Khan Raymond, Al-Dorzi Hasan M, Al-Attas Khalid, Ahmed Faisal Wali, Marini Abdellatif M, Mundekkadan Shihab, Balkhy Hanan H, Tannous Joseph, Almesnad Adel, Mannion Dianne, Tamim Hani M, Arabi Yaseen M
Intensive Care Department, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Riyadh, Saudi Arabia; College of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
Intensive Care Department, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Riyadh, Saudi Arabia; College of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
Am J Infect Control. 2016 Mar 1;44(3):320-6. doi: 10.1016/j.ajic.2015.09.025.
Ventilator-associated pneumonia (VAP) is a frequent hospital acquired infections among intensive care unit patients. The Institute for Healthcare Improvement has suggested a "care bundle" approach for the prevention of VAP. This report describes the effects of implementing this strategy on VAP rates.
All mechanically ventilated patients admitted to the intensive care unit between 2008 and 2013 were prospectively followed for VAP development according to the National Healthcare Safety Network criteria. In 2011, a 7-element care bundle was implemented, including head-of-bed elevation 30°-45°, daily sedation vacation and assessment for extubation, peptic ulcer disease prophylaxis, deep vein thrombosis prophylaxis, oral care with chlorhexidine, endotracheal intubation with in-line suction and subglottic suctioning, and maintenance of endotracheal tube cuff pressure at 20-30 mmHg. The bundle compliance and VAP rates were then followed.
A total of 3665 patients received mechanical ventilation, and there were 9445 monitored observations for bundle compliance. The total bundle compliance before and after initiation of the VAP team was 90.7% and 94.2%, respectively (P < .001). The number of VAP episodes decreased from 144 during 2008-2010 to only 14 during 2011-2013 (P < .0001). The rate of VAP decreased from 8.6 per 1000 ventilator-days to 2.0 per 1000 ventilator-days (P < .0001) after implementation of the care bundle.
This study suggests that systematic implementation of a multidisciplinary team approach can reduce the incidence of VAP. Further sustained improvement requires persistent vigilant inspections.
呼吸机相关性肺炎（VAP）是重症监护病房患者中常见的医院获得性感染。医疗改进研究所建议采用“综合护理措施”来预防VAP。本报告描述了实施该策略对VAP发生率的影响。
根据国家医疗安全网络标准，对2008年至2013年期间入住重症监护病房的所有机械通气患者进行前瞻性VAP发生情况随访。2011年实施了一项包含7个要素的综合护理措施，包括床头抬高30°-45°、每日中断镇静并评估是否拔管、预防消化性溃疡疾病、预防深静脉血栓形成、用洗必泰进行口腔护理、带内置吸引和声门下吸引的气管插管，以及将气管导管套囊压力维持在20-30 mmHg。然后跟踪综合护理措施的依从性和VAP发生率。
共有3665例患者接受了机械通气，对综合护理措施依从性的监测观察共有9445次。VAP团队启动前后综合护理措施的总依从率分别为90.7%和94.2%（P <.001）。VAP发作次数从2008 - 2010年的144次降至2011 - 2013年的仅14次（P <.0001）。实施综合护理措施后VAP发生率从每1000呼吸机日8.6例降至每1000呼吸机日2.0例（P <.0001）。
本研究表明，系统实施多学科团队方法可降低VAP的发生率。进一步持续改进需要持续进行严格检查。
