某综合医院呼吸机相关性肺炎预防控制措施调查
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摘要
目的调查医院医护人员在呼吸机相关性肺炎(VAP)预防控制措施方面的认知度及执行情况,查找相关培训与预防控制措施落实的漏洞,为降低呼吸机相关性肺炎发生率提供依据。方法 2015年8月对医院医护人员进行VAP的预防控制措施认知度和执行力的问卷调查,内容包括基线资料、集束化预防控制措施的认知情况、执行状况以及影响预防控制措施执行的因素,并对资料进行分析总结。结果医师和护士对于VAP预防控制知识的总认知率分别为67.56%、68.64%,对维持气管导管套囊压力恒定于25~30cmH2O的认知率分别为41.46%、28.57%,对于VAP的诊断标准、每日评估撤机和拔管指征的认知率护士低于医师(63.41%/11.69%,90.24%/53.25%),差异有统计学意义(P<0.05);而对于患者半卧位、床头提高和冷凝水集水杯位于管路最低处的认知率医师低于护士(65.85%/84.42%,60.98%/83.12%),差异有统计学意义(P<0.05);医师与护士对预防控制措施的总执行率分别为73.66%、73.34%。结论医师与护士对呼吸机相关性肺炎各项预防控制措施的认知率及执行率存在差异,应通过针对性的培训提高预防控制措施的执行。
OBJECTIVE To survey the recognition and implementation of medical staff in the prevention and control measures of ventilator associated pneumonia(VAP),look for the vulnerability of training and the prevention and control measures,so as to provide references for reducing the incidence of VAP.METHODS A survey about cognition and implementation in the prevention and control measures of VAP in Aug.2015 was carried out,including baseline data,cognition of cluster prevention and control measures,implementation,and factors affecting the implementation of preventive and control measures.The data were analyzed and summarized.RESULTS The total recognition of VAP prevention and control rate of doctors and nurses were 67.56% and 68.64%.The recognition of maintaining constant endotracheal catheter cuff pressure(25~30cmH2O)of doctors and nurses were 41.46% and28.57%,The cognitive rates about the VAP criteria,daily assessment of weaning and extubation indications of nurses were significantly lower than those of doctors(63.41%/11.69%,90.24%/53.25%)(P<0.05).The cognitive rates about semisupine,bedside raising and condensate water seting at the lowest point of the pipeline of doctors were significantly lower than those of nurses(65.85%/84.42%,60.98%/83.12%),(P<0.05).The total compliance rates of doctors and nurses to prevention and control measures were 73.66% and 73.34% respectively.CONCLUSIONDoctors and nurses have different cognitive rate and executive rate of the prevention and control measures of ventilator associated pneumonia,so we should improve the implementation of prevention and control measures through targeted training.
OBJECTIVE To survey the recognition and implementation of medical staff in the prevention and control measures of ventilator associated pneumonia(VAP),look for the vulnerability of training and the prevention and control measures,so as to provide references for reducing the incidence of VAP.METHODS A survey about cognition and implementation in the prevention and control measures of VAP in Aug.2015 was carried out,including baseline data,cognition of cluster prevention and control measures,implementation,and factors affecting the implementation of preventive and control measures.The data were analyzed and summarized.RESULTS The total recognition of VAP prevention and control rate of doctors and nurses were 67.56% and 68.64%.The recognition of maintaining constant endotracheal catheter cuff pressure(25~30cmH2O)of doctors and nurses were 41.46% and28.57%,The cognitive rates about the VAP criteria,daily assessment of weaning and extubation indications of nurses were significantly lower than those of doctors(63.41%/11.69%,90.24%/53.25%)(P<0.05).The cognitive rates about semisupine,bedside raising and condensate water seting at the lowest point of the pipeline of doctors were significantly lower than those of nurses(65.85%/84.42%,60.98%/83.12%),(P<0.05).The total compliance rates of doctors and nurses to prevention and control measures were 73.66% and 73.34% respectively.CONCLUSIONDoctors and nurses have different cognitive rate and executive rate of the prevention and control measures of ventilator associated pneumonia,so we should improve the implementation of prevention and control measures through targeted training.
引文
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[9]贾会学,吴安华,胡必杰,等.46所医院多药耐药菌预防控制措施依从性与发生医院感染的关系[J].中华医院感染学杂志,2015,25(11):2478-2480.
[10]崔扬文,胡必杰,高晓东,等.ICU医护人员对科学预防控制医院感染认知度的调查[J].中华医院感染学杂志,2014,24(10):2554-2556.
[11]潘爱红,程琳.老年冠状动脉旁路移植术后机械通气的护理[J].中华现代护理杂志,2010,16(1):52-53.
[12]Hadda V,Khilnani GC,Dubey G,et al.Impact of ventilatorassociated pneumonia on outcome in patients with chronic obstructive pulmonary disease exacerbation[J].Lung India,2014,31(1):4-8.
[13]Akerman E,Larsson C,Ersson A.Clinical experience and incidence of ventilator-associated pneumonia using closed versus open suction system[J].Nurs Crit Care,2014,19(1):34-41.
[14]朱晨迪,胡必杰,高晓东,等.岗位培训对提升医院感染预防控制知识效果评价[J].中华医院感染学杂志,2015,25(11):2604-2606.
[2]Berra L,Sampson J,Fumagalli J,et al.Alternative approaches to ventilator-associated pneumonia prevention[J].Minerva Anestesiol,2011,77(3):323-333.
[3]Wang F,Bo L,Tang L,et al.Subglottic secretion drainage for preventing ventilator-associated pneumonia:an updated metaanalysis of randomized controlled trials[J].J Trauma Acute Care Surg,2012,72(5):1276-1285.
[4]中华医学会重症医学分会.机械通气临床应用指南(2006)[J].中国危重病急救医学,2007,19(2):65-72.
[5]Augustyn B.Ventilator-associated pneumonia:risk factors and prevention[J].Crit Care Nurse,2007,27(4):32-36.
[6]刘竹,黄琼华,安寒,等.重症监护病房呼吸机相关肺炎的集束干预效果观察[J].华西医学,2014,29(3):449-451.
[7]李丽华,王丽.综合ICU呼吸机相关性肺炎的预防及护理措施[J].华西医学,2010,25(9):1745-1746.
[8]王峥,张连心.重症监护室发生呼吸机相关性肺炎的相关危险因素及对策分析[J].中外医学研究,2015,13(6):31-32.
[9]贾会学,吴安华,胡必杰,等.46所医院多药耐药菌预防控制措施依从性与发生医院感染的关系[J].中华医院感染学杂志,2015,25(11):2478-2480.
[10]崔扬文,胡必杰,高晓东,等.ICU医护人员对科学预防控制医院感染认知度的调查[J].中华医院感染学杂志,2014,24(10):2554-2556.
[11]潘爱红,程琳.老年冠状动脉旁路移植术后机械通气的护理[J].中华现代护理杂志,2010,16(1):52-53.
[12]Hadda V,Khilnani GC,Dubey G,et al.Impact of ventilatorassociated pneumonia on outcome in patients with chronic obstructive pulmonary disease exacerbation[J].Lung India,2014,31(1):4-8.
[13]Akerman E,Larsson C,Ersson A.Clinical experience and incidence of ventilator-associated pneumonia using closed versus open suction system[J].Nurs Crit Care,2014,19(1):34-41.
[14]朱晨迪,胡必杰,高晓东,等.岗位培训对提升医院感染预防控制知识效果评价[J].中华医院感染学杂志,2015,25(11):2604-2606.