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护士对呼吸机相关性肺炎预防集束化措施的依从性及其对重症监护病房患者结局的影响。

Nurses' compliance to ventilator-associated pneumonia prevention bundle and its effect on patient outcomes in intensive care units.

作者信息

Al-Harthi Fatma, Al-Noumani Huda, Matua Gerald Amandu, Al-Abri Harith, Joseph Annie

机构信息

Sultan Qaboos University, College of Nursing, Muscat, Oman.

University Medical City, Muscat, Oman.

出版信息

Nurs Crit Care. 2025 May;30(3):e70043. doi: 10.1111/nicc.70043.

Abstract

BACKGROUND

Ventilator-associated pneumonia (VAP) is a significant healthcare-associated infection. Compliance with VAP guidelines reduces infection and leads to better patient outcomes.

AIM

The study investigated the VAP rate, nurses' compliance with the VAP bundle and the correlation between nurses' compliance with the VAP bundle and key patient-related outcomes.

STUDY DESIGN

This descriptive correlational prospective study was conducted at two tertiary hospitals. All intensive care unit patients on mechanical ventilators who met the inclusion criteria for 48 h or more were recruited. Data were analysed using descriptive statistics, Chi-square, independent t-test and Spearman's rank correlation.

RESULTS

Out of the 103 patients recruited, 22.3% of patients developed VAP, with a VAP rate of 5.6 per thousand ventilator days. Nurses' compliance with VAP guidelines in both hospitals was 69% and decreased over the admission period. Compliance with the VAP bundle was linked to less length of stay (rho = -0.260, p < .008), fewer mechanical ventilation days (rho = -0.300, p < .002) and less hospital cost (rho = -0.266, p < .007). The mean compliance with the VAP care bundle was higher in the non-VAP group (M = 72.9, SD = 23.79) than in patients who developed VAP (M = 56.6, SD = 18.96).

CONCLUSIONS

The findings underscore the critical need for healthcare organizations to prioritize strategies to enhance compliance with VAP guidelines for improved patient outcomes.

RELEVANCE TO CLINICAL PRACTICE

Ongoing quality improvement efforts through regular audits of the VAP bundle implementation are crucial for reducing infections and complications and improving patient outcomes. Future research is recommended to investigate factors that impact nurses' adherence to VAP guidelines to develop interventions to enhance compliance.

摘要

背景

呼吸机相关性肺炎(VAP)是一种严重的医疗相关感染。遵守VAP指南可减少感染并带来更好的患者预后。

目的

本研究调查了VAP发生率、护士对VAP集束方案的依从性以及护士对VAP集束方案的依从性与关键患者相关结局之间的相关性。

研究设计

这项描述性相关性前瞻性研究在两家三级医院进行。招募了所有在机械通气下符合纳入标准达48小时或更长时间的重症监护病房患者。数据采用描述性统计、卡方检验、独立t检验和Spearman等级相关性分析。

结果

在招募的103例患者中,22.3%的患者发生了VAP,VAP发生率为每千个呼吸机日5.6例。两家医院护士对VAP指南的依从性均为69%,且在住院期间有所下降。对VAP集束方案的依从性与住院时间缩短(rho = -0.260,p <.008)、机械通气天数减少(rho = -0.300,p <.002)和住院费用降低(rho = -0.266,p <.007)相关。非VAP组对VAP护理集束方案的平均依从性(M = 72.9,SD = 23.79)高于发生VAP的患者(M = 56.6,SD = 18.96)。

结论

研究结果强调了医疗机构迫切需要优先采取策略,以提高对VAP指南的依从性,从而改善患者预后。

与临床实践的相关性

通过定期审核VAP集束方案的实施情况持续进行质量改进工作,对于减少感染和并发症以及改善患者预后至关重要。建议未来的研究调查影响护士遵守VAP指南的因素,以制定提高依从性的干预措施。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c4e5/12022936/6a8c7eec45be/NICC-30-0-g001.jpg

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