手卫生依从性对儿童呼吸机相关性肺炎发病率影响的研究

目的调查手卫生依从性对儿童呼吸机相关性肺炎(VAP)发病率的影响,探讨手卫生在预防和控制VAP中的作用。方法对某院儿科综合ICU(PICU)医务人员手卫生依从性进行干预,比较2012年3月1日—10月31日(干预前)和2013年1月1日—8月31日(干预后)医务人员手卫生依从率和所有应用有创机械通气患儿VAP发病率。结果干预后医务人员手卫生依从率为37.31%(97/260),高于干预前的24.17%(58/240),干预前后比较,差异有统计学意义(χ2=10.08,P0.01);PICU洗手液和快速手消毒剂消耗量由干预前的3.48 mL/床日,提高至干预后的4.49 mL/床日,增长率为29.02%。干预后VAP日感染率为2.21‰(5/2 261),低于干预前的6.50‰(13/2 001)(χ2=4.67,P0.05)。结论通过综合措施,提高医务人员手卫生依从性,可以降低儿童VAP发生率。

Effect of hand hygiene compliance on the incidence of ventilator associated pneumonia in children

ObjectiveTo analyze the effect of hand hygiene compliance on the incidence of ventilator associated pneumonia(VAP) in children,  and explore the role of hand hygiene in the prevention and control of VAP. MethodsHand hygiene compliance among HCWs in a pediatric intensive care unit  (PICU) was intervened, hand hygiene compliance rate of HCWs and incidence of VAP in children with mechanical ventilation from March 1, to October 31, 2012  (before intervention)  and from January 1, to August 31,2013  (after intervention) were compared.  ResultsHand hygiene compliance rate after intervention was higher than before intervention( 37.31%［97/260］ vs 24.17% ［58/240］) （χ2=10.08,P＜0.01）;  the consumption of hand washing liquid and alcohol based handrub enhanced from 3.48mL /bed day before intervention to 4.49 mL/bed day after intervention,which  increasing by 29.02%. The incidence of VAP after intervention was lower than before intervention (2.21‰［5/2 261］ vs 6.50‰［13/2 001］）（χ2=4.67,P＜0.05）. ConclusionImplementation of comprehensive measures and improvement of HCWs’ hand hygiene compliance can reduce the incidence of VAP in children.