Cason Carolyn L, Tyner Tracy, Saunders Sue, Broome Lisa
The School of Nursing, University of Texas at Arlington, TX 76109-0407, USA.
Am J Crit Care. 2007 Jan;16(1):28-36; discussion 37; quiz 38.
Ventilator-associated pneumonia accounts for 47% of infections in patients in intensive care units. Adherence to the best nursing practices recommended in the 2003 guidelines for the prevention of ventilator-associated pneumonia from the Centers for Disease Control and Prevention should reduce the risk of ventilator-associated pneumonia.
To evaluate the extent to which nurses working in intensive care units implement best practices when managing adult patients receiving mechanical ventilation.
Nurses attending education seminars in the United States completed a 29-item questionnaire about the type and frequency of care provided.
Twelve hundred nurses completed the questionnaire. Most (82%) reported compliance with hand-washing guidelines, 75% reported wearing gloves, half reported elevating the head of the bed, a third reported performing subglottic suctioning, and half reported having an oral care protocol in their hospital. Nurses in hospitals with an oral care protocol reported better compliance with hand washing and maintaining head-of-bed elevation, were more likely to regularly provide oral care, and were more familiar with rates of ventilator-associated pneumonia and the organisms involved than were nurses working in hospitals without such protocols.
The guidelines for the prevention of ventilator-associated pneumonia from the Centers for Disease Control and Prevention are not consistently or uniformly implemented. Practices of nurses employed in hospitals with oral care protocols are more often congruent with the guidelines than are practices of nurses employed in hospitals without such protocols. Significant reductions in rates of ventilator-associated pneumonia may be achieved by broader implementation of oral care protocols.
呼吸机相关性肺炎占重症监护病房患者感染的47%。遵守疾病控制与预防中心2003年预防呼吸机相关性肺炎指南中推荐的最佳护理措施应能降低呼吸机相关性肺炎的风险。
评估重症监护病房的护士在管理接受机械通气的成年患者时实施最佳实践的程度。
在美国参加教育研讨会的护士完成了一份关于所提供护理类型和频率的29项问卷。
1200名护士完成了问卷。大多数（82%）报告遵守洗手指南，75%报告戴手套，一半报告抬高床头，三分之一报告进行声门下吸引，一半报告其所在医院有口腔护理方案。有口腔护理方案的医院的护士在洗手和保持床头抬高方面报告的依从性更好，更有可能定期提供口腔护理，并且比没有此类方案的医院的护士更熟悉呼吸机相关性肺炎的发生率及相关病原体。
疾病控制与预防中心预防呼吸机相关性肺炎的指南并未得到一致或统一的实施。有口腔护理方案的医院的护士的做法比没有此类方案的医院的护士的做法更符合指南。通过更广泛地实施口腔护理方案，可能会显著降低呼吸机相关性肺炎的发生率。
