Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Infect Control Hosp Epidemiol. 2011 Apr;32(4):305-14. doi: 10.1086/658938.
To evaluate the impact of a multifaceted intervention on compliance with evidence-based therapies and ventilator-associated pneumonia (VAP) rates.
Collaborative cohort before-after study.
Intensive care units (ICUs) predominantly in Michigan.
We implemented a multifaceted intervention to improve compliance with 5 evidence-based recommendations for mechanically ventilated patients and to prevent VAP. A standardized CDC definition of VAP was used and maintained at each site, and data on the number of VAPs and ventilator-days were obtained from the hospital's infection preventionists. Baseline data were reported and postimplementation data were reported for 30 months. VAP rates (in cases per 1,000 ventilator-days) were calculated as the proportion of ventilator-days per quarter in which patients received all 5 therapies in the ventilator care bundle. Two interventions to improve safety culture and communication were implemented first.
One hundred twelve ICUs reporting 3,228 ICU-months and 550,800 ventilator-days were included. The overall median VAP rate decreased from 5.5 cases (mean, 6.9 cases) per 1,000 ventilator-days at baseline to 0 cases (mean, 3.4 cases) at 16-18 months after implementation (P < .001) and 0 cases (mean, 2.4 cases) at 28-30 months after implementation (P < .001). Compared to baseline, VAP rates decreased during all observation periods, with incidence rate ratios of 0.51 (95% confidence interval, 0.41-0.64) at 16-18 months after implementation and 0.29 (95% confidence interval, 0.24-0.34) at 28-30 months after implementation. Compliance with evidence-based therapies increased from 32% at baseline to 75% at 16-18 months after implementation (P < .001) and 84% at 28-30 months after implementation (P < .001).
A multifaceted intervention was associated with an increased use of evidence-based therapies and a substantial (up to 71%) and sustained (up to 2.5 years) decrease in VAP rates.
评估多方面干预措施对循证治疗依从性和呼吸机相关性肺炎（VAP）发生率的影响。
协作队列前后研究。
主要在密歇根州的重症监护病房（ICUs）。
我们实施了一项多方面的干预措施，以提高对 5 项机械通气患者循证治疗建议的依从性，并预防 VAP。每个地点都使用并维持了 CDC 对 VAP 的标准化定义，并从医院感染预防人员处获得了 VAP 数量和呼吸机天数的数据。报告了基线数据，并在实施后 30 个月报告了实施后数据。VAP 发生率（每 1000 个呼吸机日的病例数）计算为每个季度接受呼吸机护理包中所有 5 种治疗方法的呼吸机天数比例。首先实施了两项提高安全文化和沟通的干预措施。
报告了 112 个 ICU 的 3228 个 ICU 月和 550800 个呼吸机日的数据。总体中位 VAP 发生率从基线时的每 1000 个呼吸机日 5.5 例（均值，6.9 例）降至实施后 16-18 个月的 0 例（均值，3.4 例）（P <.001）和实施后 28-30 个月的 0 例（均值，2.4 例）（P <.001）。与基线相比，在所有观察期内，VAP 发生率均下降，实施后 16-18 个月的发病率比为 0.51（95%置信区间，0.41-0.64），实施后 28-30 个月的发病率比为 0.29（95%置信区间，0.24-0.34）。循证治疗的依从性从基线时的 32%提高到实施后 16-18 个月时的 75%（P <.001）和实施后 28-30 个月时的 84%（P <.001）。
多方面的干预措施与循证治疗的广泛应用以及 VAP 发生率的显著（高达 71%）和持续（长达 2.5 年）下降有关。
