Design And Application Of The Quality Control Checklist Regarding The Prevention Of Ventilator-associated Pneumonia In ICU

Background Ventilator-associated pneumonia(VAP)is one of the most common nosocomial infections in intensive care unit(ICU).Prevention of VAP is more important than treatment,because of its high incidence and high mortality,and its difficulty to diagnose.A variety of preventive measures can reduce the VAP incidence.The ventilator care bundles(VCB)including a series of evidence-based prevention measures can significantly reduce the VAP incidence.A large number of studies have shown that the compliance can significantly affect the validity of VCB.However,how to strengthen the compliance and the management effect of clinical practice is still relatively limited.Checklist which is applied in the aviation industry firstly can remind important link for quality inspection in a short period of time.Its application in the clinical setting is mainly the perioperative security check.The impact of checklist in reducing complications and improving the quality of ICU care as a quality control tool is still limited.Is the quality checklist valid,and how to design an appropriate checklist of VAP prevention,the research on these two aspects are rarely reported.Objective This study aimed to design the quality control checklist regarding the prevention of VAP,guide the nursing staff to carry out the checklist in their clinical work,and thus improve the quality of nursing care.Method With using quasi-experimental study,a new checklist of VAP prevention and control measures was designed and applied for the quality control of mechanical ventilation patients.Patients with applying the checklist from May to July 2015 were treated as the intervention group,while the control group consisted of the patients without using checklist from January to March 2015.Nurses responsible for infection control collected mechanical ventilation days,actual days for single-item and overall items to be executed,through the ICU patient log and the record of implementation of preventive measures for VAP.In addition,Nurses responsible for infection control collected cases of VAP which are confirmed by the responsible physician and infection management section.The overall and single-item compliance of performing the checklist and differences of these indicators in two groups were compared.Patients were assessed for the VAP incidence and the VAP incidence per 1,000 ventilator days.Result After application of the checklist,the overall compliance of performing the checklist was improved(31.8% vs 54.5%),the VAP incidence was decreased(20.63% vs 7.46%)and the VAP incidence per 1,000 ventilator days was decreased(34.2‰ vs 14.6‰).Among seven evidence-based items of checklist,differences in the compliance of performing hand hygiene,elevation of the head of the bed 30-45 degrees,mouth care,interruption of continuous sedation,deep vein thrombosis(DVT)prophylaxis and artificial airway management were statistically significant,while that of peptic ulcer prophylaxis was not improved.Conclusion The application of the quality control checklist of VAP could improve most of the compliance of performing VAP prevention and control measures and help reduce the VAP incidence and the VAP incidence per 1,000 ventilator days in ICU.