基于医护一体化的ICU呼吸机相关性肺炎预防控制质量核查单的设计与应用

Design and Application of an Integrated Medical-Nursing Quality Checklist for the Prevention and Control of Ventilator-Associated Pneumonia in ICUs

摘要: 目的：设计并应用基于医护一体化的ICU呼吸机相关性肺炎(VAP)预防控制质量核查单，以提升VAP的预防与控制质量，降低ICU患者VAP的发生率，改善预后并提高ICU安全管理水平。方法：通过查阅国内外VAP防控指南和最新研究进展，并结合临床实践，制定适用于ICU的VAP预防控制质量核查单。核查单涵盖从气道管理、护理操作、病情监测到消毒与卫生等多个方面，体现医护协同合作的原则。纳入ICU护理人员和医师共同参与核查单的设计，确保其科学性和可操作性。选择我院ICU机械通气患者为研究对象，将患者分为使用核查单组和常规护理组，观察两组患者VAP发生率、ICU住院时间、机械通气时间等临床结局。结果：与常规护理组相比，使用质量核查单的患者组VAP发生率显著降低(P < 0.05)，ICU住院时间和机械通气时长也有所缩短。结论：基于医护一体化的ICU呼吸机相关性肺炎预防控制质量核查单可有效降低VAP发生率，提高防控质量，具有良好的临床应用价值。通过医护协同、规范化操作和持续质量改进，可为ICU患者的安全提供有力保障，建议在更多ICU病房中推广应用。

Abstract: Objective: To design and implement a quality checklist for the prevention and control of ventilator-associated pneumonia (VAP) in intensive care units (ICUs) based on an integrated medical-nursing approach, aiming to improve the quality of VAP prevention and control, reduce the incidence of VAP in ICU patients, improve clinical outcomes, and enhance patient safety. Methods: A VAP prevention and control quality checklist tailored to ICU settings was developed through a review of domestic and international guidelines and the latest research advances, combined with clinical practice. The checklist covered multiple aspects, including airway management, nursing practices, patient monitoring, and disinfection and hygiene, reflecting the principle of collaboration between medical and nursing staff. ICU nurses and physicians were included in the checklist’s design process to ensure scientific validity and practicality. ICU patients receiving mechanical ventilation in our hospital were selected as study subjects and divided into two groups: the checklist group and the routine care group. Clinical outcomes, including VAP incidence, ICU length of stay, and duration of mechanical ventilation, were compared between the two groups. Results: Compared with the routine care group, the checklist group showed a significantly lower VAP incidence (P < 0.05). ICU length of stay and duration of mechanical ventilation were also reduced. Conclusion: The VAP prevention and control quality checklist, based on an integrated medical-nursing approach, effectively reduces the incidence of VAP, improves the quality of prevention and control, and demonstrates substantial clinical value. Through medical-nursing collaboration, standardized practices, and continuous quality improvement, the checklist provides robust protection for ICU patient safety. It is recommended for wider applications in other ICUs settings.