Ma Shaolei, Liu Songqiao, Huang Lili, Xu Changsheng, Liu Wenge, Huang Yingzi
Department of Emergency and Critical Care Medicine, Zhongda Hospital, Southeast University, Nanjing 210009, Jiangsu, China. Corresponding author: Huang Yingzi, Email:
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2014 May;26(5):304-8. doi: 10.3760/cma.j.issn.2095-4352.2014.05.004.
To determine the effect of enhanced hand hygiene on the morbidity of ventilator-associated pneumonia (VAP).
Clinical studies which were related to enhanced hand cleansing to the risk of VAP, which were published between July 1992 and June 2013 in English or Chinese were retrieved via computer and manual screening. Data were extracted according to appropriate inclusion and exclusion criteria and analyzed with RevMan 5.0 software.
A total of 6 studies, all of which were performed with well controlled protocol, involving 28 461 mechanical ventilator days and 32 428 mechanical ventilator days were analyzed. The morbidity of VAP was 39.5 days per 1 000 mechanical ventilator days and 19.5 days per 1 000 mechanical ventilator days before and after enhanced hand cleaning, respectively. The methods of enhancing hand hygiene included feasible hand hygiene apparatus, long-term education, supervision and feedback, as well as increased hand cleaning compliance. All 6 eligible studies reported that enhanced hand washing lowered the risk of VAP, with risk reduction ranging from 29.8% to 65.5% with a mean reduction value of 50.6%. Meta analysis showed that enhanced hand cleaning could protect patients from VAP with odds ratio (OR) varying from 1.43 to 5.82 [pooled OR=2.23, 95% confidence interval (95%CI) 1.62-3.07, P<0.000 01]. It was showed in funnel chart that bias in the published articles was not significant.
Enhanced hand hygiene has an effect of prevention of VAP morbidity and is associated with lowered morbidity of VAP. However, the reliability of this conclusion is questionable because of poor quality of these studies.
确定强化手卫生对呼吸机相关性肺炎（VAP）发病率的影响。
通过计算机检索和人工筛选1992年7月至2013年6月期间发表的英文或中文的、与强化手部清洁对VAP风险影响相关的临床研究。根据适当的纳入和排除标准提取数据，并使用RevMan 5.0软件进行分析。
共分析了6项研究，所有研究均采用严格控制的方案，涉及28461个机械通气日和32428个机械通气日。强化手部清洁前后，VAP的发病率分别为每1000个机械通气日39.5天和19.5天。强化手卫生的方法包括可行的手卫生设备、长期教育、监督和反馈，以及提高手部清洁依从性。所有6项符合条件的研究均报告强化洗手降低了VAP的风险，风险降低范围为29.8%至65.5%，平均降低值为50.6%。Meta分析表明，强化手部清洁可使患者预防VAP，比值比（OR）在1.43至5.82之间[合并OR = 2.23，95%置信区间（95%CI）1.62 - 3.07，P < 0.00001]。漏斗图显示发表文章中的偏倚不显著。
强化手卫生对预防VAP发病率有作用，且与VAP发病率降低相关。然而，由于这些研究质量较差，该结论的可靠性值得怀疑。
