儿童先天性心脏病术后呼吸机相关性肺炎防控管理效果观察

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摘要目的分析院感规范管理对预防儿童心胸外科监护室(CICU)先天性心脏病术后呼吸机相关性肺炎(VAP)的干预效果。方法调查2017年1月—2022年12月在本院CICU进行先天性心脏病手术且术后予机械通气超过48 h的全部患儿及其医护人员VAP预防措施执行情况,比较院感规范管理干预前(2017年)后(2018—2022年)科室VAP预防措施执行问题率、手卫生依从率及先心术后VAP发病率。结果 CICU先天性心脏病术后VAP预防措施执行问题占比由高到低依次为病情和镇静评估(33.82%)、环境消毒(14.71%)、口腔护理(10.66%)、清理冷凝液(7.72%)、清理呼吸道(5.15%)、应激性溃疡药物使用评估(5.15%)、床头抬高(2.91%)。院感规范管理干预后,VAP预防措施执行问题率由20.81%降至9.54%(χ2=24.962,P<0.001);手卫生依从率由67.10%升至75.78%(χ2=9.036,P=0.003);CICU先心术后VAP的发病率由31.38‰降至15.72‰,差异有统计学意义(χ2=6.061,P=0.014)。结论手卫生、病情和麻醉评估及环境消毒为CICU违反VAP预防措施的常见问题,加强院感规范管理,可以有效降低CICU儿童先天性心脏病术后VAP的发病率。　

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	燕超
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	郭珍

关键词 ：先天性心脏病, 呼吸机相关性肺炎, 感染控制, 手部卫生

Abstract：Objective To analyze the effect of standardized management of hospital infection on the prevention of ventilator-associated pneumonia (VAP) after congenital heart disease among children in cardiothoracic surgery intensive care unit (CICU). Methods From January 2017 to December 2022, all children who underwent congenital heart disease surgery in the CICU of our hospital and were mechanically ventilated for more than 48 hours after surgery and their medical staff were investigated for the implementation of VAP preventive measures, the compliance rate of hand hygiene, and the incidence of VAP after congenital cardiac surgery before (2017) and after (2018-2022) in the standardized management of hospital infection management were compared. Results The proportion of VAP preventive measures after congenital heart disease in CICU from high to low was condition and sedation assessment (33.82%), environmental disinfection (14.71%), oral care (10.66%), condensate cleaning (7.72%), respiratory tract cleaning (5.15%), the use of stress ulcer medication assessment (5.15%), and bedside elevation (2.91%). After the intervention of standardized management of hospital infection, the implementation rate of VAP preventive measures decreased from 20.81% to 9.54% (χ2=24.962, P<0.001), and the hand hygiene compliance rate increased from 67.10% to 75.78% (χ2=9.036, P=0.003). The incidence of VAP after CICU congenital cardiac surgery decreased from 31.38‰ to 15.72‰, and the difference was statistically significant (χ2=6.061, P=0.014). Conclusion Hand hygiene, disease, anesthesia assessment, and environmental disinfection are common problems in CICU for violating VAP preventive measures, and increasing the standardized management of hospital infection can effectively reduce the incidence of VAP after congenital heart disease in children in CICU.

Key words： Congenital heart disease Ventilator-associated pneumonia Infection control Hand hygiene

收稿日期: 2023-08-09

ZTFLH:

R726

作者简介: 燕超(1983—),男,江苏徐州人,副主任医师,本科学历,主要从事医院感染管理工作。

引用本文:

燕超,王伟,刘莉,郭珍. 儿童先天性心脏病术后呼吸机相关性肺炎防控管理效果观察[J]. 中国校医, 2024, 38(1): 68-71.
YAN Chao, WANG Wei, LIU Li, GUO Zhen. Effect of prevention and control of ventilator-associated pneumonia (VAP) in children with congenital heart disease after surgery. Chinese Journal of School Doctor, 2024, 38(1): 68-71.

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https://www.zgxyzz.org.cn/CN/ 或 https://www.zgxyzz.org.cn/CN/Y2024/V38/I1/68

[1] Dolk H,Loane M,Garne E.Congenital heart defects in Europe:Prevalence and perinatal mortality,2000 to 2005 [J]. Circulation,2011,123(8) :841-849.
[2] 张晓辉,陈艳敏,孙瑜,等.浙江省出生缺陷人群监测地区不同生育政策时期生育情况分析[J].中华预防医学杂志,2020,54(5):519-522.
[3] Huang HF.Year-end academic review of 2021: Advances in thefield of birth defect prevention and control in China as of 2021[J].Rep Dev Med,2022,6(1):1-3.
[4] lareddy V,Asad R,Min KL,et al.Impact of ventilator associatedpneumonia on outcomes in hospitalized children in USA[J]. CriticalCare Med,2013,41(12):A274-A276.
[5] Nik Z,Mohamad H,Laila M,et al.Clinical characteristics andfactors associated with diagnoses of ventilator and non-ventilatorassociated pneumonia in Intensive care unit[J]. Med J Malaysia,2021,76(39):353-359.
[6] 《中华儿科杂志》编辑委员会,中华医学会儿科学分会呼吸学组,中华医学会儿科学分会急救学组,等.儿童医院获得性肺炎管理方案(2010版)[J].中华儿科杂志,2011,49(2):106-115.
[7] 张燕搏,王飞燕,龙村,等.先天性心脏病体外循环术后呼吸机相关性肺炎的研究[J].中国体外循环杂志,2011,9(1):20-23,39.
[8] 中华人民共和国国家卫生健康委员会.WS/T 313—2019,医务人员手卫生规范 [EB/OL].(2019-11-26)[2023-08-05].http://www.nhc.gov.cn/wjw/s9496/202002/dbd143c44abd4de8b59a235feef7d75e/files/6a3e2bf3d82b4ee8a718dbfc3cde8338.pdf.
[9] 中华人民共和国国家卫生健康委员会.WS/T 312—2023,医院感染监测标准 [EB/OL].(2023-08-20)[2023-09-05].http://www.nhc.gov.cn/wjw/s9496/202309/432d0f9af63443e890019af57afaf853/files/1b7f01c077834443ba2b50aaf20be56e.pdf.
[10] 贾建侠,吴菲,姚希,等.呼吸科重症监护病房器械相关医院感染趋势分析[J].中华医院感染学杂志,2017,27(8):1747-1750.
[11] 周可欣.医院制度建设之我见[J].中国卫生标准管理,2017,8(20):35-37.
[12] Weiss M,Dullenkopf A,Fischer JE,et al.Prospective randomizedcontrolled multi-centre trial of cuffed or uncuffed endotrachealtubes in small children[J].Br J Anaesth,2009,103(6):867-873.
[13] 孙小南,柴文昭,孙建华,等. ICU医务人员手卫生依从性差异的深层次原因分析[J].协和医学杂志,2021,12(2):216-220.
[14] 王锦,谭善娟,王干,等. 2016 —2020年某医院重症监护病房多重耐药菌感染与环境消毒质量监测[J].中国消毒学杂志,2022,39(4):254-257.
[15] 万友仓,潘秀娟. PICU患儿发生呼吸机相关性肺炎的影响因素[J].临床肺科志,2021,26 (1):36-39,44.
[16] 朱明华,毕艳华,刘华,等.呼吸机管路内细菌污染与呼吸机相关性肺炎的相关性研究[J].中华医院感染学杂志,2017,27(10):2233-2236.
[17] 刘思娣,黄勋,李春辉,等. 2016 —2020年某三级甲等医院医务人员手卫生依从性调查[J].中华医院感染学杂志,2020,30(24):3823-3827.
[18] 黄慧敏,穆小苏,李亚楠,等.防范公共卫生风险的医院感染防控行为及其影响因素——基于扎根理论的探索性分析[J].中国医院管理,2019,39(5):39-41.
[19] 黄艳芳,郭声敏,李翠,等.四川省36所医院医院感染预防与控制人员岗位胜任力现状调查及影响因素[J].中华医院感染学杂志,2023,33(6):943-947.
[20] 崔扬文,汪可可,李春燕,等. 2021年上海市不同级别医疗机构医院感染管理人员岗位胜任力现况调查[J].中华医院感染学杂志,2023,33(2):281-285.