected into the control group,the bundle interventions were adopted,and the incidence of VAP was compared between the two groups.Result：The bundle interventions could effectively prevent the incidence of VAP.After the implementation of bundle interventions,there were 10 cases with VAP in the intervention group with the incidence of 17.48‰ and 23 cases in the control group with the incidence of 40.00‰.The infect rate of the patients using breathing machine last 48 hours decreased from 47.92‰ to 23.26‰.The bundle intervention compliance directly affected the consequence.Conclusion：Cluster intervention measures of fully implement can effectively reduce the occurrence of VAP in ICU, its compliance is directly affect the outcome.Measures implementation is the core of its intervention effect,take corresponding measures to improve the clinical medical staff compliance of intervention measures,is the feeling of department to reduce VAP have been the focus of the management by objectives.