A program for sustained improvement in preventing ventilator associated pneumonia in an intensive care setting.
A program for sustained improvement in preventing ventilator associated pneumonia in an intensive care setting.
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DOI：
10.1186/1471-2334-12-234
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发表时间：
2012-09-29
影响因子：
3.7
通讯作者：
Timenetsky KT
中科院分区：
文献类型：
--
作者：
Caserta RA;Marra AR;Durão MS;Silva CV;Pavao dos Santos OF;Neves HS;Edmond MB;Timenetsky KT
呼吸机相关性肺炎(VAP)是重症监护病房(ICU)常见的一种感染，病死率高。在内外科ICU进行了一项准实验研究。从2008年10月至2010年12月实施了多项干预措施，以优化VAP的预防。所有这些过程，包括医疗保健改进研究所(IHI)的呼吸机包加洗必泰口服去污和声门下分泌物的持续吸入(CASS)，都被用于接受机械通气的患者。我们评估了总共21,984个病人日，以及总共6,052个呼吸机日(呼吸机利用率为0.27)。我们发现，2009年和2010年的VAP发生率分别为每1,000个呼吸机日1.3和2.0，在12个月内，只要VAP捆绑依从性超过90%，VAP就有几次实现了零发生率。这些结果表明，将VAP率降至接近零并保持这些比率是可能的，但这需要一个复杂的过程，涉及必须长期监测的多种绩效衡量和干预措施。
Ventilator-associated pneumonia (VAP) is a common infection in the intensive care unit (ICU) and associated with a high mortality. A quasi-experimental study was conducted in a medical-surgical ICU. Multiple interventions to optimize VAP prevention were performed from October 2008 to December 2010. All of these processes, including the Institute for Healthcare Improvement’s (IHI) ventilator bundle plus oral decontamination with chlorhexidine and continuous aspiration of subglottic secretions (CASS), were adopted for patients undergoing mechanical ventilation. We evaluated a total of 21,984 patient-days, and a total of 6,052 ventilator-days (ventilator utilization rate of 0.27). We found VAP rates of 1.3 and 2.0 per 1,000 ventilator days respectively in 2009 and 2010, achieving zero incidence of VAP several times during 12 months, whenever VAP bundle compliance was over 90%. These results suggest that it is possible to reduce VAP rates to near zero and sustain these rates, but it requires a complex process involving multiple performance measures and interventions that must be permanently monitored.