多维方案预防****患者VAP：来自于4个大洲和14个发展中国家的研究报告

蓝鱼o_0

Effectiveness of a multidimensional approach for prevention of ventilator-associated pneumonia in adult intensive care units from 14 developing countries of four continents: Findings of the International Nosocomial Infection Control Consortium*

Rosenthal, Victor D. MD; Rodrigues, Camilla MD; álvarez-Moreno, Carlos MD; Madani, Naoufel MD; Mitrev, Zan MD; Ye, Guxiang MD; Salomao, Reinaldo MD; Ulger, Fatma MD; Guanche-Garcell, Humberto MD; Kanj, Souha S. MD; Cuéllar, Luis E. MD; Higuera, Francisco MD; Mapp, Trudell RN; Fernández-Hidalgo, Rosalía MSc; INICC members

Abstract

Objectives: The aim of this study was to analyze the effect of the International Nosocomial Infection Control Consortium’s multidimensional approach on the reduction of ventilator-associated pneumonia in patients hospitalized in intensive care units.

Design: A prospective active surveillance before–after study. The study was divided into two phases. During phase 1, the infection control team at each intensive care unit conducted active prospective surveillance of ventilator-associated pneumonia by applying the definitions of the Centers for Disease Control and Prevention National Health Safety Network, and the methodology of International Nosocomial Infection Control Consortium. During phase 2, the multidimensional approach for ventilator-associated pneumonia was implemented at each intensive care unit, in addition to the active surveillance.

Setting: Forty-four adult intensive care units in 38 hospitals, members of the International Nosocomial Infection Control Consortium, from 31 cities of the following 14 developing countries: Argentina, Brazil, China, Colombia, Costa Rica, Cuba, India, Lebanon, Macedonia, Mexico, Morocco, Panama, Peru, and Turkey.

Patients: A total of 55,507 adult patients admitted to 44 intensive care units in 38 hospitals.

Interventions: The International Nosocomial Infection Control Consortium ventilator-associated pneumonia multidimensional approach included the following measures: 1) bundle of infection-control interventions; 2) education; 3) outcome surveillance; 4) process surveillance; 5) feedback of ventilator-associated pneumonia rates; and 6) performance feedback of infection-control practices.

Measurements: The ventilator-associated pneumonia rates obtained in phase 1 were compared with the rates obtained in phase 2. We performed a time-series analysis to analyze the impact of our intervention.

Main Result: During phase 1, we recorded 10,292 mechanical ventilator days, and during phase 2, with the implementation of the multidimensional approach, we recorded 127,374 mechanical ventilator days. The rate of ventilator-associated pneumonia was 22.0 per 1,000 mechanical ventilator days during phase 1, and 17.2 per 1,000 mechanical ventilator days during phase 2.The adjusted model of linear trend shows a 55.83% reduction in the rate of ventilator-associated pneumonia at the end of the study period; that is, the ventilator-associated pneumonia rate was 55.83% lower than it was at the beginning of the study.

Conclusion: The implementation the International Nosocomial Infection Control Consortium multidimensional approach for ventilator-associated pneumonia was associated with a significant reduction in the ventilator-associated pneumonia rate in the adult intensive care units setting of developing countries.

Critical Care Medicine:
December 2012 - Volume 40 - Issue 12 - p 3121–3128
doi: 10.1097/CCM.0b013e3182657916
Feature Articles

蓝鱼o_0

里面采用了一个很有意思的词multidimensional approach。这个有别于我们理解的BUNDLE。
看到他的方法部分，大家可以看到，包含了：
1) bundle of infection-control interventions;
2) education;
3) outcome surveillance;
4) process surveillance;
5) feedback of ventilator-associated pneumonia rates; and
6) performance feedback of infection-control practices.
6大干预措施。

美洛洛

要好好学习英文啦，有些看不懂啊

晴天也飘雨

蓝鱼老师总是有新东西给大家。

青青从这里来

有些看不懂，谁翻译一下呀？

舒窈

需要好好学习。有全文吗？

toto

阿根廷、巴西、中国、哥伦比亚、哥斯达黎加、古巴、印度、黎巴嫩、马其顿、墨西哥、摩洛哥、巴拿马、秘鲁、和土耳其这么多国家和医院怎么合作的啊？质量控制？？

蓝鱼o_0

toto 发表于 2012-12-7 14:38

                               
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阿根廷、巴西、中国、哥伦比亚、哥斯达黎加、古巴、印度、黎巴嫩、马其顿、墨西哥、摩洛哥、巴拿马、秘鲁、 ...

哈哈，看看不就知道了？

蓝鱼o_0

toto 发表于 2012-12-7 14:38

                               
登录/注册后可看大图

阿根廷、巴西、中国、哥伦比亚、哥斯达黎加、古巴、印度、黎巴嫩、马其顿、墨西哥、摩洛哥、巴拿马、秘鲁、 ...

我在想这个问题，覆盖4个大洲，14个国家才能上CCM。按照这个样本量不至于。可能国家内的抽样没有控制好，虽然来自于这些国家，但是代表性不够。否则可以上JAMA了。

蓝鱼o_0

蓝鱼o_0 发表于 2012-12-7 14:42

                               
登录/注册后可看大图

我在想这个问题，覆盖4个大洲，14个国家才能上CCM。按照这个样本量不至于。可能国家内的抽样没有控制好， ...

这个可以有。。。。

青豆果子

效力的一个多层面的办法预防呼吸机相关性肺炎在****重症监护单位从14个发展中国家的四大洲：结果的国际医院感染控制协会*罗氏，胜利D博士；罗觉果斯，卡米拉；álvarez-moreno，卡洛斯博士；迈达尼，naoufel博士；米特列夫，赞博士；你们，古巷博士；萨洛芒，雷纳多博士；ulger，法博士；guanche-garcell，温贝托博士；kanj，souha美国医学博士；铜é省，路易斯所有，弗朗西斯科博士；医学博士；马普，鲁德尔；蕨类植物ández-hidalgo罗梭，í硕士；inicc成员摘要目标：

青豆果子

本研究的目的是分析的影响，医院感染控制的国际财团的多层面的办法在减少呼吸机相关性肺炎患者在医院重症监护病房。设计：前瞻性积极监测之前–之后的研究。这项研究分为2个阶段。在1阶段，感染控制小组在每个ICU积极开展前瞻性监测呼吸机相关性肺炎的定义的疾病控制和预防中心全国健康安全网络，方法和国际医院感染控制联盟。在2阶段，多层面的方法，呼吸机相关性肺炎是执行在每个ICU，除了积极监测。设置：四十四个(  )重症监护病房的38所医院，成员国际医院感染控制联合会，来自31个城市的下列14个发展中国家：阿根廷，巴西，中国，哥伦比亚，哥斯达黎加，古巴，印度，黎巴嫩，墨西哥，马其顿，巴拿马，秘鲁，和摩，土耳其。例：共有55507例(  )承认44个重症监护病房的38所医院。

青豆果子

干预：国际医院感染控制联合呼吸机相关性肺炎多层面的方法包括以下措施：1）捆绑的感染控制措施；2）教育；3）结果监测；4）过程监督；5）反馈的呼吸机相关性肺炎率；和6）绩效反馈的感染控制的做法。测量：呼吸机相关性肺炎率在1阶段进行比较，利率在2期。我们进行了时间序列分析，分析了影响我们的干预。主要结果：在1阶段，我们记录10292呼吸器天，并在2阶段，实现了与多方面的方法，我们记录127374呼吸器天。利率的呼吸机相关性肺炎是22每1000呼吸器天1和17.2阶段期间，每1000呼吸器天阶段2。调整后的模型的线性趋势表明减少55.83%的速度呼吸机相关性肺炎在年底的研究期间；即，呼吸机相关性肺炎发生率为55.83%，低于它在开始的研究。

青豆果子

结论：实施国际医院感染控制联盟层面的方法,呼吸机相关性肺炎在(  )重症监护病房环境对发展中国家显著减少.

鬼才

这无疑是一篇多中心合作研究的好文章，请贴出全文，让大家更好地学习。