Marra Alexandre R, Cal Ruy Guilherme Rodrigues, Silva Cláudia Vallone, Caserta Raquel Afonso, Paes Angela Tavares, Moura Denis Faria, dos Santos Oscar Fernando Pavão, Edmond Michael B, Durão Marcelino Souza
Intensive Care, Hospital Israelita Albert Einstein, São Paulo, Brazil.
Am J Infect Control. 2009 Oct;37(8):619-25. doi: 10.1016/j.ajic.2009.03.009. Epub 2009 Jun 25.
Ventilator-associated pneumonia (VAP) is one of the most common health care-associated infections (HAIs) in critical care settings.
Our objective was to examine the effect of a series of interventions, implemented in 3 different periods to reduce the incidence of VAP in an intensive care unit (ICU).
A quasiexperimental study was conducted in a medical-surgical ICU. Multiple interventions to optimize VAP prevention were performed during different phases. From March 2001 to December 2002 (phase 1: P1), some Centers for Disease Control and Prevention (CDC) evidence-based practices were implemented. From January 2003 to December 2006 (P2), we intervened in these processes at the same time that performance monitoring was occurring at the bedside, and, from January 2007 to September 2008 (P3), we continued P2 interventions and implemented the Institute for Healthcare Improvement's ventilator bundle plus oral decontamination with chlorhexidine and continuous aspiration of subglottic secretions.
The incidence density of VAP in the ICU per 1000 patient-days was 16.4 in phase 1, 15.0 in phase 2, and 10.4 in phase 3, P=.05. Getting to zero VAP was possible only in P3 when compliance with all interventions exceeded 95%.
These results suggest that reducing VAP rates to zero is a complex process that involves multiple performance measures and interventions.
呼吸机相关性肺炎（VAP）是重症监护环境中最常见的医疗保健相关感染（HAIs）之一。
我们的目的是研究在3个不同时期实施的一系列干预措施对降低重症监护病房（ICU）中VAP发病率的影响。
在一个内科-外科ICU进行了一项准实验研究。在不同阶段实施了多种优化VAP预防的干预措施。从2001年3月至2002年12月（第1阶段：P1），实施了一些疾病控制与预防中心（CDC）基于证据的做法。从2003年1月至2006年12月（P2），我们在床边进行绩效监测的同时对这些流程进行干预，并且从2007年1月至2008年9月（P3），我们继续P2阶段的干预措施，并实施了医疗保健改进研究所的呼吸机集束方案加洗必泰口腔去污以及声门下分泌物持续吸引。
ICU中每1000患者日VAP的发病密度在第1阶段为16.4，第2阶段为15.0，第3阶段为10.4，P = 0.05。仅在P3阶段，当所有干预措施的依从性超过95%时才有可能实现VAP发病率降至零。
这些结果表明，将VAP发病率降至零是一个复杂的过程，涉及多种绩效指标和干预措施。
