持续质量改进在降低ICU呼吸机相关肺炎感染管理中的作用

目的针对ICU呼吸机相关肺炎(VAP)感染率较高和引起VAP感染的各种因素,探讨运用持续质量改进措施在降低VAP感染率和医务人员对VAP防控措施执行依从性的作用。方法选择2017年7月1日-2018年6月30日,入住ICU行机械通气超过48 h且无肺部基础疾病的重症患者,用随机数字表法分为观察组(55例)和对照组(55例),对照组采取常规诊疗与护理措施,观察组运用持续质量改进法,比较2组VAP感染率及医护集束化控制措施执行依从率的变化。结果观察组患者VAP千日感染率(11.3‰)明显低于对照组(27.5‰),差异有统计学意义(χ2=6.11,P<0.05)。医护人员对VAP预防措施执行项目的依从率,2组比较差异均有统计学意义(P<0.05)。结论持续质量改进一方面能降低ICU VAP感染率,另一方面提高了医护人员对落实各项管理措施执行的依从性,提升了医护管理质量,保障了患者的诊疗安全。

Effect of continuous quality improvement on reduction of ventilator-associated pneumonia (VAP) infection rate

Objective To explore the effect of continuous quality improvement on the reduction of ventilator-associated pneumonia (VAP) infection rate in intensive care unit (ICU). Methods From July 1, 2017 to June 30, 2018, critically ill patients who underwent mechanical ventilation for more than 48 hours in the ICU without basic lung disease were randomly divided into an observation group (55 cases) and a control group (55 cases). The control group received the routine medical treatment and nursing measures, and the observation group was given the continuous quality improvement method. The VAP infection rate and compliance rate of the medical staff on the implementation of VAP preventive measures were investigated and compared between the two groups. Results The VAP thousand-day infection rate was 11.3‰ in the observation group, which was significantly lower than that in the control group (27.5‰) , and the difference was statistically significant (χ2=6.11, P<0.05). The compliance rate of the medical staff on the implementation of VAP preventive measures in the observation group was superior to that in the control group (P<0.05). Conclusion The continuous quality improvement can reduce the infection rate of VAP in ICU and also can improve the compliance of medical staff on the implementation of VAP preventive measures, therefore it improves the quality of medical management and ensures the safety of the patients.