Effect of implementation of a new preventive measure bundle on the incidence of ventilator associated pneumonia
Authors:
P. Novotný; M. Voldřich; T. Tyll
Authors‘ workplace:
Klinika anesteziologie, resuscitace a intenzivní medicíny 1. LF UK a Ústřední vojenská nemocnice-Vojenská fakultní nemocnice Praha
Published in:
Anest. intenziv. Med., 26, 2015, č. 6, s. 342-349
Category:
Intensive Care Medicine - Original Paper
Overview
Objective:
Our goal was to assess the influence of implementation of a new preventive measure bundle against ventilator associated pneumonia (VAP) on the incidence of VAP in the period of 2008–2013.
Design:
Single centre, prospective, observational study.
Setting:
ICU of a University hospital.
Materials and methods:
Patients hospitalized in the ICU from 1st January 2008 to 31st December 2013 were enrolled into the study. We prospectively collected the following data: the number of patients on artificial lung ventilation (ALV), number of patients on ALV longer than 48 hours, number of days of treatment, number of ventilator days and the rate of VAP. From 2011 we regularly evaluated compliance with the preventive measure bundle initially once a week, later on once a month. In colaboration with the hospital epidemiologist, from 2010 we also evaluated compliance with hand hygiene by random checks.
Results:
Implementation of a preventive measure bundle against VAP, including systematic education of the hospital staff and improvement in the compliance with preventive measures, led to decreased incidence of this nosocomial complication. Our results are comparable or better than the data published in the database of the European Center for Disease Prevention and Control (ECDC).
Conclusion:
Implementation of a simple set of preventive measures led to a substantial reduction in VAP incidence.
Keywords:
audit – incidence preventive measure – ventilator associated pneumonia
Sources
1. American Thoracic Society Documents, Guidelines for the Management of Adults with Hospital-acquired, Ventilator--associated, and Healthcare-associated Pneumonia. This official statement of the American Thoracic Society and the Infectious Diseases Society of America was approved by the ATS. Dostupné na www: https://www.thoracic.org/statements/resources/mtpi/guide1-29.pdf
2. Salfdar Nasia, M. D., Dezfulian, M. S. et al. Clinical and economic consequences of ventilator-associated pneumonia: A systematic review. Critical Care Medicine, 2005, 33, 10, p. 2184–2193.
3. ECDC technical document: Point prevalence survey of health-care-associated infections and antimicrobial use in European acute care hospitals. Protocol version 4.3. Dostupné na www: http://www.ecdc.europa.eu/en/publications/Publications/0512-TED-PPS-HAI-antimicrobialuse- protocol.pdf
4. Adair, C. G., Gorman, S. P., Feron, B. M. et al. Implications of endotracheal tube biofilm for ventilator-associated pneumonia. Intensive Care Med., 1999, 25, p. 1072–1076.
5. Jindrák, V., Hedlová, D., Urbášková, P. et al. Antibiotická politika a prevence infekcí v nemocnici, Mladá fronta a. s., 2014, 18–19 s. ISBN:978-80-204-2815-8.
6. ECDC Annual epidemiological report 2013. Dostupné na www: http://www.ecdc.europa.eu/en/ publications/ Publications/annual-epidemiological-report-13.pdf
7. Rello, Afonso, Lisboa et al. A care bundle approach for prevention of ventilator-associated pneumonia. Clin. Microbiol. Infect., 2013, 19, 4, p. 363–369.
8. Tablan, O. C., Anderson, L. J., Besser, R. et al. CDC Healthcare Infection Control Practices Advisory Committee. Guidelines for preventing health care-associated pneumonia, 2003: Recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee. MMWR Recomm Rep., 2004, 26, 53, RR-3, p. 1–36.
9. Munro, N., Ruggiero, M. Ventilator-Associated Pneumonia Bundle. Reconstruction for Best Care. AACN Advanced Critical Care, 2014, 25, 2, p. 163–175.
10. Health Care Protocol: Prevention of Ventilator-AssociatedPneumonia 2011. Dostupné na www:http://www.icsi.org/_asset/y24ruh/VAP.pdf
11. Nseir, S., Di Pompeo, C., Pronnier, P. et al. Nosocomial tracheobronchitis in mechanically ventilated patients: incidence,aetiology and outcome. Eur. Respir. J., 2002, 20, p. 1483–1489.
12. Alvaro Rea Neto, Gomes, G. S., Nogueira, P. M. et al. Diagnosis of ventilator-associated pneumonia: a systematic review of the literature. Critical Care, 2008, 12, 56.
13. Niederman, M. S., Craven, D. E., Bonten, M. J. et al. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am. J. Respir. Crit. Care Med., 2005, 171, p. 388–416.
14. Knaus, W. A., Zimmerman, J. E., et al. APACHE-acute physiology and chronic health evaluation: a physiologically based classification system. Critical Care Medicine, 1981.
15. Mälstam, J., Lindt, L. Therapeutic intervention scoring system (TISS) – a method for measuring workload and calculating costs in the ICU. Acta Anaestesiol. Scand., 1992, 36, 8, p. 758–763.
16. Bird, D., Ambuto, A., O´Donell, C. et al. Adherence to ventilator-associated pneumonia bundle and incidence of ventilator-associated pneumonia in the surgical intensive care unit. Arch Surg., 2010, 145, 5, p. 465–470
17. Majid S. Al-Thaquafy, Aiman El-Saed, Yaseen M. Arabi et al. Association of compliance of ventilator bundle with incidence of ventilator-associated pneumonia and ventilator utilization among ctirical patients over 4 years. Annals of Thoracic Med., 2014, 9, 4, p. 221–226.
18. Pier Paolo Terragni et al. Early vs Late Tracheotomy for Prevention of Pneumonia in Mechanically Ventilated Adult ICU PatientsA Randomized Controlled Trial. JAMA, 2010, 303, 15, p. 1483–1489REE.
19. Koch, T. Early tracheostomy decreases ventilation time but has no impact on mortality of intensive care patients: a randomized study. Langenbecks Arch. Surg., 2012, 397, 6, p. 1001–1008.
20. Guiliano, C., Wilhelm, S. M., Kale-Pradhan, P. B. Are proton pump inhibitors associated with the development of community-acquired pneumonia? A meta-analysis. Expert Rev. Clin. Pharmacol., 2012, 5, 3, p. 337–344.
21. Rello, J. et al. Pneumonia in intubated patients: role of respiratory airway care. Am. J. Resp. Crit. Care Med., 1996, 154, 1, p. 111–115.
22. Orozco-Levi, M., Torres, A., Ferrer, M. et al. Semirecumbent position protects from pulmonary aspiration but not completely from gastroesophageal reflux in mechanically ventilated patients. Am. J. Respir. Crit. Care Med., 1995,152, p. 1387–1390.
23. Sas, I. Nozokomiální infekce a infekce multirezistentními organismy v podmínkách intenzivní péče. Postgraduální medicína, 2010, 9, p. 1079.
24. Torres, A., Gatell, J. P., Aznar, E. et al. Re-intubation increases the risk of nosocomial pneumonia in patiens needing mechanical ventilation. Am. J. Respir. Crit. Care Med., 1995, 152, p. 137–141.
25. Conti, M., Pougeoise, M., Wurtz, A., Porte, H., Fourrier, F., Ramon, P., Marquette, C.-H. Management of postintubation tracheobronchial rupture. Chest, 2006,130, p. 412–418.
26. Alhazzani, W., Smith, O., Muscedere, J., Medd, J., Cook, D. Toothbrushing for critically ill mechanically ventilated patients: a systematic review and meta-analysis of randomized trials evaluating ventilator-associated pneumonia. Crit. Care Med., 2013, 41, 2, p. 646–655.
27. CDC. Guideline for hand hygiene in health-care settings. MMWR, 2002, 51, 16.
28. Eckmanns, T., Bessert, J., Behnke, M. et al. Compliance with antiseptic hand rub use in intensive care units: The Hawthorne effect. Infect. Control. Hosp. Epidemiol., 2006, 27, p. 931–934.
29. Reichardt, C., Mönch, N., Hansen, S. et al. German wide reference data of alcoholic hand rub consumption. Hyg. Med., 2009, 34, 1, 2.
30. Haas, J. P., Larson, E. L. Measurement of compliance with hand hygiene. Journal of Hospital Infection, 2007, 66, p. 6–14.
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Anaesthesiology, Resuscitation and Inten Intensive Care MedicineArticle was published in
Anaesthesiology and Intensive Care Medicine
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