Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India.
Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India.
Am J Infect Control. 2014 Feb;42(2):111-5. doi: 10.1016/j.ajic.2013.09.026.
Ongoing educational programs targeting health care professionals have shown positive outcomes by reducing the morbidity and mortality associated with health care-associated infections (HAIs). We undertook this study to measure the impact of such a program in a pediatric critical care unit of a developing country.
This prospective study was conducted in 2 time periods of 6 months each, with an educational intervention for resident doctors and nurses in between. The rates of ventilator-associated pneumonia (VAP) during the preintervention and postintervention periods were estimated by active surveillance.
The incidence density of VAP was reduced by 28% (20.2 vs 14.6 per 1,000 ventilator-days; P = .21, Z test) despite a significant increase in the ventilator utilization ratio during the postintervention period (0.64 vs 0.88; P < .0001, Pearson's χ² test). There was a statistically significant reduction in mortality among patients who received mechanical ventilation for ≥48 hours in the postintervention period (49.3% vs 31.4%; P = .029, Pearson's χ² test).
Educational programs have a positive impact on reducing the morbidity and mortality associated with HAIs. Incidence rates based on device-days should be compared by keeping the variations in device utilization ratio in mind.
针对医疗保健专业人员的持续教育计划已通过降低与医疗保健相关感染（HAI）相关的发病率和死亡率显示出积极的结果。我们进行这项研究是为了衡量在发展中国家的儿科重症监护病房中实施此类计划的效果。
这项前瞻性研究分为两个 6 个月的时间段进行，期间对住院医生和护士进行教育干预。通过主动监测估计干预前和干预后时期呼吸机相关性肺炎（VAP）的发生率。
尽管干预后时期呼吸机使用率显著增加（0.64 比 0.88；P<0.0001，皮尔逊卡方检验），但 VAP 的发病率密度仍降低了 28%（20.2 比 14.6 每 1000 通气天数；P=0.21，Z 检验）。接受机械通气≥48 小时的患者死亡率在干预后时期显著降低（49.3%比 31.4%；P=0.029，皮尔逊卡方检验）。
教育计划对降低与 HAI 相关的发病率和死亡率有积极影响。基于设备天数的发病率应考虑设备使用率的变化进行比较。
