Rosenthal Victor D, Guzman Sandra, Crnich Christopher
Bernal Medical Center, Buenos Aires, Argentina.
Am J Infect Control. 2006 Mar;34(2):58-63. doi: 10.1016/j.ajic.2005.11.002.
Hospitalized, critically ill patients have a significant risk of developing nosocomial infection. Most episodes of nosocomial pneumonia occur in patients undergoing mechanical ventilation (MV).
To ascertain the effect of an infection control program on rates of ventilator-associated pneumonia (VAP) in intensive care units (ICUs) in Argentina.
All adult patients who received MV for at least 24 hours in 4, level III adult ICUs in 2 Argentinean hospitals were included in the study. A before-after study in which rates of VAP were determined during a period of active surveillance without an infection control program (phase 1) were compared with rates of VAP after implementation of an infection control program that included educational and surveillance feedback components (phase 2).
One thousand six hundred thirty-eight MV-days were accumulated in phase 1, and 1520 MV-days were accumulated during phase 2. Rates of VAP were significantly lower in phase 2 than in phase 1 (51.28 vs 35.50 episodes of VAP per 1000 MV-days, respectively, RR = 0.69, 95% CI: 0.49-0.98, P <or= .003).
Implementation of a multicomponent infection control program in Argentinean ICUs was associated with significant reductions in rates of VAP.
住院重症患者发生医院感染的风险很高。大多数医院获得性肺炎病例发生在接受机械通气（MV）的患者中。
确定感染控制计划对阿根廷重症监护病房（ICU）呼吸机相关性肺炎（VAP）发生率的影响。
本研究纳入了阿根廷两家医院4个三级成人ICU中所有接受MV至少24小时的成年患者。采用前后对照研究，将在无感染控制计划的主动监测期间（第1阶段）确定的VAP发生率与实施包括教育和监测反馈内容的感染控制计划后（第2阶段）的VAP发生率进行比较。
第1阶段累计机械通气日为1638日，第2阶段累计1520日。第2阶段的VAP发生率显著低于第1阶段（分别为每1000机械通气日51.28例和35.50例VAP，RR = 0.69，95%CI：0.49 - 0.98，P≤0.003）。
在阿根廷ICU实施多组分感染控制计划与VAP发生率显著降低相关。
