综合干预措施对ICU医务人员呼吸机集束化策略执行率与呼吸机相关肺炎发病率的影响

Impact of integrated intervention measures on the compliance of ventilator care bundles by medical staff and the incidence of ventilator associated pneumonia of patients in general intensive care unit

目的通过对重症监护病房(ICU)机械通气患者进行呼吸机集束化策略(VCB)干预,并利用综合措施提高医护人员对VCB的执行率,降低呼吸机相关肺炎(VAP)的发生率。方法采取整群抽样的方法,分别选取2015年5-7月和2015年9月-2016年8月入住重症ICU且行机械通气≥48h的患者37例和151例,分为干预前组和干预后组;基线调查结束后,通过问卷调查找出综合ICU医护人员对VCB不执行的原因,采取综合干预措施后比较两组医护人员对机械通气患者VCB的执行率及患者VAP发生率,评价干预效果。结果 ICU医护人员中认为VAP是可预防的仅占43.5%,对各项防控措施的知晓率为21.7%~52.2%,所有人员均认为表格繁琐是VAP防控措施未执行的主要原因;干预前后患者呼吸机使用率分别为26.8%和28.1%,差异无统计学意义;干预前VCB整体执行达标率为19.2%,干预后达到76.5%;床头抬高30~45°、每日拔管撤机评估、洗必泰口腔护理、气囊压力≥20cmH_2O和手卫生的执行达标率干预前与干预后比较差异有统计学意义(P<0.05)。结论 ICU医护人员对VAP防控措施知晓率及规范执行率较低,综合措施可提高ICU医护人员对患者VCB的执行率,降低VAP发病率,但呼吸机使用率未见显著降低。

OBJECTIVE To intervene patients on mechanical ventilation in general intensive care unit （ICU） with ventilator care bundles （VCB）, and improve the compliance of patients receiving VCB by carrying out some inte- grated intervention measures on medical staff in the ICU, so as to reduce the incidence of ventilator associated pneumonia （VAP）. METHODS We adopted cluster sampling method, and selected 37 patients in ICU from May to Jul. 2015 as control group, and 151 patients from Sept. 2015 toAug. 2016 as intervention group, who were all treated with mechanical ventilation（MV） for more than 48 hours. After the baseline survey, questionnaire was used to find out the causes of the medical staff who did not follow the VCB in general ICU. The compliance of VCB and incidence of VAP between patients who were treated with mechanical ventilation（MV） for more than 48 hours in the two groups were compared, and the effect of the intervention was evaluated. RESULTS Only 43.5 % of medical staff in the ICU considered that VAP was preventable. Awareness rates of prevention and control meas- ures of VAP were from 21.7% to 52.2%. All medical staff in the ICU considered that the complicated form which needed to be completed was the main reason why the VCB was not implemented. Mechanical ventilation use of control group and intervention group were 26.8 % and 28.1 %, and the difference was not significant. The compli- ance rate of the VCB was higher in intervention group（76.5%） than that in control group（19.2%）. The compli anee rate of elevation of bedhead with 30° to 45°, daily evaluation of medical condition with no ventilator, oral care with chlorhexidine, cuff pressurej20cmH20 and hand hygiene in intervention group were all higher than those in control group, and the differences were significant （P≤0.05）. CONCLUSION Awareness rates of prevention and control measures of VAP and the standard compliance rate of VCB were both low in ICU medical staff. Integrated intervention measures can improve the standard compliance of patients receiving VCB, and reduce the incidence of VAP, but there is no obviously decrease in ventilator use.