Han Jingjing, Li Dan, Rao Yan, Wang Gaohua
Department of Infection Control, Renmin Hospital of Wuhan University, Wuhan, Hubei, China.
Department of Pharmacy, Renmin Hospital of Wuhan University, Wuhan, Hubei, China.
Front Psychiatry. 2023 Jun 2;14:1184999. doi: 10.3389/fpsyt.2023.1184999. eCollection 2023.
The incidence of hospital-acquired pneumonia (HAP) is high in the medical setting for mental disorders. To date, effective measurements for preventing HAP in hospitalized mental disorder patients are unavailable.
This study was conducted at the Large-Scale Mental Health Center of Renmin Hospital of Wuhan University (Wuhan, China) in two phases: baseline phase (January 2017-December 2019) and intervention phase (May 2020-April 2022). In the intervention phase, the HAP bundle management strategy was implemented in the Mental Health Center, and the data on HAP were collected continuously for analysis.
A total of 18,795 and 9,618 patients were included in the baseline and intervention phases, respectively. The age, gender, ward admitted to, type of mental disorder, and Charlson comorbidity index did not differ significantly. After intervention, the rate of HAP occurrence decreased from 0.95 to 0.52% ( < 0.001). Specifically, the HAP rate decreased from 1.70 to 0.95% ( = 0.007) in the closed ward and from 0.63 to 0.35% ( = 0.009) in the open ward. The HAP rate in the subgroups was higher in patients with schizophrenia spectrum disorders (1.66 . 0.74%) and organic mental disorders (4.92 . 1.41%), and in those ≥65 years old (2.82 . 1.11%) but decreased significantly after intervention (all < 0.05).
The implementation of the HAP bundle management strategy reduced the occurrence of HAP in hospitalized patients with mental disorders.
在精神障碍医疗环境中，医院获得性肺炎（HAP）的发病率很高。迄今为止，尚无有效的措施来预防住院精神障碍患者发生HAP。
本研究在武汉大学人民医院大型精神卫生中心（中国武汉）分两个阶段进行：基线阶段（2017年1月至2019年12月）和干预阶段（2020年5月至2022年4月）。在干预阶段，精神卫生中心实施了HAP集束化管理策略，并持续收集HAP数据进行分析。
基线阶段和干预阶段分别纳入了18795例和9618例患者。年龄、性别、入住病房、精神障碍类型和Charlson合并症指数差异均无统计学意义。干预后，HAP发生率从0.95%降至0.52%（P<0.001）。具体而言，封闭病房的HAP发生率从1.70%降至0.95%（P = 0.007），开放病房的HAP发生率从0.63%降至0.35%（P = 0.009）。精神分裂症谱系障碍患者（1.66±0.74%）、器质性精神障碍患者（4.92±1.41%）以及≥65岁患者（2.82±1.11%）的亚组HAP发生率较高，但干预后均显著下降（均P<0.05）。
实施HAP集束化管理策略降低了住院精神障碍患者HAP的发生率。
