| Summary: | 碩士 === 高雄醫學大學 === 護理學研究所 === 96 === Abstract
Background:
Nosocomial pneumonia is the second most costly infection occurring in Taiwan hospitals. Ventilator-associated pneumonia (VAP), which is usually defined as an infection occurring greater than 48 hours after hospital admission in a patient requiring mechanical ventilation. It is associated with high mortality and morbidity and is considered one of the most difficult infections to diagnose and prevent. A quality improvement process to guide evidence-based care related to in wash-hand, mouth care, airway manage, semi-recumbent positions is also described. How to prevent VAP is very importance, so we must to research this oral health-care protocol for prevention of ventilator associated pneumonia.
Purpose:
To evaluate the effectiveness of an evidence-basedoral health-care protocol for prevention of ventilator associated pneumonia.
Method:
This study was conducted in the medical and surgical intensive care units in a University Hospital of 1400 beds from 1st March, 2007 to 31st March, 2008. A quasi-experimental non-randomized trial study design was used. A total of 199 mechanically ventilated patients enrolled. They were divided into two groups, study group (N=99) and control group (N=100). The control group was cared by routine nursing care procedures, and the study group was used the evidence-based oral health-care protocol (including wash-hand, mouth care, airway management and the semi-recumbent positions). Patients of each group were given the interventions for four consecutive days. Then, the incidence of the VAP, Clinical Pneumonia Infection Scale (CPIS) and the oral assessment scale were compared.
Results :
There were not statistically significant between two groups for demographic data, specialty, operation or not, reasons of intubation, severity of disease (APACHE II) and the comorbidity (P> 0.05). It indicated that the basic data are similar for both groups. The incidence of VAP was 4% (4/95) in the study group; and it was significantly lower than the control group, 21% (18/82) (P< 0.05). The mean of the CPIS scale was 4.2 (SD2.15) in the study group and 5.57(SD2.38) in the control group. On the other hand, the mean of the OAG scale was 9.16 (SD2.07) and 10.07 (SD1.79) in the control group. There were statistically significant correlations between CPIS and OAG scale in both groups using Wilcoxon signed-rank test (P< 0.05). Intriguingly, the CPIS was decreasing in value as the time length. As a result, the incidence of pneumonia was lowering. The OAG was decreasing as the time length and had a statistically significant result. It showed that the improvement of oral mucosa may be indirectly lowering the infection rate of the airway.
Conclusion :
The evidence-based oral health-care protocol is supported to be effective in the prevention of VAP in this study.This study results significant reductions in rates of VAP may be achieved by broader implemention of oral health-care protocol.In the future oral health-care protocol is effective nursing care interventions guideline for prevention of VAP. May be reductions in patient use ventilator time, length of stay, and mortality.
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