Effect Of Care Bundles To Prevent Ventilator Associated Pneumonnia: A Meta-Analysis

Objective :to systematically review the effect of the interventions of care bundles for prevention of ventilator-associated pneumonia(VAP)in the mechanic ventilated patients.To better develop nursing measures for preventing and decreasing the occurrence of VAP,provide reference to improve the quality of nursing management and scientific basis for decision of clinical nursing.Methods :Searching the published literature from 2004 to 2017 by using the databases of CBM,CNKI,VIP,WANFANG Periodical Databases,and Cochrane library,Embase,Pubmed database.Data were analyzed by Stata12.0 software.Results :24 articles on the interventions of care bundles in preventing ventilator-associated pneumonia(VAP)were collected that is include 6000 patients.The meta-analysis showed that the VAP incidence and patient's fatality rate in the study group was significantly lower than that in the control group,with the Risk Ratio(RR)being 0.49(95% CI:0.44~0.55,Z =12.34,P<0.01)and 0.44(95% CI:0.34~0.57,Z = 6.43,P<0.01);and theduration of mechanical ventilation and the length of stay in intensive-care unit was shorter than that in the control group,with the standardized mean difference(SMD)being-0.75(95%CI:-0.9~-0.55)and-0.78(95%CI:-0.98~-0.53).Single analysis of more included measures,head-of-bed elevation(RR=0.47,95% CI:0.41~0.54,Z=10.83);oral care(RR=0.51,95%CI:0.46~0.58,Z=10.72);hand hygiene(RR=0.50,95% CI:0.44~0.57,Z=10.36);sedation holds and weaning protocol(RR=0.50,95% CI:0.43~0.58,Z=8.65);ventilator and pipeline management(RR=0.45,95% CI:0.0,38~0.53,Z=9.25);intra-cuff pressure control(RR=0.49,95% CI:0.41~0.59,Z=7.73),all the difference was statistically significant(P<0.01).Conclusion: The bundles of care can reduce the incidence of VAP and fatality rate,shorten the mechanical ventilation time and length of stay in intensive-care unit.head-of-bed elevation,oral care,hand hygiene,sedation holds and weaning protocol,ventilator and pipeline management,intra-cuff pressure control,etc.are widely recognized and easily implemented measures to prevent VAP,recommend them as the basic content of the clustering intervention strategy.The results of this study can provide evidence-based basis for clinical practice and should be promoted in clinical practice.