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循证实践:使用呼吸机集束干预措施预防呼吸机相关性肺炎

Evidence-based practice: use of the ventilator bundle to prevent ventilator-associated pneumonia.

作者信息

Tolentino-DelosReyes Arlene F, Ruppert Susan D, Shiao Shyang-Yun Pamela K

机构信息

The School of Nursing, The University of Texas Health Science Center at Houston, TX 77030, USA.

出版信息

Am J Crit Care. 2007 Jan;16(1):20-7.

Abstract

PURPOSE

To examine critical care nurses' knowledge about the use of the ventilator bundle to prevent ventilator-associated pneumonia.

METHOD

Published reports were reviewed for current evidence on the use of the ventilator bundle to prevent ventilator-associated pneumonia, and education sessions were held to present the findings to 61 nurses in coronary care and surgical intensive care units. Changes in the nurses' knowledge were evaluated by using a 10-item test, given both before and after the sessions. Changes in the nurses' practices related to ventilator-associated pneumonia, including elevation of the head of the bed to 30 degrees to 45 degrees , were observed in 99 intubated patients.

RESULTS

After the education sessions, the nurses performed better on 8 of the 10 items tested (P from .03 to <.001). The areas of most significant improvement were elevation of the head of the bed (P < .001), charting of the elevation of the head of the bed (P= .009), oral care (P= .009), checking of the nasogastric tube for residual volume (P = .008), washing of hands before contact with patients (P < .001), and limiting the wearing of rings (P < .001) and nail polish (P = .04). Even after the education sessions, the nurses' compliance with hand-washing recommendations before contact with patients was low, though statistically some improvement was apparent. Contraindications to elevation of the head of the bed did not appear to affect the nurses' practices (P= .38).

CONCLUSION

Education sessions designed to inform nurses about the ventilator bundle and its use to prevent ventilator-associated pneumonia have a significant effect on participants' knowledge and subsequent clinical practice.

摘要

目的

探讨重症监护护士对使用呼吸机集束化治疗预防呼吸机相关性肺炎的知识掌握情况。

方法

查阅已发表的报告,获取关于使用呼吸机集束化治疗预防呼吸机相关性肺炎的当前证据,并举办教育讲座,向61名冠心病监护病房和外科重症监护病房的护士介绍研究结果。通过在讲座前后进行的一项包含10个项目的测试来评估护士知识的变化。在99例插管患者中观察护士与呼吸机相关性肺炎相关的实践变化,包括将床头抬高至30度至45度。

结果

教育讲座后,护士在10项测试项目中的8项表现更好(P值从0.03至<0.001)。改善最显著的方面是床头抬高(P<0.001)、床头抬高记录(P=0.009)、口腔护理(P=0.009)、检查鼻胃管残余量(P=0.008)、接触患者前洗手(P<0.001)以及限制佩戴戒指(P<0.001)和指甲油(P=0.04)。即使在教育讲座后,护士接触患者前洗手的依从性仍然较低,尽管在统计学上有明显改善。床头抬高的禁忌似乎并未影响护士的实践(P=0.38)。

结论

旨在告知护士呼吸机集束化治疗及其用于预防呼吸机相关性肺炎的教育讲座对参与者的知识和后续临床实践有显著影响。

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