| Background Ventilator-associated pneumonia(VAP) is one of the most common Nosocomial infections in intensive care units(ICUs). Currently.The epidemiology, risk factors, and etiology characteristics have been widely studied. Clinical practice of multidimensional strategy have also been shown to reduce VAP rates in intensive care units(ICUs)and pediatric intensive care units effectively;However,the impact of multidimensional approach and how to evaluate the intervention measures quantificationally is still relatively limited in NICU.Objective To investigate the interventional effects of multidimensional strategy to reduce the incidence of neonatal ventilator-associated pneumoniaMethods The patients who were admitted to the NICU department of Lu′an Affiliated Hospital of Anhui Medical University and received mechanical ventilation(MV) for more than 48 hours from October 2012 to October 2014 were recruited in this study. This was a before –after study, The control group received the experienced care from October 2012 to September 2013;The Intervention period was October 2013 to October 2014,neonates were subjected as the intervention group received multidimensional controlling strategy,including bundle care,education,process surveillance, outcome surveillance and feedback on the practices.The respective duties and division of work were clear. In addition to evaluating the compliance and qualified rates of before-after implementation of main interventions(hand hygiene,sputum suction, oral care, drain condensation from ventilator circuit, semi-recumbent position, antacid and antibiotic use) quantitatively, the rate of VAP was also compared between the two groups.Besides, the pathogenic bacteria distribution and drug sensitivity were also under surveillanced through this study.Results The compliance and qualified rate of major interventions had promoted inordinately after implementation of multidimensional strategy. The compliance of hand hygiene had risen 17%(c2=294.36,P<0.01), Nursing staff was responsible for the part, such as sputum suction, oral care, drain condensation from ventilator circuit, semi-recumbent position before and after the intervention had improved 11.4%, 14.73%, 18.21% and 37.5% respectively, and had statistical difference(c2=36.47~82.2,P<0.01;Moreover, We found that the lowest time of the compliance was about in November to march or April the following year both before and after the intervention. The clinician was responsible for the part, such as antacid use had promoted 56.3%, and had statistical difference(c2=70.74,P<0.01).;But the qualified rate of antibiotic use only was 66.1% in the post-VAP bundle phases,and showed no statistical difference before and after(P=0.078)A total of 192 patients were enrolled in the current study, and The general incidence of VAP was 28.6/1000 MV-days, and 41.7/1,000 MV-days during control group and 19.7/1,000 MV-days during intervention group, indicating a 52.8% reduction,had statistical significance(P<0.05), But the rate of ventilator application and Mechanical ventilation time showed no statistical difference between two group(P>0.05. The most common isolated bacteria of the pathogen spectrum were Gram-negative bacteria, accounting for 76.1%, among them, the top three bacteria were acinetobacter baumannii(28.3%), Klebsiella pneumonia(15.2%) and Escherichia coli(10.9%).Fungous infection(15.2%) in the second place,and mainly happened in the control group,The percentage of Gram-positive bacteria was the smallest(8.7%), two MRAS infection occurred in the intervention group; In addition,the drug sensitivity test showed that the multi-drug resistance of pathogens was severe.Conclusion The multidimensional strategy can effectively reduce the incidence of VAP,and doing so requires a culture change and joint efforts that involves the entire NICU team, including physicians, nurses, respiratory therapists, full-time staff for nosocomial infection. It emphasizes comprehensive, reliable and continuous power to make the effect optimization. |
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