ICU感控小组责任制对呼吸机相关性肺炎的预防效果

Effectiveness of healthcareassociated infection monitoring team on preventing ventilatorassociated pneumonia in an intensive care unit

摘要:

目的探讨设置感染控制（感控）小组专职督导各项预防呼吸机相关性肺炎（VAP）措施的实行，对预防重症监护室（ICU）机械通气患者发生VAP的影响。方法选择2011年1—12月入住本院ICU并行机械通气，时间＞48 h的患者480例。分为对照组：2011年1—6月入住ICU的233例患者，采用预防VAP 集束化管理，但无感控小组督导；干预组：2011年7—12月入住ICU的247例患者，采用常规预防措施，由感控小组监督各项预防VAP措施的执行。对两组结果进行比较。结果干预组患者的床头抬高率为93.79%，显著高于对照组的61.11%（χ2=703.43，P<0.001）；机械通气时间，干预组患者为（5.56±4.43）d，显著低于对照组的（6.87±6.76）d（t=2.49，P=0.013）； VAP发生率，干预组为11.00‰，显著低于对照组的 24.62‰（χ2=6.87，P=0.009）；病死率，干预组和对照组分别为6.07%、9.44%，差异无统计学意义（χ2=1.91，P=0.142）。结论在ICU，通过设置感控小组专职严格督导，能有效落实VAP预防措施，降低VAP的发生率。

关键词:

呼吸机相关性肺炎; 重症监护室; 机械通气; 医院感染; 感染控制

Abstract:

ObjectiveTo evaluate the effectiveness of healthcareassociated infection(HAI) monitoring team on preventing ventilatorassociated pneumonia (VAP) in patients undergoing mechanical ventilation in an intensive care unit(ICU).MethodsFrom January to December, 2011, 480 ICU patients receiving mechanical ventilation for >48 hours were studied. Patients were divided into two groups, control group included 233 patients who admitted to ICU between January and June received VAP prevention bundle, but without being monitored by HAI monitoring team; intervention group included 247 patients who admitted to ICU between July and December received routine preventive measures and were supervised the implementation of VAP prevention measures by HAI monitoring team. The elevation rate of the head of bed, incidence of VAP, duration of mechanical ventilation and mortality in two groups were compared and analyzed.ResultsThe elevation rate of the head of bed of intervention group was significantly higher than control group (93.79% vs 61.11‰, χ2=703.43, P<0.001）; duration of mechanical ventilation in intervention group was significantly lower than control group (［5.56±4.43］d vs ［6.87±6.76］d, t=2.49，P=0.013）; the incidence of VAP in intervention group was significantly lower than control group (11.00‰ vs 24.62‰, χ2=6.87, P=0.009）; there was no significant difference in mortality of two groups （6.07% vs 9.44%, χ2=1.91，P=0.142）.ConclusionThe preventive measures of VAP can be carried out effectively by the strict supervision of infection monitoring team, VAP can decrease through effective work of infection monitoring team.

Key words:

ventilatorassociated pneumonia; intensive care unit; mechanical ventilation; healthcareassociated infection; infection control