关键词: 肺炎, 呼吸机相关, 耐甲氧西林金黄色葡萄球菌, 预防, 循证护理

Abstract:

Objective To retrieve and analyze available evidence on prevention of ventilator-associated pneumonia（VAP） due to methicillin-resistant Staphylococcus aureus（MRSA） and summarize the best available evidence. Methods We searched the PubMed,Embase,Cochrane Library,BMJ-Clinical Evidence,BMJ-Best Practice,uptodate,Joanna Briggs Institute（JBI）,Registered Nurses’ Association of Ontario（RNAO）,National Guideline Clearinghouse（NGC）,National Institute for Health and Care Excellence（NICE）,and complementally searched CNKI,Wanfang Database,VIP Database and CBM published up until June 2018,to collect articles including guidelines,evidence summary（ES）,best practice information sheet（BPIS）,expert consensus,systematic review（SR） and original research. Three authors independently evaluated quality of literatures and extracted data. Results Nine articles were enrolled,including one Chinese language article and eight English articles;one experimental study,one cohort study,five SRs,one expert consensus,and one guideline. Best evidence included：mouth rinses with 15ml of 2% Chlorhexidine（CHX） digluconate for twice per day until discharge,bed bath with Chlorhexidine daily;active screening with nasal and pharyngeal swab culture for MRSA when admitted to ICU and within 24 hours,using mupirocin in the nostrils for MRSA colonized patients,protective isolation might be cancelled for hospitals with high levels of compliance with hand hygiene and standardized infection prevention strategy,cleaning and disinfection of hospital environment and medical equipments. Conclusion Health care providers should take strategies such as active screening for MRSA as patients admitted to ICU,decolonization,mouth rinses with CHX in early mechanical ventilation,and cleaning and disinfection of environment and equipments,to prevent MRSA-VAP.

Key words: Pneumonia, Ventilator-associated, Methicillin-Resistant Staphylococcus Aureus, Prevention, Evidence-Based Nursing