Department of Nursing, Kaohsiung Veterans General Hospital, Kaohsiung City 813414, Taiwan.
Department of Nursing, Meiho University, Neipu, Pingtung 91202, Taiwan.
Int J Environ Res Public Health. 2021 Oct 22;18(21):11128. doi: 10.3390/ijerph182111128.
Ventilator-associated pneumonia is a common hospital-acquired infection. It causes patients to stay longer in the hospital and increases medical costs. This study explores the effect of applying an automatic medical information system to implement five-item prevention care bundles on the prevention of ventilator-related pneumonia. This study was a retrospective cohort study. This study was conducted from October 2017 to February 2018 and collected data from the intensive care unit of a medical center in southern Taiwan from January 2013 to May 2016. The control group (enrolled from January 2013 to June 2014) received oral hygiene. The experimental group (enrolled from July 2014 to December 2015) received five-item ventilator-associated pneumonia prevention care bundles, which consisted of (1) elevation of the head of the bed to 30-45°; (2) daily oral care with 0.12-0.2% chlorhexidine twice daily; (3) daily assessment of readiness to extubate; (4) daily sedative interruption; and (5) emptying water from the respirator tube. Results showed the incidence of ventilator-associated pneumonia in the bundle group was significantly less than the oral hygiene group ( = 0.029). The factors that significantly affected the incidence of ventilator-associated pneumonia were ventilator-associated pneumonia care bundle, ventilator-days, and intensive care unit length of stay. A significant reduction in ventilator-associated pneumonia rate in the bundle group compared to the oral hygiene group (OR = 0.366, 95% CI = 0.159-0.840) was observed, with 63.4% effectiveness. Application of an automatic medical information system to implement bundle care can significantly reduce the incidence of ventilator-associated pneumonia.
呼吸机相关性肺炎是一种常见的医院获得性感染。它导致患者在医院停留时间更长，并增加医疗费用。本研究探讨了应用自动医疗信息系统实施五项预防护理包对预防呼吸机相关性肺炎的效果。本研究是一项回顾性队列研究。本研究于 2017 年 10 月至 2018 年 2 月进行，收集了来自台湾南部一家医疗中心重症监护病房 2013 年 1 月至 2016 年 5 月的数据。对照组（2013 年 1 月至 2014 年 6 月入组）接受口腔卫生护理。实验组（2014 年 7 月至 2015 年 12 月入组）接受五项呼吸机相关性肺炎预防护理包，包括（1）床头抬高至 30-45°；（2）每天用 0.12-0.2%洗必泰进行两次口腔护理；（3）每天评估拔管准备情况；（4）每天中断镇静；（5）从呼吸机管中排空水。结果显示，护理包组呼吸机相关性肺炎发生率明显低于口腔卫生组（=0.029）。显著影响呼吸机相关性肺炎发生率的因素是呼吸机相关性肺炎护理包、呼吸机使用天数和重症监护病房住院时间。与口腔卫生组相比，护理包组呼吸机相关性肺炎发生率显著降低（OR=0.366，95%CI=0.159-0.840），有效率为 63.4%。应用自动医疗信息系统实施护理包可以显著降低呼吸机相关性肺炎的发生率。
