儿童先天性心脏病术后呼吸机相关性肺炎防控管理效果观察  

Effect of prevention and control of ventilator-associated pneumonia (VAP) in children with congenital heart disease after surgery

作　　者：燕超 王伟 刘莉 郭珍 YAN Chao;WANG Wei;LIU Li;GUO Zhen(Infection Management Department of Xuzhou Children’s Hospital,Xuzhou 221000,Jiangsu,China;Neonatology Department of Xuzhou Children’s Hospital,Xuzhou 221000,Jiangsu,China)

机构地区：[1]徐州市儿童医院感染管理科,江苏徐州221000 [2]徐州市儿童医院新生儿科,江苏徐州221000

出　　处：《中国校医》2024年第1期68-71,共4页Chinese Journal of School Doctor

摘　　要：目的 分析院感规范管理对预防儿童心胸外科监护室(CICU)先天性心脏病术后呼吸机相关性肺炎(VAP)的干预效果。方法 调查2017年1月—2022年12月在本院CICU进行先天性心脏病手术且术后予机械通气超过48 h的全部患儿及其医护人员VAP预防措施执行情况,比较院感规范管理干预前(2017年)后(2018—2022年)科室VAP预防措施执行问题率、手卫生依从率及先心术后VAP发病率。结果 CICU先天性心脏病术后VAP预防措施执行问题占比由高到低依次为病情和镇静评估(33.82%)、环境消毒(14.71%)、口腔护理(10.66%)、清理冷凝液(7.72%)、清理呼吸道(5.15%)、应激性溃疡药物使用评估(5.15%)、床头抬高(2.91%)。院感规范管理干预后,VAP预防措施执行问题率由20.81%降至9.54%(χ^(2)=24.962,P<0.001);手卫生依从率由67.10%升至75.78%(χ^(2)=9.036,P=0.003);CICU先心术后VAP的发病率由31.38‰降至15.72‰,差异有统计学意义(χ^(2)=6.061,P=0.014)。结论 手卫生、病情和麻醉评估及环境消毒为CICU违反VAP预防措施的常见问题,加强院感规范管理,可以有效降低CICU儿童先天性心脏病术后VAP的发病率。Objective To analyze the effect of standardized management of hospital infection on the prevention of ventilator-associated pneumonia(VAP)after congenital heart disease among children in cardiothoracic surgery intensive care unit(CICU).Methods From January 2017 to December 2022,all children who underwent congenital heart disease surgery in the CICU of our hospital and were mechanically ventilated for more than 48 hours after surgery and their medical staff were investigated for the implementation of VAP preventive measures,the compliance rate of hand hygiene,and the incidence of VAP after congenital cardiac surgery before(2017)and after(2018-2022)in the standardized management of hospital infection management were compared.Results The proportion of VAP preventive measures after congenital heart disease in CICU from high to low was condition and sedation assessment(33.82%),environmental disinfection(14.71%),oral care(10.66%),condensate cleaning(7.72%),respiratory tract cleaning(5.15%),the use of stress ulcer medication assessment(5.15%),and bedside elevation(2.91%).After the intervention of standardized management of hospital infection,the implementation rate of VAP preventive measures decreased from 20.81%to 9.54%(χ^(2)=24.962,P<0.001),and the hand hygiene compliance rate increased from 67.10%to 75.78%(χ^(2)=9.036,P=0.003).The incidence of VAP after CICU congenital cardiac surgery decreased from 31.38‰to 15.72‰,and the difference was statistically significant(χ^(2)=6.061,P=0.014).Conclusion Hand hygiene,disease,anesthesia assessment,and environmental disinfection are common problems in CICU for violating VAP preventive measures,and increasing the standardized management of hospital infection can effectively reduce the incidence of VAP after congenital heart disease in children in CICU.

关 键 词：先天性心脏病 呼吸机相关性肺炎 感染控制 手部卫生 

分 类 号：R726[医药卫生—儿科]