Prevention of Ventilator-Associated Pneumonia: The Multimodal Approach of the Spanish ICU "Pneumonia Zero" Program
Prevention of Ventilator-Associated Pneumonia: The Multimodal Approach of the Spanish ICU "Pneumonia Zero" Program
复制标题
呼吸机相关肺炎的预防：西班牙ICU“肺炎零”计划的多模式方法
DOI：
10.1097/ccm.0000000000002736
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发表时间：
2018-02-01
影响因子：
8.8
通讯作者：
Agra, Yolanda
中科院分区：
文献类型：
--
作者：
Alvarez-Lerma, Francisco;Palomar-Martinez, Mercedes;Agra, Yolanda
目的：“肺炎零”项目是一项全国性的多模式干预，其基础是同时实施全面的循证捆绑措施，以预防入住ICU的危重患者发生呼吸机相关肺炎。设计：前瞻性、干预性和多中心研究。设置：整个西班牙共有181个ICU。患者：所有患者在2011年4月1日至2012年12月31日期间入住参与ICU超过24小时。干预：实施了10项呼吸机相关肺炎预防措施（7项是强制性措施，3项是强烈建议的措施）。使用国家ICU获得性感染监测研究数据库（Estudio Nacional de Vigilancia de Acupunctiones No.11ales [ENVIN]）进行数据收集。呼吸机相关性肺炎发生率表示为每1,000个呼吸机日的发病密度。从ICU纳入项目开始，每3个月将呼吸机相关性肺炎发生率与ENVIN登记数据（2010年4月至6月）作为基线期进行比较。呼吸机相关性肺炎的发病率进行了调整的特点，医院，包括规模，类型（公立或私立），和教学（研究生）或大学附属（本科）status. Measures和主要结果：181参与ICU占75%的所有ICU在西班牙。在总共171，237例ICU住院患者中，人工气道存在505，802天（ICU住院天数的50.0%）。在3,186例患者中，共诊断出3,474例呼吸机相关性肺炎发作。调整后的呼吸机相关性肺炎发病密度率从9.83（95% CI，8.42-11.48）从基线期每1，000个呼吸机日增加至4.34（95% CI，3.22-5.84）。结论：实施包括在“零肺炎”项目中的捆绑措施，使西班牙ICU中呼吸机相关肺炎的发病率显著降低了50%以上。这一减少在实施后持续了21个月。
Objectives: The "Pneumonia Zero" project is a nationwide multimodal intervention based on the simultaneous implementation of a comprehensive evidence-based bundle measures to prevent ventilator-associated pneumonia in critically ill patients admitted to the ICU.Design: Prospective, interventional, and multicenter study.Setting: A total of 181 ICUs throughout Spain.Patients: All patients admitted for more than 24 hours to the participating ICUs between April 1, 2011, and December 31, 2012.Intervention: Ten ventilator-associated pneumonia prevention measures were implemented (seven were mandatory and three highly recommended). The database of the National ICU-Acquired Infections Surveillance Study (Estudio Nacional de Vigilancia de Infecciones Nosocomiales [ENVIN]) was used for data collection. Ventilator-associated pneumonia rate was expressed as incidence density per 1,000 ventilator days. Ventilator-associated pneumonia rates from the incorporation of the ICUs to the project, every 3 months, were compared with data of the ENVIN registry (April-June 2010) as the baseline period. Ventilator-associated pneumonia rates were adjusted by characteristics of the hospital, including size, type (public or private), and teaching (postgraduate) or university-affiliated (undergraduate) status.Measurements and Main Results: The 181 participating ICUs accounted for 75% of all ICUs in Spain. In a total of 171,237 ICU admissions, an artificial airway was present on 505,802 days (50.0% of days of stay in the ICU). A total of 3,474 ventilator-associated pneumonia episodes were diagnosed in 3,186 patients. The adjusted ventilator-associated pneumonia incidence density rate decreased from 9.83 (95% CI, 8.42-11.48) per 1,000 ventilator days in the baseline period to 4.34 (95% CI, 3.22-5.84) after 19-21 months of participation.Conclusions: Implementation of the bundle measures included in the Pneumonia Zero project resulted in a significant reduction of more than 50% of the incidence of ventilator-associated pneumonia in Spanish ICUs. This reduction was sustained 21 months after implementation.