马上注册登录，享用更多感控资源，助你轻松入门。
您需要 登录 才可以下载或查看，没有账号？注册
|
×
本帖最后由 感控雏鹰 于 2018-2-18 23:54 编辑
医院获得性肺炎预防倡议-2：在美国发生非呼吸机医院获得性肺炎
在过去的十年中，减少医院获得性肺炎（HAP）和其他医院获得性感染（HAIs）一直是美国医疗保险支付政策和国家医疗安全网络的焦点。自2008年以来，与设备相关的感染（包括呼吸机相关性肺炎（VAP），导管相关性尿路感染和中心线相关血流感染）的监测和预防已导致设备相关性感染的发病率和成本显着降低，相关感染。目前，只有25％的HAI是由3种最常见的设备相关感染引起的，而VAP仅占所有HAP病例的38％。[1-2] 在HAIs中，非通气HAP（NV-HAP）正在成为与VAP相关的成本较高的主要患者安全问题，同样具有危险性。[3]，[4]， [5]按照医疗成本和利用项目全国住院样本中，有35-38万总年度美出院[6] ; 其中，83％来自医疗外科单位，而不是重症监护。即使是重症监护病房（ICU）的患者，只有39.5％的患者接受机械通气。[7l]使用这些数据，32.6-35.4万美元患者是在每年的风险NV-HAP，而只有3.6〜3.9亿人处于VAP的风险。[6] 2009 - 2011年在宾夕法尼亚进行的一项为期3年的HAP研究发现，NV-HAP影响的人数多于VAP（5,597 vs 2,299），死亡率相当（18.7％比18.9％），总成本更高（1.56亿美元vs 8600万美元）。[4l]此外，最近的一项病例对照研究发现，谁开发NV-HAP患者8.4倍更有可能在住院期间死亡，可能更需要精心呵护，8.0倍，可能需要机械通气，并有较长的平均住院时间（LOS）的患者比不发生NV-HAP的患者（分别为15.9和4.4天）。[8l]在对宾夕法尼亚州8家医院的便利样本进行的进一步研究中，大多数医疗保健相关肺炎病例报告在危重病护理机构之外（74.1％），肺炎患者死亡率达到30.9％，四分之一的医疗保健相关的肺炎病例归因于愿望，这是通过针对预防吸入的护理活动可以最小化的原因。[9] 我们之前来自医院获得性肺炎预防倡议（HAPPI-1）的报告突出显示，在3家美国医院的便利样本中，有大量未报告的NV-HAP病例（每1,000天有1.2-8.9个病例）。[3]在一家医院实施了针对所有急性护理患者的NV-HAP预防的基于证据的口腔护理方案后，每100例患者出院的NV-HAP的发生率从0.5降至0.3，下降了38.8％。在12个月的干预期间，NV-HAP病例总数也减少了37％。避免NV-HAP病例导致大约节约8人的生命，避免了172万美元的费用，并且在研究时间框架内避免了500天的额外住院天数。[3]这一举措始于2012年，我们继续监测NV-HAP的发生率。截至2014年，医院范围内NV-HAP总体减少70％，NV-HAP减少164例，减少31例患者死亡，减少590万美元的成本（Quinn和Baker，2016，未发表的质量改进数据）。 有几种与预防HAP有关的治疗干预措施，其中大部分是患者在住院期间应接受的医院护理的组成部分。这些包括（1）口腔护理，[10-13]（2）的床的高度头至30°-45°，[14]（3）患者的移动性，[15]（4）使用刺激性肺量测定，的[16]和（5 ）深呼吸和咳嗽练习。[16]然而，一些研究表明，与住院期间患者接受护理相关的基础医院护理可能会因为预防肺炎而失去。无法提供所需医院护理的所有方面是一种被称为漏诊（即未完成的标准护理）的概念。[17]未接护理也被称为未充分利用的护理，省略护理，配给护理，未能保持，和未完成的护理。[18.19]从一些研究数据支持了大量的基础护理被错过了在美国的急诊医院。[17,19-25]此外，在美国和国际研究中错过医院护理都与患者的许多有害结果以及医院成本增加有关。[17]这些治疗干预的最近的两个系统评价，以预防肺炎发现，使用口腔护理与效益的最相关的证据。不幸的是，口腔护理是最常见的错失护理类型之一。[26-27] HAPPI-2研究继续我们的HAPPI研究计划，增加了NV-HAP发病率的现有知识以及肺炎预防治疗干预的基本方面。具体而言，我们试图了解24家美国医院的NV-HAP的发病率和影响，并包括与肺炎预防有关的护理频率的测量。我们将口腔护理纳入肺炎预防保健的一个基本方面，因为它是（1）被公认为预防VAP的策略，（2）对所有目前已知的NV-HAP预防干预措施有最大的了解， （3）与疾病控制和预防中心（CDC）关于可变风险因素的观点一致。[28] 此外，它是适用于100％患者的唯一可修改的风险因素。
参考文献： - Magill, S., Edwards, J.R., Bamberg, W., Beldavs, Z.G., Dumyati, G., Kainer, M.A. et al. Multistate point-prevalence survey of health care-associated infections. N Engl J Med. 2014; 370: 1198–1208
- Quinn, B. and Baker, D. Using oral care to prevent nonventilator hospital-acquired pneumonia. Am Nurse Today. 2015; 10: 18–23
- Quinn, B., Baker, D.L., Cohen, S., Stewart, J.L., Lima, C.A., and Parise, C. Basic nursing care to prevent nonventilator hospital-acquired pneumonia. J Nurs Scholarsh. 2014; 46: 11–19
- Davis, J. and Finley, D. The breadth of hospital-acquired pneumonia: nonventilated versus ventilated patients in Pennsylvania. Pennsylvania Patient Safety Advisory. 2012; 9: 99–105
- DiBiase, L.M., Weber, D.J., Sickbert-Bennett, E.E., Anderson, D.J., and Rutala, W.A. The growing importance of non-device-associated healthcare-associated infections: a relative proportion and incidence study at an academic medical center, 2008-2012. Infect Control Hosp Epidemiol. 2014; 35: 200–202
- Weiss, A.J. and Elixhauser, A. Overview of hospital stays in the United States, 2012: statistical brief #180. Healthcare Cost and Utilization Project (HCUP) Statistical Briefs, Rockville (MD); 2006
- Kalanuria, A.A., Ziai, W., and Mirski, M. Ventilator-associated pneumonia in the ICU. Crit Care. 2014;18: 208
- Micek, S.T., Chew, B., Hampton, N., and Kollef, M.H. A case-control study assessing the impact of non-ventilated hospital-acquired pneumonia on patient outcomes. Chest. 2016; 150: 1008–1014
- See, I., Chang, J., Gualandi, N., Buser, G.L., Rohrbach, P., Smeltz, D.A. et al. Clinical correlates of surveillance events detected by National Healthcare Safety Network pneumonia and lower respiratory infection definitions-Pennsylvania, 2011-2012. Infect Control Hosp Epidemiol. 2016; 37: 818–824
- Ames, N.J. Evidence to support tooth brushing in critically ill patients. Am J Crit Care. 2011; 20: 242–250
- de Lacerda Vidal, C.F., Vidal, A.L., Monteiro, J.M., Cavalcanti, A., Trindade Henriques, A.P., Oliveira, M. et al. Impact of oral hygiene involving toothbrushing versus chlorhexidine in the prevention of ventilator-associated pneumonia: a randomized study. BMC Infect Dis. 2017; 17: 1–9
- Munro, C.L. Oral health: something to smile about!. (quiz 89)Am J Crit Care. 2014; 23: 282–288
- Munro, C.L., Grap, M.J., Jones, D.J., McClish, D.K., and Sessler, C.N. Chlohexidine, toothbrushing, and preventing ventilator-associated pneumonia in critically ill adults. Am J Crit Care. 2009; 18: 428–438
- Niël-Weise, B.S., Gastmeier, P., Kola, A., Vonberg, R.P., Wille, J.C., van den Broek, P.J. et al. An evidence-based recommendation on bed head elevation for mechanically ventilated patients. Crit Care. 2011; 15: R111
- Stolbrink, M., McGowan, L., Saman, H., Nguyen, T., Knightly, R., Sharpe, J. et al. The early mobility bundle: a simple enhancement of therapy which may reduce incidence of hospital-acquired pneumonia and length of hospital stay. J Hosp Infect. 2014; 88: 34–39
- Pasquina, P., Tramer, M.R., Granier, J.M., and Walder, B. Respiratory physiotherapy to prevent pulmonary complications after abdominal surgery: a systematic review. Chest. 2006; 130: 1887–1899
- Kalisch, B.J. and Xie, B. Errors of omission: missed nursing care. West J Nurs Res. 2014; 36: 875–890
- Bail, K. and Grealish, L. “Failure to maintain”: a theoretical proposition for a new quality indicator of nurse care rationing for complex older people in hospital. Int J Nurs Stud. 2016; 63: 146–161
- Jones, T.L., Hamilton, P., and Murry, N. Unfinished nursing care, missed care, and implicitly rationed care: state of the science review. Int J Nurs Stud. 2015; 52: 1121–1137
- Carthon, J.M.B., Lasater, K.B., Sloane, D.M., and Kutney-Lee, A. The quality of hospital work environments and missed nursing care is linked to heart failure readmissions: a cross-sectional study of US hospitals. BMJ Qual Saf. 2015; 24: 255–263
- Kalisch, B.J., Tschannen, D., Lee, H., and Friese, C.R. Hospital variation in missed nursing care. Am J Med Qual. 2011; 26: 291–299
- Schubert, M., Clarke, S.P., Glass, T.R., Schaffert-Witvliet, B., and De Geest, S. Identifying thresholds for relationships between impacts of rationing of nursing care and nurse- and patient-reported outcomes in Swiss hospitals: a correlational study. Int J Nurs Stud. 2009; 46: 884–893
- Schubert, M., Glass, T.R., Clarke, S.P., Aiken, L.H., Schaffert-Witvliet, B., Sloane, D.M. et al. Rationing of nursing care and its relationship to patient outcomes: the Swiss extension of the International Hospital Outcomes Study. Int J Qual Health Care. 2008; 20: 227–237
- Maeda, K. and Akagi, J. Oral care may reduce pneumonia in the tube-fed elderly: a preliminary study. Dysphagia. 2014; 29: 616–621
- Valles, J.H.H. Nursing care missed in patients at risk of or having pressure ulcers. Rev Lat Am Enfermagem. 2016; 24: e2817
- Pedersen, P.U., Larsen, P., and Hakonsen, S.J. The effectiveness of systematic perioperative oral hygiene in reduction of postoperative respiratory tract infections after elective thoracic surgery in adults: a systematic review. JBI Database System Rev Implement Rep. 2016; 14: 140–173
- Pássaro, L., Harbarth, S., and Landelle, C. Prevention of hospital-acquired pneumonia in non-ventilated adult patients: a narrative review. Antimicrob Resist Infect Control. 2016; 5: 1–11
- Tablan, O.C., Anderson, L.J., Besser, R., Bridges, C., Hajjeh, R...., and CDC. Guidelines for preventing health-care–associated pneumonia, 2003: recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee. MMWR Recommendations and reports. MMWR Recomm Rep. 2004; 53: 1–36
|
#AI工具#
发表于 2018-2-18 23:26
发表于 2018-2-19 00:31
发表于 2018-2-19 22:15
发表于 2018-2-19 22:16