教育培训对预防呼吸机相关肺炎集束化策略依从性的影响  

Effect of staff training on compliance of bundle to prevent ventilator-associated pneumonia

作　　者：蒲丹[1] 唐怀蓉[1] 宗志勇[1] 张卫东[1] 尹维佳[1] 舒明蓉[1] 杨宝玉[1] 刘葆华[1] 

机构地区：[1]四川大学华西医院感染管理科,四川成都610041

出　　处：《中华医院感染学杂志》2013年第7期1545-1547,共3页Chinese Journal of Nosocomiology

基　　金：四川省科技厅项目资助(20101SZ0178)

摘　　要：目的调查综合ICU中呼吸机相关性肺炎(VAP)患者,实施集束化策略(Bundle)以及评价一系列相关的教育培训对提高其依从性、改善机械通气患者预后的影响。方法调查拥有4500张床位的大型教学医院、床位数为52张的综合ICU,以留置机械通气>24h的患者为研究对象,评价培训前后半卧位、氯己定口腔冲洗每1次/6h、每日评估是否留置呼吸机的必要性、预防消化性溃疡、预防深静脉血栓、尽量减少使用或尽早停用预防应激性溃疡的药物等一系列预防VAP的措施的执行。结果培训前后分别有635例和582例患者纳入该研究,Bundle依从率从16.5%增加至33.8%(P<0.001);培训前后患者半卧位、床头抬高角度差异有统计学意义(P<0.01);氯己定口腔冲洗每1次/6h,实施率培训前后分别为30.1%、80.7%(P<0.05),每日是否评估留置呼吸机的必要性的实施培训前为61.6%,培训后为89.3%(P<0.05),深度静脉血栓预防的实施率从85.5%增加至90.4%(P=0.048),两组溃疡预防率均>88.0%;机械通气时间从10d(四分位数间距从2～20d)减少至7d(四分位数间距从2～10)(P=0.021);呼吸机相关性肺炎的发病率、ICU住院时间、ICU的死亡率均未发生改变。结论尽管未完全实施预防VAP的集束化策略,但通过对综合ICU的教育培训,提高了实施Bundle的依从性,减少了机械通气的天数。OBJECTIVE To assess the effectiveness of predefined interventions （bundle） to staff training in improving the quality of care of the patients with ventilator-associated pneumonia so as to adherence to guidelines to avoid complications associated with mechanical ventilation. METHODS This study was performed on a 52-bed intensive care unit in a university teaching hospital with 4500 beds. The application of a ventilator bundle consisting of semirecumbent positioning; Chlorhexidine oral rinse, ulcer prophylaxis, and deep vein thrombosis prophylaxis （DVTP） were assessed before and after the staff training. RESULTS A total of 635 patients were enrolled in the study before the personnel training, and 582 patients were enrolled after the personnel training. The overall hundle adherence increased from 16.5 % to 33.8% （P〈 0. 001）. The difference inthe elevated angle of semirecumbent position between, before and after the personnel training was statistically significant （P〈0.01） ; the implementation rate of Chlorhexidine oral rinse for once per 6 hours was 30.1% before the personnel training , 80.7% after the personnel training （P〈0.05）% the rate of evaluating the necessity of application of indwelling ventilator was 61.6% before the personnel training, 89.3 after the personnel training （P〈0.05） ; the implemen- tation rate of the ulcer prophylaxis increased from 85.5% to 90.4% （P=0. 048）, the rates of prevention of ulcer were more than 88.0% in both of the two groups ; the duration of mechanical ventilation reduced from 10 days （interquartile range 2-20 d ） to 7 days （ interquartile range 2-10） （P=0. 021）. The incidence of VAP, length of ICU stay, and the mortality in ICU remained unaffected. CONCLUSION Despite incomplete implementation of bundle interventions to prevent VAP, the staff training in the ICU has improved the compliance of bundle and has reduced the duration of mechanical ventilation.

关 键 词：重症监护病房 机械通气 机械通气相关性肺炎 

分 类 号：R181.32[医药卫生—流行病学]