Effect Of Cluster Intervention On Prevention Of Ventilator - Associated Pneumonia In Patients With Postoperative Tumor

Objective To explore the effect of IHI latest ventilator bundle on post-operative patients with cancer.Methods Convenient sampling was used in the study. The patients with ventilator were selected from January2011to March2013in ICU of a cancer hospital.The patients who hospitalized in ICU between January2012and March2013accepted ventilator bundle as experimental group, including (1)head of bed elevation30-45°;(2) sedation vacation;(3) Prevention of the digestive ulcer;(4) using antithrombotic gradient elastic stockings and the intermittent pressure air pump (ICP) to prevent the deep vein thrombosis;(5) oral care daily using chlorhexidine3times a day.The patients who hospitalized in ICU from January2011to December2011received routine care as control group.Incidence of ventilation associated pneumonia (VAP)were compared between the two groups.Results422patients were enrolled, the experimental group202cases, control group220cases. There were no statistically significant difference between two groups of patients in gender, age, SAPS3score, enteral nutrition, mechanical ventilation time, into the way, as well as the usage of antibiotics. The implementation of interventions for ventilator bundle:head of bed elevation30-45°,check2884cases,1023standard cases, the success rate was38%, daily awakening patients and evaluate whether to extubation, check715cases,standard593cases, the success rate was89.4%, the prevention of peptic ulcer, examination705cases,558standard cases, the success rate was96.4%, the prevention of deep vein thrombosis (DVT), check2125cases,1829standard cases, the success rate was85.0%, the oral care, check2158cases,2032standard cases, the success rate was94.2%. The overall success rate was36.6%.Experimental group has14VAP cases, the incidence of VAP was6.9%, the incidence rate of19.4per thousand, the control group has29VAP cases, the incidence of VAP was13.2%, the incidence rate of31.1per thousand. There was statistically significant difference in incidence of VAP between the two groups (χ2=4.57, P<0.05).Between January2012and June2012,success rate of the head of bed elevation30-45°was21.5%, after the intervention in July2012to March2013, the success rate was47.6%, compared before and after intervention,using chi-square test,P<0.01, the difference was statistically significant. Conclusion (1) using ventilator bundle can reduce the incidence of VAP.(2) elevation of head of bed of30-450is one of the factors to prevent the occurrence of VAP, but its clinical implementation rate is very low;(3) clinical compliance can be improved by training and educating nurses.