ICU成人失禁相关性皮炎预防及管理的循证护理实践

目的 将ICU成人失禁相关性皮炎预防和管理的最佳证据应用于临床实践,提高ICU护士对失禁相关性皮炎预防和管理的能力和依从性,从而降低ICU成人失禁相关性皮炎和导尿管相关泌尿道感染的发生率。方法 根据前期研究获得的最佳证据制定ICU成人失禁相关性皮炎预防及管理的审查指标,指导并规范ICU护士的临床实践;开展多渠道培训结合模式,对ICU护士进行ICU成人失禁相关性皮炎预防及管理最佳证据的培训,比较最佳证据应用前后ICU成人失禁相关性皮炎和导尿管相关泌尿道感染的发生率及质量审查结果,培训前后ICU护士对成人失禁相关性皮炎的认知水平。结果 最佳证据应用后,ICU成人失禁相关性皮炎发生率从12%下降至3%;导尿管相关泌尿道感染发生率从4%下降至0%;失禁性皮炎证据的执行率和ICU护士对失禁相关性皮炎的认知水平显著提高,差异具有统计学意义（P<0.05）。结论 将基于循证的最佳证据应用于临床实践,可促进ICU患者失禁相关性皮炎的预防及管理工作,降低成人失禁相关性皮炎和导尿管相关泌尿道感染的发生率,提高临床护理质量。

Evidence-based Practice of Prevention and Management of Incontinence-associated Dermatitis in ICU Adult Patients

Objective To improve ICU nurses’ ability and compliance of prevention and management of incontinence-associated dermatitis (IAD) by using the best evidence for the prevention and management of IAD in ICU adult patients, so as to reduce the incidence of ICU adult IAD and catheter-related urinary tract infection. Methods We developed the criteria according to the best evidences from the previous study to guide and standardize the clinical practice; and carried out multi-channel training of the prevention and management of IAD in ICU adult patients for ICU nurses. The incidence of ICU adult IAD and catheter-related urinary tract infection before and after the application of the best evidences was compared, and the cognition and implementation of the best evidences of ICU nurses before and after the training were also compared. Results After the application of the best evidences, the prevalence of IAD decreased from 12% to 3%; that of catheter-related urinary tract infection from 4% to 0%. The implementation rate of the IAD evidences was improved obviously; ICU nurses’ cognition on IAD was improved from a moderate to a high level and the difference was statistically significant (P<0.05). Conclusion With evidence-based best evidences in clinical practice, the prevention and management of IAD in ICU patients is promoted, and the incidence of adult IAD and catheter-related urinary tract infection is decreased, thus the quality of clinical nursing is improved.