口腔护理方案对约旦部分重症监护病房呼吸机相关性肺炎发病率的影响。
The Effects of Oral Care Protocol on the Incidence of Ventilation-Associated Pneumonia in Selected Intensive Care Units in Jordan.
作者信息
Alja'afreh Mahmoud A, Mosleh Sultan M, Habashneh Sakhaa S
机构信息
Mahmoud Ali Alja'afreh, RN, PhD, is an assistant professor, vice dean, and head of the Adult Health Nursing Department, Faculty of Nursing, Mutah University, Mutah, Karak, Jordan. His research interest is focused on four major areas: (1) studying of patient and family satisfaction in acute and critical care settings; (2) use of local resources to develop student center knowledge about disaster education; (3) development of patient safety guidelines for pressure ulcers patients, mechanically ventilated patients, and critical care practices issues; and (4) reshaping and enforcement of structures, processes, and outcomes of risk assessment, and management of pressure ulcers patients and critical care/cancer patients. Sultan Mosleh, RN, PhD, is an associate professor and a former head of the Adult Health Nursing Department, Faculty of Nursing, Mutah University, Jordan. His research interest is focused on four major areas: (1) critical care environment issues for patients and staff; (2) palliative care and end-of-life care of cancer patients; (3) clinical cardiac patients' rehabilitation; and (4) patient and nursing education. Sakhaa S. Habashneh, RN, MsN, is a lecturer at the Department of Adult Health Nursing, Faculty of Nursing, University of Mutah, Mutah, Karak, Jordan. Her research interest is focused on four major areas: (1) clinical critical nursing issues; (2) knowledge and compliances of critical care units' staff; and (3) patient and nursing education.
出版信息
Dimens Crit Care Nurs. 2019 Jan/Feb;38(1):5-12. doi: 10.1097/DCC.0000000000000334.
PURPOSE
This study aims to evaluate the effects of oral care protocol on the incidence of ventilator-associated pneumonia (VAP) at selected intensive care units (ICUs) in Jordan using clinical pulmonary infection score.
METHODS
A quasi-experimental design was used, and 1 large teaching hospital from the Jordanian capital, along with 2 hospitals from the southern region, was selected. A total of 218 patients participated, among which VAP risk in 2 independent groups was evaluated through the Clinical Pulmonary Infection Score sheet.
RESULTS
The VAP incidence rate was significantly lower in the intervention group (n = 102) as compared with control group (n = 116) (21.6 vs 35.3, respectively; P = .018); in addition, ICU stay and intubation period were significantly shorter among the intervention group. A higher risk of VAP was independently predicted by previous lung diseases (odds ratio [OR], 1.441; 95% confidence interval [CI], 1.185-1.88), open suctioning system (OR, 2.536; 95% CI, 1.261-5.101), and duration of intubation (OR, 1.770; 95% CI, 0.845-2.220). The oral care protocol has effectively improved ventilated patients' oral health, which has statistically reduced the incidence of VAP. It occurred more frequently among patients who have lung disease and those who were intubated for more than 7 days and have an open suctioning system.
CONCLUSION
Health care teams should ensure that effective care protocol is implemented among patients.
目的
本研究旨在使用临床肺部感染评分评估口腔护理方案对约旦选定重症监护病房（ICU）呼吸机相关性肺炎（VAP）发病率的影响。
方法
采用准实验设计，选取了约旦首都的1家大型教学医院以及南部地区的2家医院。共有218名患者参与，通过临床肺部感染评分表对2个独立组中的VAP风险进行评估。
结果
干预组（n = 102）的VAP发病率显著低于对照组（n = 116）（分别为21.6和35.3；P = .018）；此外，干预组的ICU住院时间和插管时间显著缩短。既往肺部疾病（比值比[OR]，1.441；95%置信区间[CI]，1.185 - 1.88）、开放式吸痰系统（OR，2.536；95% CI，1.261 - 5.101）和插管持续时间（OR，1.770；95% CI，0.845 - 2.220）可独立预测较高的VAP风险。口腔护理方案有效改善了机械通气患者的口腔健康，在统计学上降低了VAP的发病率。在患有肺部疾病、插管超过7天且采用开放式吸痰系统的患者中，VAP发生更为频繁。
结论
医疗团队应确保在患者中实施有效的护理方案。
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