Kaynar A Murat, Mathew Jacob J, Hudlin Margaret M, Gingras Dan J, Ritz Ray H, Jackson Michael R, Kacmarek Robert M, Kollef Marin H
Department of Critical Care Medicine, University of Pittsburgh School of Medicine, 3550 Terrace Street, Room 639 Scaife Hall, Pittsburgh PA 15261, USA.
Respir Care. 2007 Dec;52(12):1687-94.
To understand the reported practices of and adherence to evidence-based guidelines for the prevention of ventilator-associated pneumonia (VAP) among respiratory therapists (RTs) and registered nurses (RNs) in academic and nonacademic intensive care units.
We conducted a multicenter, cross-sectional survey. We first obtained demographic information about health care professionals in a nonidentifiable method. We next questioned the practice patterns of RTs and RNs for preventing VAP based on evidence-supported guidelines. The participants were RTs and RNs working in academic and nonacademic intensive care units; 278 respondents participated in this study (172 RTs and 106 RNs). There were no interventions.
The 3 major findings were: (1) both the RTs and the RNs reported that they frequently practice VAP-prevention measures, (2) the rate of adherence to ineffective measures (eg, routine changes of the ventilator circuit, disposable catheters) is also relatively high, which suggests that the evidence is not translated into bedside practice, (3) a substantial proportion of participants did not know the VAP rate in their institution, which might make it difficult to convince bedside practitioners to apply evidence-based practice, and might reflect a lack of infection-control/surveillance programs at hospitals.
Consumers, the Centers for Disease Control and Prevention, and other organizations are currently trying to implement mandatory reporting of hospital infections, including VAP rate. Without a definition of VAP suited to individual institutions, an organized data-collection and reporting method, and team-based approaches to preventing and treating VAP, hospitals may not be able to meet these requests and track improvement efforts. Prevention measures need to be translated to bedside practice to improve the outcomes of critically ill patients.
了解学术性和非学术性重症监护病房中呼吸治疗师（RTs）和注册护士（RNs）预防呼吸机相关性肺炎（VAP）的报告实践及对循证指南的遵循情况。
我们开展了一项多中心横断面调查。首先以无法识别身份的方式获取医护人员的人口统计学信息。接着根据循证指南询问RTs和RNs预防VAP的实践模式。参与者为在学术性和非学术性重症监护病房工作的RTs和RNs；278名受访者参与了本研究（172名RTs和106名RNs）。未进行干预。
三大主要发现为：（1）RTs和RNs均报告他们经常实施VAP预防措施；（2）对无效措施（如定期更换呼吸机回路、使用一次性导管）的遵循率也相对较高，这表明证据未转化为床边实践；（3）相当比例的参与者不知道所在机构的VAP发生率，这可能使说服床边从业者应用循证实践变得困难，也可能反映出医院缺乏感染控制/监测项目。
消费者、疾病控制与预防中心及其他组织目前正试图强制报告医院感染情况，包括VAP发生率。若没有适用于各机构的VAP定义、有组织的数据收集和报告方法以及基于团队的VAP防治方法，医院可能无法满足这些要求并跟踪改进工作。预防措施需要转化为床边实践以改善重症患者的治疗结果。
