目标管理加品管圈降低重症病房呼吸机相关性肺炎效果观察  

Effect of target management combined with quality control circle on reduction of incidence of ventilator-associated pneumonia in ICU

作　　者：向凤玲[1] 石朝凯 胥树平[3] 刘晞照[4] 王沙沙 XIANG Feng-ling;SHI Chao-kai;XU Shu-ping;LIU Xi-zhao;WANG Sha-sha(Chongqing Three Gorges Central Hospital,Chongqing 404100,China)

机构地区：[1]重庆三峡中心医院护理部,重庆404100 [2]重庆三峡中心医院质控部,重庆404100 [3]重庆三峡中心医院消毒供应科,重庆404100 [4]重庆三峡中心医院感染管理科,重庆404100 [5]重庆三峡中心医院神经内科ICU,重庆404100

出　　处：《中华医院感染学杂志》2018年第14期2209-2211,2215,共4页Chinese Journal of Nosocomiology

基　　金：重庆市卫计委医学科研计划基金资助项目(2015MSXM126)

摘　　要：目的探讨目标管理联合品管圈活动降低重症监护病房呼吸机相关性肺炎发生的应用效果。方法应用目标管理及品管圈活动的步骤及方法,即确定总目标值、分目标值,全员参与,组织培训,制定并落实计划,加强过程监管及目标考核,对全院7个重症监护病房呼吸机相关性肺炎发生情况进行监测。比较目标管理联合品管圈活动前后重症监护病房呼吸机相关性肺炎的发生率及预防呼吸机相关性肺炎护士集束化护理措施依从率、半卧位依从率、手卫生依从率、手卫生正确率、口腔护理依从率。结果目标管理联合品管圈活动后重症监护病房呼吸机相关性肺炎发生率为10.29‰(例/千机械通气日),显著低于基线值12‰(P<0.01)。预防呼吸机相关性肺炎护士集束化护理措施依从率从活动前的78.1%上升到活动后的96.3%;半卧位依从率从活动前的87.7%上升到活动后的97.8%;手卫生依从率从活动前的67.0%上升到活动后的89.4%;手卫生正确率从活动前的78.3%上升到活动后的89.7%;口腔护理依从率从活动前的91.4%上升到活动后的98.4%,差异有统计学意义(P<0.01)。结论目标管理联合品管圈活动能降低重症监护病房呼吸机相关性肺炎的发生率,提高护理人员落实各项护理措施的依从性和正确率,提升了护理质量,保障了患者安全。OBJECTIVE To explore the effect of management combined with quality control circle on reduction of incidence of ventilator-associated pneumonia（VAP）in intensive care unit（ICU）.METHODS The steps and methods of the target management and quality control circle activity were employed to determine the total target value and target value,full participation,organize the training,formulate and implement plans and strengthen process surveillance and targeted assessment,the incidence of VAP in 7 ICUs of the hospitals was monitored.The incidence rate of VAP and compliance rates of cluster nursing measures for prevention of VAP,semireclining position,hand hygiene and oral care,as well as rate of correct hand hygiene,were observed and compared before and after the target management combined with quality control circle activity was conducted.RESULTS The incidence rate of VAP was 10.29‰in the ICUs after the target management combined with quality control circle activity was conducted,significantly lower than 12‰ of the baseline value（P〈0.01）.The compliance rate of cluster nursing measures for prevention of VAP was increased from 78.1% before the activity to 96.3% after the activity;the compliance rate of semireclining position was increased from 87.7% before the activity to 97.8%after the activity;the compliance rate of hand hygiene was increased from 67.0% before the activity to 89.4% after the activity;the rate of correct hand hygiene was increased from 78.3% before the activity to 89.7% after the activity;the compliance rate of oral care was increased from 91.4% before the activity to 98.4%after the activity,and there were significant differences（P〈0.01）.CONCLUSIONThe target management combined with quality control circle may reduce the incidence of VAP in the ICUs,raise the compliance rates and correct rates of the nursing measures,improve the nursing quality and ensure the safety of the patients..

关 键 词：重症监护病房 呼吸机相关性肺炎 目标管理 品管圈 

分 类 号：R563.1[医药卫生—呼吸系统]