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

摘要：

目的 检索和分析预防耐甲氧西林金黄色葡萄球菌（methicillin-resistant Staphylococcus aureus,MRSA）呼吸机相关性肺炎的证据,并对最佳证据进行总结。方法 通过计算机检索PubMed、Embase、Cochrane循证医学数据库、BMJ-Clinical Evidence、BMJ-Best Practice、uptodate、JBI循证卫生保健国际合作中心图书馆、加拿大安大略护理学会网站、美国国立指南库、英国国家临床优化研究所、中国知网、维普、万方数据库、中国生物医学数据库等,包括所有指南、证据总结、最佳实践信息册、专家共识、系统评价及原始研究。检索时段为建库至2018年6月。由3名研究者对文献质量进行评价,对符合质量标准的文献进行证据提取。 结果 最终纳入文献9篇,其中1篇中文文献,8篇英文文献;实验研究1篇,队列研究1篇,系统评价5篇,专家共识1篇,指南1篇。总结的最佳证据如下：15 ml 2%氯己定进行口腔冲洗,2次/d,直至患者出院;每日氯己定擦浴;患者入住ICU时及24 h内采集鼻和咽拭子进行MRSA主动筛查;对于鼻腔有MRSA定植的患者,采用莫匹罗星软膏鼻内涂抹;手卫生依从性高及有规范的感染控制措施的医疗机构,可考虑终止保护性隔离;医院环境与医疗设备的清洁和消毒。 结论 建议临床医护人员对ICU患者进行MRSA的主动筛查,对早期定植患者进行去定植处理,机械通气早期进行氯己定口腔冲洗,保持环境清洁,预防MRSA呼吸机相关性肺炎的发生。

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