集束化综合护理方案预防呼吸机相关性肺炎的研究

目的:探讨呼吸机相关性肺炎集束化综合预防护理方案的制定和实施。方法:通过比较该院SICU使用集束化综合护理方案前后1年的VAP发生率和医生对VAP护理措施的评价,确定预防VAP集束化综合护理方案的有效性。结果:使用集束化综合护理方案后,SICU的VAP发生率下降20.03%。结论:集束化综合护理预防作为主动预防措施比传统的被动预防更有针对性,更有效。     

集束化护理措施预防呼吸机相关性肺炎效果观察

目的观察集束化综合护理措施预防呼吸机相关性肺炎(VAP)的效果。方法通过临床观察和病原学标本检验方法,对集束化综合护理方案预防VAP效果进行了比较研究。结果采取集束化护理方案之前,该医院ICU住院病人(对照组)VAP发生率为25.2%;采用集束化护理方案(干预组)病人的VAP发生率为14.1%,差异有统计学意义(P<0.05)。结论集束化护理方案可有效降低病人VAP发生率,值得推广应用。     

预防呼吸机相关性肺炎的集束化护理措施

目的探讨预防呼吸机相关性肺炎(VAP)的集束化护理措施。方法选择本院ICU行机械通气治疗的104例患者作为研究对象,以随机数字表将其分为对照组与研究组各52例。对照组采取常规机械通气护理方案,研究组在此基础上实施集束化护理干预。观察对比2组机械通气患者VAP的发生率、气管切开率与病死率,以及ICU入住时间、机械通气时间与住院费用。结果研究组机械通气患者VAP的发生率、气管切开率与病死率均低于对照组(P0.05);研究组机械通气患者ICU入住时间、机械通气时间与住院费用均低于对照组(P0.05)。结论集束化护理措施能够有效预防VAP的发生,缩短机械通气、住院费用、ICU入住时间,降低气管切开率与病死率,进一步保证了患者的就医质量。     

基于PDCA循环法的集束化综合护理在提高 PICU 患儿 VAP 防控措施规范率中的应用

目的 探讨 PICU 科室对患儿实施 PDCA 循环法的集束化综合护理对呼吸机相关性肺炎（VAP）防控措施规范率的影响。 方法 选取本院 PICU 于 2021 年 1 月至 2021 年 12 月收治的 27 例留置气管插管患儿作为对照组,由本科室 8 名护士为患儿提供 常规护理服务。选取本院于 2022 年 1 月至 2022 年 12 月收治的 48 例留置气管插管患儿作为观察组,由 10 名护士为患儿提供 PDCA 循环法的集束化综合护理服务。对比两组护士的 VAP 防控措施规范率,以及两组患儿的 VAP 防控措施实施效果,患儿 家属的心理状态。结果 观察组护士的 VAP 防控措施规范率（91.67%）高于对照组（70.37%）（P<0.05）。观察组患儿的呼吸 机使用总日数、平均住院天数均短于对照组,且 VAP 发病率低于对照组（P<0.05）。护理后观察组患儿家属的 SAS 评分、SDS 评分均低于对照组（P<0.05）。结论 基于 PDCA 循环法的集束化综合护理在 PICU 患儿护理中能够有效提高护士的 VAP 防控 措施规范率以及患儿的 VAP 防控措施实施效果,改善患儿家属的心理状态。     

集束化护理方案预防呼吸机相关性肺炎的临床观察

目的探讨集束化护理方案在预防呼吸机相关性肺炎（VAP）中的效果。方法对2010年1～12月收住ICU的176例机械通气≥48h的患者进行集束化护理的前瞻性研究，选取2009年1～12月ICU收治的163例机械通气≥48h的患者为对照组。比较两组患者VAP发生率、机械通气时间、ICU住院时间、费用及气管切开和死亡率。结果与对照组相比，采用集束化护理方案后VAP发生率明显下降（P〈O．05），气管切开和死亡率明显降低（P〈0．05），机械通气时间以及ICU住院时间明显缩短（P〈0．05），平均住院费用明显减少（P〈0．05）。结论集束化护理方案对预防VAP有着重要的意义。加强对医护人员的培训，提高集束化护理方案的依从性和完善的质量控制，是降低VAP的关键。     

集束化护理对呼吸机相关性肺炎发生率的影响

[目的]探讨集束化护理对呼吸机相关性肺炎(ventilation associated pneumonia,VAP)发生率的影响。[方法]将行机械通气的病人80例随机分为观察组和对照组。观察组从开始行机械通气即运用抬高床头、定期密闭式吸痰、严格手部清洁、加强口咽部护理、避免质子泵抑制剂、定期更换呼吸机管道及使用温湿交换装置等集束化护理;对照组根据经验决定护理措施。比较两组病人VAP发生率。[结果]观察组病人VAP发生率显著低于对照组,两组气管插管病人VAP发生率低于气管切开病人。[结论]集束化护理模式可显著降低VAP的发生率,相比气管切开,气管插管病人VAP发生率较低。     

集束化护理措施对降低VAP发生率的探讨

集束化护理是指针对某一类或某一例患者实施的一组护理干预措施,该组措施中的每个元素都经临床证实能改善患者结局.国内外研究证明集束化护理对呼吸机相关肺炎(VAP)发生率有显著影响.高明榕[1]等研究发现,使用集束化综合护理方案后,外科重症病人的VAP发生率下降20.03％,入住重症医学科时间明显缩短,表明集束化综合护理预防作为主动预防措施比传统的被动预防更有针对性,更有效.国外一项回顾性研究[2]分析没有接受集束化护理的患者发生VAP的风险是接受集束化护理的患者的1.33倍.     

运用Bundle Care理念预防呼吸机相关性肺炎发生的临床研究

目的 调查、分析集束化护理干预体系在预防呼吸机相关性肺炎(ventilator associated pneumonia,VAP)中的临床应用成效.方法 选择行气管插管或气管切开并使用呼吸机超过48 h的病人,将病人完全随机分为常规组、研究组,常规组按基础护理课本要求对上呼吸机的病人进行护理;研究组按制订的护理干预体系进行VAP的预防护理,将收集的各种数据整理后进行统计,比较组间差异.结果 常规组VAP的发病率为29.51%,而研究组VAP的发病率为18.03%.结论 对使用呼吸机的患者,按照集束化护理干预体系实施专项护理,可以明显降低VAP的发生率.     

集束化预防方案降低呼吸机相关肺炎发生率效果观察

目的:探讨集束化预防方案对降低呼吸机相关肺炎(VAP)发生的作用。方法:选取我院重症医学科机械通气时间超过48 h的患者,其中2011年集束化VAP预防方案实施前选取患者247例,2012~2013年方案实施后选取患者858例,比较实施前后VAP的发生情况。结果:集束化VAP预防方案实施前(2011年)我科VAP发生率为12.42‰,集束化VAP预防方案实施后(2012~2013年)VAP发生率为6.41‰,实施前后VAP发生率比较有显著性差异(P0.01)。结论:集束化预防方案可有效降低VAP的发生率。     

品管圈在提高预防VAP集束化护理落实率中的应用

[目的]探讨品管圈活动在提高预防呼吸机相关性肺炎(VAP)集束化护理落实率中的应用效果。[方法]由11人组成品管圈,分析预防VAP集束化护理落实率低的原因,制定相应对策并实施,评价改进措施实施后的效果。[结果]开展品管圈活动后,落实率由活动前65.63%提高到活动后81.99%,差异有统计学意义(P0.000 1),进步率30.08%,目标达成率126.16%;VAP发生率由原来的4.60%下降为3.82%。[结论]推行品管圈活动后,预防VAP集束化护理措施落实情况得到明显改善,VAP发生率下降,同时提高了护士团队凝聚力和科研意识,有助于护理质量的持续改进。     

集束化护理干预策略预防新生儿呼吸机相关性肺炎

目的探讨新生儿呼吸机相关性肺炎(VAP)集束化护理干预策略的制定与实施。方法对2010年7月—2012年6月NICU收治的机械通气>48 h的31例患儿实施集束化护理干预策略,观察其体温、血常规、胸片及下呼吸道细菌学检查,并选取2008年7月—2010年6月机械通气患儿30例作为对照。结果实施集束化护理干预前VAP的发病率为26.7%,干预后则为16.1%,差异有统计学意义(P<0.05)。结论集束化护理干预策略能减少机械通气患儿VAP的发生。     

集束化护理方案在新生儿经鼻持续气道正压通气中的应用

目的探讨经鼻持续气道正压通气(NCPAP)的新生儿采用集束化护理方案的效果。方法对在NICU给予NC-PAP的62例患儿进行集束化护理,观察患儿的鼻中隔损伤、气压伤、腹胀和呼吸机相关性肺炎(VAP)的发生率,与60例常规护理组NCPAP的患儿作比较。结果集束化组患儿鼻中隔损伤、腹胀和VAP的发生率明显低于对照组(P<0.05),气压伤的发生率和对照组相比,虽无统计学意义(P>0.05),但也表现出一种下降的趋势。结论集束化护理方案可以有效地降低新生儿经鼻持续气道正压通气中并发症的发生。     

经口气管插管患者个性化口腔护理综合干预方案的运用效果

目的探讨经口气管插管患者个性化口腔护理综合干预方案的应用效果。方法 2013年8月-2014年9月,便利抽样法选取在第三军医大学新桥医院神经外科经口气管插管行机械通气、入重症监护室(intensive care unit,ICU)时依据改良ICU口腔护理频次评价表评分为6分的患者54例为研究对象。依照入院顺序将其分为对照组和观察组,每组27例。对照组患者按照传统方式进行口腔护理,2次/d。观察组患者采用个性化口腔护理综合干预方案。比较两组患者第2、3、5天首次口腔护理前改良ICU口腔护理频次评分及机械通气第5天时呼吸机相关肺炎(ventilator-associated pneumonia,VAP)的发生率。结果两组患者第2天首次口腔护理前改良ICU口腔护理频次评价的差异无统计学意义(P0.05),但第3、5天,两组患者首次口腔护理前改良ICU口腔护理频次评价的差异均有统计学意义(均P0.05)。第5天,对照组有16例患者发生VAP,发生率为59.26%,而观察组仅有8例患者发生VAP,发生率为29.63%,差异有统计学意义(χ~2=4.800,P=0.028)。结论综合口腔护理干预方案有利于保护患者口腔功能,量化口腔环境状态,维持口腔健康状况,减少口咽部细菌滋生,降低VAP的发生率。     

"集束化"治疗措施对呼吸机相关性肺炎的预防作用

目的 探讨"集束化"治疗措施在预防重症监护病房呼吸机相关性肺炎(VAP)中的作用.方法 82例经口气管插管、机械通气的患者随机分为"集束化"治疗组(集束化组)40例及传统方法治疗组(对照组)42例.比较两组患者VAP的发病率、入住ICU时间及病死率.结果 集束化组VAP发病率21.4%,平均入住ICU时间16.23d;对照组VAP发病率47.5%,平均入住ICU时间21.45d,两组差异有统计学意义;两组VAP患者较非VAP患者病死率明显增高;集束化组较对照组混合感染发生率降低,真菌感染发生率降低.结论 "集束化"治疗措施与传统治疗措施相比较能够降低VAP的发病率,减少患者入住ICU时间."集束化"治疗措施对于预防机械通气患者VAP的发生有一定作用.     

基于Beck口腔评分的综合口腔护理干预体系在气管插管病人中的应用

目的评价以Beck口腔评分为指导的综合性口腔护理干预体系在气管插管病人口腔护理中的运用效果,为建立规范化的口腔护理协议提供循证依据。方法 2012年10月—2014年2月对进入我科行经口气管插管机械通气治疗的、符合纳入标准的33例病人,使用基于Beck口腔评分的综合性口腔护理干预体系进行口腔护理。综合性的口腔护理干预体系包含了:Beck口腔评分,由评分确定系统性口腔护理的频次,系统性口腔护理,以及干预后的再次评分。根据评分情况给予2次/d至1次/4 h的口腔护理,采用综合气道吸引、负压吸引式牙刷刷牙、口腔冲洗、口腔擦拭、口腔湿润及氯己定漱口液共同作用的系统性口腔护理程序进行口腔护理。观察期为5 d。观察病人第1天、第3天、第5天口腔护理前口腔异味发生率、口咽部细菌培养结果、Beck口腔评分及呼吸机相关性肺炎发生率。结果 3个测量时间点口腔异味发生率、口咽部细菌培养致病菌菌株数及Beck口腔评分差异有统计学意义(P0.05),各个指标呈现下降趋势,呼吸机相关性肺炎发生率6.1%。结论以Beck口腔评分为指导的综合性护理干预体系对经口气管插管病人进行口腔护理,能减少口腔异味的发生,减少口咽部细菌定植、改善口腔健康状况,并降低呼吸机相关性肺炎的发生率。     

Impact of four sequential measures on the prevention of ventilator-associated pneumonia in cardiac surgery patients

Introduction

Ventilator-associated pneumonia (VAP) is the most frequent infection in patients admitted to intensive care units.The efficacy of individual measures for the prevention of VAP is well documented, and data on the impact of implementing bundle measures have usually been reported from studies in which several measures are implemented simultaneously in the general intensive care unit (ICU).The objective of our work was to evaluate the impact of four sequentially implemented measures for preventing VAP in a major heart surgery ICU. The measures were a specific training program, aspiration of subglottic secretions (ASSs), introduction of an inclinometer to improve the semirecumbent position, and reinforcement of oral care with chlorhexidine.

Methods

We compared rates of VAP, days on mechanical ventilation (MV), and cost of antimicrobial agents before and during implementation.

Results

We collected data from 401 patients before the intervention and from 1,534 patients during the intervention. Both groups were comparable. No significant differences in EuroSCORE were observed between the patients of both periods (6.4 versus 6.3; P = 0.7). The rates of VAP (episodes/1,000 days of ventilation) were, respectively, 23.9 versus 13.5 (P = 0.005). Mean number of days of MV/1,000 days of stay was 507 versus 375 (P = 0.001), and the cost of antimicrobial therapy (Euros/1,000 days of stay) was €70,612 versus €52,775 (P = 0.10). The main effect of sequential application of preventive measures in time achieved a relative-rate reduction of VAP of 41% (IRR, 0.41; 95% CI, 0.28 to 0.62). The mortality rate before and during the intervention was 13.0% and 10.2%, respectively.VAP rate was most significantly reduced by training and the use of the inclinometer.

Conclusions

A sequentially applied bundle of four preventive measures reduces VAP rates, days of MV, and the cost of antimicrobial therapy in patients admitted to the major heart surgery ICU.

Trial registration

Clinical Trials.gov: {"type":"clinical-trial","attrs":{"text":"NCT02060045","term_id":"NCT02060045"}}NCT02060045. Registered 4 February 2014.     

Reducing Ventilator Associated Pneumonia in the NICU through oral care education: A quality improvement project

BackgroundInadequate oral care in the Neonatal Intensive Care Unit (NICU) can lead to Ventilator Associated Pneumonia (VAP). VAP rate was reported at 2.52 per 1000 ventilator days for the 12 months prior to intervention. A root cause analysis of VAPs during this period revealed only 70% compliance with oral care. VAP contributes to higher costs for the hospital, patient pain and suffering, morbidity and mortality, length of time on mechanical ventilation and increased hospital length of stay. This Quality Project aims to reduce VAP in the NICU through multidisciplinary re-education on the importance of oral care, and fostering an interdisciplinary oral care team of Respiratory Therapists and Registered Nurses.MethodAn IRB approved interventional pre and post intervention review of VAP rate was conducted on intubated neonatal patients from June 1, 2015–May 31, 2017. Intervention consisted of education perform as an interdisciplinary oral care team. Education was coordinated between Respiratory (RT) and Nursing (RN) educators, Lactation, and unit leaders to ensure standardized education to all staff. An oral care poster was created and presented to both RT and NICU RN staff at department meetings. An oral care PowerPoint was created and sent to all NICU RN's and was required as annual mandatory education for all RT's. Encouragement was provided through random chart audits from June 2016–May 2017, praising staff that coordinated care, and reminding staff who did not through friendly face to face interaction and email of the importance of routine, coordinated oral care.ResultsNICU VAP rates dropped during June, and came back up in July 2016 and dropped again in March 2017. Chart review revealed insufficient oral care (72% and 78%) in the two days prior to VAP events. Oral Care poster and education were re-introduced in August 2016 and April 2017. NICU VAP rates post intervention, June 2016–May 2017, was reported as 0.78 per 1000 ventilator days.ConclusionsIdentifying the primary factor through VAP root cause analysis made us aware of a VAP bundle component that was not being routinely followed. Having identified oral care as a problem in our unit enabled us to form an educational intervention with a standardized oral care technique that was effective in increasing the frequency and efficacy of oral care. Utilizing a multidisciplinary team for oral care fosters a sense of importance and responsibility to the staff and improved collaboration in care.     

ICU呼吸机相关性肺炎病原菌分析与护理对策

目的:探讨重症监护室内呼吸机相关性肺炎发生的原因及护理对策。方法:收集重症监护室内行机械通气患儿31例,其中符合VAP诊断标准19例,对其进行临床资料、病原菌分布情况分析。结果:重症监护室VAP发生率61.3%(19/31),病死率13.0%(4/31),病原菌的阳性率100%,其中G-菌占88.5%。结论:积极做好重症监护室内常规护理的同时,应严格掌握有创机械通气指征,提倡早期无创机械通气及有创与无创序贯性机械通气是减少重症监护室内呼吸机相关性肺炎发生的关键。     

呼吸机相关性肺炎的护理

目的运用护理手段对呼吸机相关性肺炎（VAP）的发生进行预防和控制,从而有效降低呼吸机相关性肺炎的发生,提高使用呼吸机患者的疗效,降低患者的医疗费用。方法2005年3月～2007年5月对72例实施人工气道并行机械通气的患者分析VAP发生的高危因素,并实施控制VAP的综合护理。结果72例患者中发生VAP10例,发生率为13.9%。结论正确吸痰、加强消毒隔离制度落实、防止误吸、加强口咽部护理等方法可有效预防VAP发生。     

Ventilator-associated pneumonia: prevention is better than cure

Background: The prevention of ventilator Assisted Pneumonia (VAP), a hospital acquired infection, among intensive care patients is a major clinical challenge. It is a condition that is associated with high rates of morbidity, mortality, length of stay and hospital costs. Aim: The aim of this paper is to critically review the available literature and identify current evidence based nursing and medical interventions to support practitioners in preventing VAP in their patients. Methods: A literature search using keywords, including ‘ventilator‐associated pneumonia’ were entered into a search engine. A number of highly pertinent papers relevant to the aims of the review were identified, however only a small sample came from nursing journals. Only those papers, which discussed specific strategies for managing VAP were selected for analysis and inclusion in this review. Discussion: We identified a number of practical and evidence based strategies that nurses can incorporate into their practice to prevent VAP and to reduce its incidence. In addition, the introduction of newer techniques, advances in equipment and use of multidisciplinary care bundles can further support and improve the quality and delivery of safe patient care. Conclusion: Targeted strategies aimed at preventing VAP, should be implemented to improve patient outcome and reduce length of intensive care unit stay and costs. Front‐line critical care nurses need to understand the factors which place their patients at risk of developing VAP and, institute evidence‐based interventions that will compromise the patients’ survival and recovery.