美国关于VAP预防措施的多中心研究

David

Infect Control Hosp Epidemiol. 2008 Aug 20. [Epub ahead of print] Links
Preventing Ventilator-Associated Pneumonia in the United States: A Multicenter Mixed-Methods Study.
美国关于VAP预防措施的多中心研究

Krein SL, Kowalski CP, Damschroder L, Forman J, Kaufman SR, Saint S.
From the Department of Veterans Affairs Ann Arbor Health Services Research and Development Center of Excellence, Department of Veterans Affairs Ann Arbor Healthcare System (S.L.K., C.P.K., L.D., J.F., S.S.), the Department of Internal Medicine, University of Michigan Medical School (S.L.K., S.R.K., S.S.), and the Ann Arbor Department of Veterans Affairs-University of Michigan Patient Safety Enhancement Program (S.R.K., S.S.), Ann Arbor, Michigan.

Objective. @nbsp; To determine what practices are used by hospitals to prevent ventilator-associated pneumonia (VAP) and, through qualitative methods, to understand more fully why hospitals use certain practices and not others. Design. @nbsp; Mixed-methods, sequential explanatory study. Methods. @nbsp; We mailed a survey to the lead infection control professionals at 719 US hospitals (119 Department of Veterans Affairs [VA] hospitals and 600 non-VA hospitals), to determine what practices are used to prevent VAP. We then selected 14 hospitals for an in-depth qualitative investigation, to ascertain why certain infection control practices are used and others not, interviewing 86 staff members and visiting 6 hospitals. Results. @nbsp; The survey response rate was 72%; 83% of hospitals reported using semirecumbent positioning, and only 21% reported using subglottic secretion drainage. Multivariable analyses indicated collaborative initiatives were associated with the use of semirecumbent positioning but provided little guidance regarding the use of subglottic secretion drainage. Qualitative analysis, however, revealed 3 themes: (1) collaboratives strongly influence the use of semirecumbent positioning but have little effect on the use of subglottic secretion drainage; (2) nurses play a major role in the use of semirecumbent positioning, but they are only minimally involved with the use of subglottic secretion drainage; and (3) there is considerable debate about the evidence supporting subglottic secretion drainage, despite a meta-analysis of 5 randomized trials of subglottic secretion drainage that generally supported this preventive practice, compared with only 2 published randomized trials of semirecumbent positioning, one of which concluded that it was ineffective at preventing the development of VAP. Conclusion. @nbsp; Semirecumbent positioning is commonly used to prevent VAP, whereas subglottic secretion drainage is used far less often. We need to understand better how evidence related to prevention practices is identified, interpreted, and used to ensure that research findings are reliably translated into clinical practice.