集束化护理预防重症监护病房多重感染的效果：一项准实验前后测试设计研究。

Efficacy of a care bundle to prevent multiple infections in the intensive care unit: A quasi-experimental pretest-posttest design study.

机构信息

Ankara Yıldırım Beyazıt University, Faculty of Health Science, Department of Nursing, Turkey.

Gazi University, Faculty of Health Science, Department of Nursing, Turkey.

出版信息

Appl Nurs Res. 2018 Feb;39:4-10. doi: 10.1016/j.apnr.2017.10.009. Epub 2017 Oct 17.

DOI:10.1016/j.apnr.2017.10.009

PMID:29422174

Abstract

BACKGROUND

Healthcare-associated infections extend hospitalization time, increase treatment costs and increase morbidity-mortality rates.

OBJECTIVES

To evaluate the efficacy of a care bundle aimed at preventing three most frequent intensive care unit-acquired infections.

MATERIALS AND METHOD

This quasi-experimental study occurred in an 18-bed tertiary care intensive care unit at a university hospital in Turkey. The sample consisted of 120 patients older than 18years and receiving invasive mechanical ventilation therapy, or had a central venous catheter or urinary catheter. The study comprised three stages. In stage one, the intensive care unit nurses were trained in infection measures, VAP, CA-UTIs and CLABSIs sections of the care bundle. In stage two, the trained nurses applied the care bundle and received feedback on any problematic issues. In stage three, the nurses' compatibility and efficacy of the infection prevention care bundle on the infection rates of VAP, CA-UTIs and CLABSIs were evaluated over three 3-month periods.

RESULTS

Over 1000 ventilation days, ventilator-associated pneumonia infection rates were 23.4, 12.6, and 11.5, during January-March, April-June and July-September, respectively, with January-March and April-June showing a significant decrease (χ=6.934, p=0.031). The central line-associated bloodstream infection rates were 8.9, 4.2, and 9.9 per 1000 catheter days, during January-March, April-June and July-September, respectively, but were not significantly different based on pair-wise comparisons (p>0.05). The catheter-associated urinary tract infection rates were higher during July-September (6.7/1000 catheter days) compared to January-March (5.7/1000 catheter days) and April-June (10.4/1000 catheter days) but the differences were not significant (p>0.05).

CONCLUSIONS

The infection rates decreased with increased compatibility of the care bundle prepared from evidence-based guidelines.

摘要

背景

医疗保健相关感染会延长住院时间、增加治疗成本并提高发病率和死亡率。

目的

评估旨在预防重症监护病房三种最常见获得性感染的护理包的疗效。

材料和方法

这是一项在土耳其一所大学医院的 18 张床位的三级重症监护病房进行的类实验研究。样本由 120 名年龄大于 18 岁、接受有创机械通气治疗或有中心静脉导管或导尿管的患者组成。研究包括三个阶段。在第一阶段，重症监护病房护士接受感染措施、呼吸机相关性肺炎、导管相关尿路感染和导管相关血流感染护理包部分的培训。在第二阶段，经过培训的护士应用护理包，并对任何有问题的问题提供反馈。在第三阶段，评估护士在感染预防护理包的适用性和对呼吸机相关性肺炎、导管相关尿路感染和导管相关血流感染感染率的影响，共进行了三个为期 3 个月的阶段。

结果

在超过 1000 个通气日中，呼吸机相关性肺炎感染率分别为 23.4%、12.6%和 11.5%，分别为 1 月至 3 月、4 月至 6 月和 7 月至 9 月，其中 1 月至 3 月和 4 月至 6 月显著下降（χ=6.934，p=0.031）。中心静脉导管相关血流感染率分别为每 1000 个导管日 8.9%、4.2%和 9.9%，分别为 1 月至 3 月、4 月至 6 月和 7 月至 9 月，但两两比较无显著性差异（p>0.05）。导管相关尿路感染率在 7 月至 9 月期间（6.7/1000 导管日）高于 1 月至 3 月（5.7/1000 导管日）和 4 月至 6 月（10.4/1000 导管日），但差异无统计学意义（p>0.05）。