摘要
目的通过管理模式在重症监护病房(ICU)患者呼吸机相关性肺炎(VAP)预防控制中的应用,降低VAP的发生率。方法 2010-2014年在ICU应用管理模式PDCA、根因分析法、失效模式与效果分析(FMEA)进行VAP预防与控制的监测及干预,数据采用医院感染杏林监测软件及SPSS13.0软件进行统计分析。结果连续5年监测,ICU患者呼吸机使用率从2010年的31.09%上升至2014年的41.36%;连续5年监测干预,VAP千日发生率由2010年的52.03‰下降至2014年的5.56‰;VAP患者共检出病原菌107株,其中革兰阴性菌94株占80.37%,革兰阳性菌21株占19.63%;实施FMEA管理模式后,8个失效模式的RPN值有所下降,差异有统计学意义(χ2=184.10,P<0.01)。结论 VAP是ICU监护中医院感染最棘手的问题,在医院感染目标性监测工作中运用管理模式进行分析、干预、改进,能有效的降低VAP的发生。
OBJECTIVE To investigate the effects of management modes on prevention and control of ventilator‐associated pneumonia （VAP） in patients of the intensive care unit （ICU ） so as to reduce the incidence of VAP . METHODS From 2010 to 2014 ,the monitoring and intervention were carried out for the prevention and control of VAP by means of the management modes ,including the PDCA ,root cause analysis ,and failure mode and effect analysis （FMEA） ,and the statistical analysis of the data was performed with the use of Xinglin monitoring soft‐ware for nosocomial infections and SPSS13 .0 software .RESULTS The five‐year consecutive monitoring showed that the utilization rate of the ventilator of the ICU patients increased from 31 .09% in 2010 to 41 .36% in 2014 . The five‐year consecutive monitoring and intervention indicated that the thousand‐day incidence rate of VAP decreased from 52 .03‰ in 2010 to 5 .56‰ in 2014 .A total of 107 strains of pathogens have been isolated from the patients with VAP ,including 94 （80 .37% ） strains of gram‐negative bacteria and 21 （19 .63% ） strains of gram‐positive bacteria .The RPN values of 8 failure modes declined to some extent after the FMEA management mode was implemented ,and there was significant difference （χ^2 =184 .10 ,P〈0 .01） .CONCLUSIONS The VAP is the most intractable problem among the nosocomial infections in the ICU ;it is an effective way to use the management modes for analysis ,intervention ,and improvement during the targeted surveillance of nosocomial infections so as to reduce the incidence of VAP .
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2015年第11期2505-2507,共3页
Chinese Journal of Nosocomiology
基金
新疆建设兵团卫生科技计划基金资助项目(兵卫发[2013]32)
关键词
管理模式
重症监护病房
呼吸机相关性肺炎
Management mode
Intensive care unit
Ventilator-associated pneumonia
