Optimize And Study Ofbundle For Prevention Of Ventilator-Associated Pneumonia In A Intensive Care Unit

ObjectiveVentilator-associated pneumonia(VAP)is the most common hospital-acquired infection.The incidence and mortality of VAP were both higher in domestic and overseas.VAP extend patients' duration of mechanical ventilation and the intensive care length of stay,increase the medical cost.The aim of the study is to investigate the influencing factors of VAPand evaluate ICU medical staff's compliance with ventilator care bundle for mechanical ventilated patients and the effect on VAP.Use the multi-criteria decision analysis to optimize the ventilator care bundle,so as to improve the medical staff's compliance with the guideline and reduce the incidence of the VAP.Methods1.Confirm the influencing factors of the VAP by reading literature,clinic practice,experts interview and brainstorming.The information of patients' clinical data was collected from the patients' cases.Clarify diagnosis according to ventilator-associated pneumonia diagnosis?prevention and treatment guideline(2013).The cases were divided into the infecton group and the control group.Chi-square test was conducted and then non-condition logistic regression analysis of the markedly different factors in the two groups was employed.2.According to Ventilator-associated pneumonia Prevention Checklist,collect compliance with the bundle care and its measures.Avaluate the medical staff's compliance with the ventilator care bundle to find out the deficiencies and problems.Chi-square test was conducted to analysis the relationship between compliance and the incidence of VAP.3.Summarize the effective preventive measures from the guideline and the results of the retrospective analysis to establish a draft.The researcher designed the questionnaire to do the specialists consultation.The criteria weight is calculated according to the average scores by the specialists.After the average scores of each measure being multiplied by the average weight value,sorted them by size,and picked the first 6 intervention measures with the highest scores to compose the bundle care,and maked the corresponding implementation rules and checklist of bundle.ResultsRretrospective research of influencing factors in ICU patients showed that The unimplemented bundle,the absence of continuous aspiration of subglottic secretions,the failure of ventilator management,tracheotomy,smoking and the age more than 60 are all the risk factors.Anteral nutrition(AT)is a protective factor.The medical staff's compliance of the head of bed 30°~45°,daily cessation of sedation,oral care and prophylaxis against peptic ulceration have impact on the development of VAP,and staff's compliance withdeep venous thrombosis prophylaxis made no impact on development of VAP.The compliance was 88.73%,82.35%,97.06%,44.61%,98.04% according to the order above.The ventilator care bundle was composed of six protocols that consisted of hand hygiene,oral care with 0.1% chlorhexidine,head of bed 30°~45°,daily cessation of sedation,continuous aspiration of subglottic secretions,never ventilator circuit changes regularly unless visible pollution and damage according to the results of the multi-criteria decision analysis.ConclusionThe risk factors of ventilator-associated pneumonia were complicated and variable,the unimplemented bundle has significant impact on the development of the VAP.The compliance with the ventilator bundle care was different,and the compliance of head of bed 30°~45°,daily cessation of sedation and prophylaxis against peptic ulceration was all below the standard(95%).The effectiveness of deep venous thrombosis prophylaxis needs further verification.Optimize the ventilator care bundle by multi-criteria decision analysis may improve the compliance with the guideline and reduce the incidence of VAP.