RESUMO
Objective To evaluate the effect of implementing quality control circle (QCC)activities on nurses’ knowledge about ventilator-associated infection(VAP),as well as head-of-bed (HOB)elevation and incidence of VAP in patients.Methods 100 patients who used ventilators in an intensive care unit(ICU)of a hospital were ran-domly selected,50 patients were selected before the implementation of QCC(January-June,2013),and 50 were se-lected after the implementation of QCC (July-December,2103).Condition of nurses and patients who used ventila-tors before and after implementation of QCC were investigated.Results After implementing QCC,the scores of nurses’recognition on knowledge about causes and risks of VAP,significance and standard of HOB elevation,and HOB elevation≥ 30°were all higher than before implementing QCC;the total score was higher than before imple-menting QCC ([18.32±3.14]vs [7.98 ±1 .12],P <0.05 );patients’compliance to HOB elevation was higher than before implementing QCC([96.00%,n=48]vs [44.00%,n=22],P <0.05);incidence of VAP was lower than before implementing QCC ([4.00%,n =2]vs [36.00%,n =18],P <0.05).Conclusion Implementation of QCC activities can effectively improve ICU nurses’recognition on knowledge about VAP and enhance patients’ compliance to HOB elevation,as well as reduce the incidence of VAP,it is helpful for improving healthcare-associat-ed infection management quality.
RESUMO
BACKGROUND: Although head of bed (HOB) elevation is an important strategy to prevent ventilator associated pneumonia (VAP), some observational studies have reported that the application of the semi-recumbent position was lower in patients receiving mechanical ventilator support. We performed this study to assess the effect of implementation of the HOB elevation protocol in the intensive care unit (ICU) on clinical and nutritional outcomes. METHODS: We developed a HOB elevation protocol including a flow chart to determine whether the HOB of newly admitted patients to ICU could be elevated. We measured the level of HOB elevation in patients with mechanical ventilator twice a day and 2 days a week for 5 weeks before and after the implementation of the protocol, respectively. Hemodynamic, respiratory and nutritional data were also collected, resulting in 251 observations from 35 patients and 467 observations from 66 patients before and after implementation. RESULTS: After implementing the protocol, the level of HOB elevation (16.7 +/- 9.9 vs. 23.6 +/-1 2.9, p 30degrees increased significantly (34 vs. 151, p 100 ml) occurred less frequently after implementing the protocol (50% vs. 17%, p = 0.001) CONCLUSIONS: Implementation of the protocol for HOB elevation could improve the level of HOB elevation, oxygenation parameter and enteral nutrition delivery.