ICU呼吸机相关性肺炎预防控制质量核查单的设计及应用

目的 通过设计《ICU呼吸机相关性肺炎预防控制质量核查单》(简称核查单),指导护理人员在临床工作中进行质量核查,以降低呼吸机相关性肺炎的发生率,促进呼吸机相关性肺炎预防的质量改进.方法 采用类实验性研究方法,2015年5-7月,将核查单应用于ICU的机械通气患者,对呼吸机相关性肺炎预防控制措施进行每日核查;将使用核查单的2015年5-7月患者作为干预组,未使用核查单的2015年1-3月患者作为对照组,比较两组呼吸机相关性肺炎预防控制措施的总执行率、单项执行率和呼吸机相关性肺炎的发生率.结果 使用核查单干预后,呼吸机相关性肺炎预防控制措施的总执行率提高(31.8％ vs 54.5％),呼吸机相关性肺炎发生率明显下降(34.2‰ vs 14.6‰).预防控制措施中“手卫生”、“抬高床头30°～45°”、“口腔护理”、“镇静休假”、“深静脉血栓预防”、“人工气道管理”的单项执行率均提高,使用前后上述各指标的差异有统计学意义(P＜0.05),“消化道溃疡预防”的单项执行率未提高.结论 应用《ICU呼吸机相关性肺炎预防控制质量核查单》有助于提高多项呼吸机相关性肺炎预防控制措施的执行率,降低呼吸机相关性肺炎的发生率.

Design and application of the quality control checklist regarding the prevention of ventilator-associated pneumonia in ICU

Objective To design the quality control checklist regarding the prevention of ventilator-associated pneumonia (VAP).Methods With using quasi-experimental study,a new checklist of VAP prevention and control measures was designed and applied for the quality control of mechanical ventilation patients.Patients,on whom the checklist was applied from May 2015 to July 2015,were treated as the intervention group,while the control group consisted of the patients without using checklist from January 2015 to March 2015.The overall and single-item compliance of performing the checklist and differences of these indicators in two groups were compared.Results After application of the checklist,the overall compliance of performing the checklist was improved (31.8％ vs.54.5％) and the VAP incidence was reduced (34.2‰ vs.14.6‰).Among seven evidence-based items of checklist,differences in the compliance of performing hand hygiene,elevation of the head by 30-45 degrees,mouth care,interruption of continuous sedation,deep vein thrombosis (DVT) prophylaxis and artificial airway management were statistically significant,while that of peptic ulcer prophylaxis was not improved.Conclusion The application of the quality control checklist of VAP in ICU could improve most of VAP prevention and control measures,and help reduce the incidence of VAP.