遵守特定机构的呼吸机相关性肺炎预防指南。

Adherence to institution-specific ventilator-associated pneumonia prevention guidelines.

作者信息

Kiyoshi-Teo Hiroko, Cabana Michael D, Froelicher Erika S, Blegen Mary A

机构信息

Hiroko Kiyoshi-Teo is a clinical assistant professor, School of Nursing, Oregon Health & Science University, Portland, Oregon. Michael Cabana is a professor of pediatrics, epidemiology and biostatistics, School of Medicine, University of California San Francisco, San Francisco, California. Erika Froelicher is a professor emerita, physiological nursing, School of Nursing, and Epidemiology & Biostatistics, School of Medicine, University of California San Francisco, San Francisco, California; and professor, Health Sciences, Sifa University, Izmir, Turkey. Mary Blegen is a professor emerita, School of Nursing, University of California San Francisco, San Francisco, California.

出版信息

Am J Crit Care. 2014 May;23(3):201-14; quiz 215. doi: 10.4037/ajcc2014837.

DOI:10.4037/ajcc2014837

PMID:24786808

Abstract

BACKGROUND

Various institution-specific guidelines have been developed to prevent ventilator-associated pneumonia. However, the availability of guidelines does not ensure adherence to recommended strategies.

OBJECTIVE

To identify factors that influence adherence to guidelines for prevention of ventilator-associated pneumonia, with a focus on oral hygiene, head-of-bed elevation, and spontaneous breathing trials.

METHODS

A cross-sectional descriptive study of critical care nurses at 8 hospitals in Northern California was conducted. A survey was created to gather information on possible facilitators of and barriers to adherence to institution-specific guidelines for preventing ventilator-associated pneumonia. User factors, guideline qualities, and contextual factors were explored and tested for possible relationships.

RESULTS

A total of 576 critical care nurses participated in the survey. Each hospital had unique guidelines for preventing ventilator-associated pneumonia. In general, nurses had positive attitudes and reported adhering to the guidelines always or most of the time. Factors associated with adherence differed according to the intervention implemented. The score on the user attitude scale was the strongest and most consistent predictor of adherence across interventions (odds ratio, 3.49-4.75). Time availability (odds ratio, 1.54) and the level of prioritization (odds ratio, 1.86) were also significant predictors.

CONCLUSION

The most consistent facilitator of adherence to guidelines for prevention of ventilator-associated pneumonia was nurses' positive attitude toward the guidelines.

摘要

背景

已制定了各种特定机构的指南以预防呼吸机相关性肺炎。然而，指南的可用性并不能确保对推荐策略的遵守。

目的

确定影响遵守预防呼吸机相关性肺炎指南的因素，重点关注口腔卫生、床头抬高和自主呼吸试验。

方法

对北加利福尼亚州8家医院的重症护理护士进行了一项横断面描述性研究。创建了一项调查，以收集有关遵守特定机构预防呼吸机相关性肺炎指南的可能促进因素和障碍的信息。探索并测试了用户因素、指南质量和背景因素之间可能的关系。

结果

共有576名重症护理护士参与了调查。每家医院都有预防呼吸机相关性肺炎的独特指南。总体而言，护士态度积极，报告总是或大部分时间遵守指南。与遵守情况相关的因素因实施的干预措施而异。用户态度量表得分是所有干预措施中遵守情况最强且最一致的预测因素（优势比，3.49 - 4.75）。可利用时间（优势比，1.54）和优先级别（优势比，1.86）也是显著的预测因素。