专职感控护士督导对综合干预措施依从性及VAP发病率的影响

Effect of full-time infection control nurses' supervision on the compliance to comprehensive intervention measures and incidence of ventilator-associated pneumonia

目的探讨科室专职感控护士督导对综合干预措施落实的依从性及呼吸机相关肺炎(VAP)发病率的影响。方法在某院综合重症监护病房(ICU)设置专职感控护士,监测所有入住综合ICU患者的综合干预措施依从情况。2012年9月—2014年4月为干预前期,2014年5月—2015年12月为干预后期。统计分析实施干预措施前后呼吸机使用及VAP发病情况。结果干预前期共监测患者1 373例,干预后期监测1 477例。干预前呼吸机使用率为31.89%,干预后呼吸机使用率为40.95%。干预前VAP发病率为31.97‰,其中MDRO感染发病率为11.99‰;干预后VAP发病率为17.82‰,其中MDRO感染发病率为6.41‰。实施干预措施后环境物体表面微生物学监测结果均在合格范围内(均≤5 CFU/cm2)。各季度荧光标记清除率及手卫生依从率均逐渐提高,后期均达80%以上;半卧位依从率2014年第4季度—2015年4季度均达100%。结论通过专职感控护士督导综合干预措施的落实,可有效降低VAP发病率,提高医疗质量,保证患者安全。

ObjectiveTo evaluate the effect of full time infection control nurses’supervision on the compliance to implementation of comprehensive intervention measures and incidence of ventilator associated pneumonia(VAP).MethodsFull time infection control nurses in the general intensive care unit(ICU)of a hospital were assigned,compliance to comprehensive intervention measures among all patients who were admitted to ICU was monitored.September2012April2014was pre intervention stage,May2014December2015was post intervention stage.Utilization of ventilator and occurrence of VAP before and after implementing intervention measures were analyzed statistically.ResultsA total of1373patients were monitored before intervention,1477were monitored after intervention.Utilization rates of ventilator before and after intervention were31.89%and40.95%respectively.Incidence of VAP before and after intervention were31.97‰and17.82‰respectively,incidence of MDRO infection were11.99‰and6.41‰respectively.Microbial monitoring results of environmental object surface after intervention were all qualified(all≤5CFU/cm2).Fluorescence labeling clearance rate and hand hygiene compliance rate increased gradually in each quarter,reached more than80%in the latter period;compliance to semireclining position was all100%from the fourth quarter of2014to the fourth quarter of2015.ConclusionThrough implementation of comprehensive intervention measures by full time infection control nurses,incidence of VAP can be decreased significantly,quality of medical treatment is improved,and safety of patients is ensured.