Bundle Care for Preventing Ventilator-associated Pneumonia at a Medical Center: A Preliminary Report

BACKGROUNDThe effectiveness of practice bundles on reducing ventilator-associated pneumonia (VAP) has been questioned.OBJECTIVETo implement a comprehensive program that included a real-time bundle compliance dashboard to improve compliance and reduce ventilator-associated complications.DESIGNBefore-and-after quasi-experimental study with interrupted time-series analysis.SETTINGAcademic medical center.METHODSIn 2007 a comprehensive institutional ventilator bundle program was developed. To assess bundle compliance and stimulate instant course correction of noncompliant parameters, a real-time computerized dashboard was developed. Program impact in 6 adult intensive care units (ICUs) was assessed. Bundle compliance was noted as an overall cumulative bundle adherence assessment, reflecting the percentage of time all elements were concurrently in compliance for all patients.RESULTSThe VAP rate in all ICUs combined decreased from 19.5 to 9.2 VAPs per 1,000 ventilator-days following program implementation (P<.001). Bundle compliance significantly increased (Z100 score of 23% in August 2007 to 83% in June 2011 [P<.001]). The implementation resulted in a significant monthly decrease in the overall ICU VAP rate of 3.28/1,000 ventilator-days (95% CI, 2.64–3.92/1,000 ventilator-days). Following the intervention, the VAP rate decreased significantly at a rate of 0.20/1,000 ventilator-days per month (95% CI, 0.14–0.30/1,000 ventilator-days per month). Among all adult ICUs combined, improved bundle compliance was moderately correlated with monthly VAP rate reductions (Pearson correlation coefficient, −0.32).CONCLUSIONA prevention program using a real-time bundle adherence dashboard was associated with significant sustained decreases in VAP rates and an increase in bundle compliance among adult ICU patients.Infect. Control Hosp. Epidemiol. 2015;36(11):1261–1267

Download Full-text

Is ventilator-associated pneumonia related to frequency of breathing circuit changes? D. Murphy, BSN, CIC,* M. H. Kollef, MD, E. Trovillion, BSN, CIC, M. Jones, BSN, CIC, M. Illig, BSN, CIC, J. Dorris, BSN, V. Fraser, MD. Barnes-Jewish Hospital at Washington University Medical Center, St. Louis, MO

American Journal of Infection Control ◽

10.1016/0196-6553(95)90115-9 ◽

1995 ◽

Vol 23 (2) ◽

pp. 98

Keyword(s):

Breathing Circuit ◽

Medical Center ◽

Ventilator Associated Pneumonia ◽

Jewish Hospital ◽

Washington University

Download Full-text

A Comparison of Diagnostic Algorithms and Clinical Parameters to Diagnose Ventilator-Associated Pneumonia: A Prospective Observational Study

10.21203/rs.3.rs-31703/v1 ◽

2020 ◽

Author(s):

Farshid Rahimibashar ◽

Andrew Carl Miller ◽

Mojtaba H. Yaghoobi ◽

Amir Vahedian-Azimi

Keyword(s):

Observational Study ◽

Prospective Observational Study ◽

Medical Center ◽

Academic Medical Center ◽

False Negative ◽

Youden Index ◽

Ventilator Associated Pneumonia ◽

Reference Standard ◽

Male Predominance ◽

Diagnostic Algorithms

Abstract BACKGROUND: Suspicion and clinical criteria continue to serve as the foundation for ventilator-associated pneumonia (VAP) diagnosis, however the criteria used to diagnose VAP vary widely. Data from head-to-head comparisons of clinical diagnostic algorithms is lacking, thus a prospective observational study was performed to determine the performance characteristics of the Johanson criteria, Clinical Pulmonary Infection Score (CPIS), and Centers for Disease Control and Prevention’s National Healthcare Safety Network (CDC/NHSN) criteria as compared to Hospital in Europe Link for Infection Control through Surveillance (HELICS) reference standard. METHODS: A prospective observational cohort study was performed in three mixed medical-surgical ICUs from one academic medical center from 1 October 2016 to 30 April 2018. VAP diagnostic criteria were applied to each patient including CDC/NHSN, CPIS, HELICS and Johanson criteria. Tracheal cultures and serum procalcitonin values were obtained for each patient. RESULTS: Eighty-five patients were enrolled (VAP 45, controls 41), mean age 46.94±18.9 years with a male predominance (72.94%). Using HELICS as the reference standard, the true positive (TP; sensitivity) and false negative (FN; miss rate) rates were CDC/NHSN (TP 44%; FN 0%), CPIS (TP 43%; FN 1%), Johnson (TP 43%; FN 1%). The highest true negative rate was seen with CPIS. CPIS had the highest Youden index; CDC/NHSN had the lowest. The positive tracheal culture rate was 81.2%. The sensitivity for positive tracheal culture with the serum procalcitonin level >0.5 ng/ml was 51.8%. CDC/NHSN had the highest false positive correlation with tracheal aspirate cultures. CONCLUSION: VAP remains a considerable source of morbidity and mortality in modern ICUs. The optimal diagnostic method remains unclear. Using HELICS criteria as the reference standard, CPIS displayed greater diagnostic accuracy compared to CDC/NHSN and Johanson criteria. Accuracy was improved with the addition of serum procalcitonin >0.5 ng/ml, but not positive quantitative endotracheal aspirate culture.TRIAL REGISTRATION: Not indicated for this study type.

Download Full-text

LAPAROSCOPIC SENTINEL NODE DETECTION IN ENDOMETRIAL CANCER AFTER INJECTION OF INDOCYANINE GREEN. PRELIMINARY REPORT FROM LJUBLJANA MEDICAL CENTER.

10.26226/morressier.597eedbdd462b80296ca11c4 ◽

2017 ◽

Author(s):

Marco Noventa

Keyword(s):

Endometrial Cancer ◽

Indocyanine Green ◽

Sentinel Node ◽

Preliminary Report ◽

Medical Center ◽

Sentinel Node Detection

Download Full-text

A comparison of diagnostic algorithms and clinical parameters to diagnose ventilator-associated pneumonia: a prospective observational study

BMC Pulmonary Medicine ◽

10.1186/s12890-021-01527-1 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Farshid Rahimibashar ◽

Andrew C. Miller ◽

Mojtaba H. Yaghoobi ◽

Amir Vahedian-Azimi

Keyword(s):

Observational Study ◽

Prospective Observational Study ◽

Medical Center ◽

Academic Medical Center ◽

Tracheal Aspirate ◽

Ventilator Associated Pneumonia ◽

Reference Standard ◽

Clinical Criteria ◽

Diagnostic Algorithms ◽

Study Type

Abstract Background Suspicion and clinical criteria continue to serve as the foundation for ventilator-associated pneumonia (VAP) diagnosis, however the criteria used to diagnose VAP vary widely. Data from head-to-head comparisons of clinical diagnostic algorithms is lacking, thus a prospective observational study was performed to determine the performance characteristics of the Johanson criteria, Clinical Pulmonary Infection Score (CPIS), and Centers for Disease Control and Prevention’s National Healthcare Safety Network (CDC/NHSN) criteria as compared to Hospital in Europe Link for Infection Control through Surveillance (HELICS) reference standard. Methods A prospective observational cohort study was performed in three mixed medical-surgical ICUs from one academic medical center from 1 October 2016 to 30 April 2018. VAP diagnostic criteria were applied to each patient including CDC/NHSN, CPIS, HELICS and Johanson criteria. Tracheal aspirate cultures (TAC) and serum procalcitonin values were obtained for each patient. Results Eighty-five patients were enrolled (VAP 45, controls 40). Using HELICS as the reference standard, the sensitivity and specificity for each of the assessed diagnostic algorithms were: CDC/NHSN (Sensitivity 54.2%; Specificity 100%), CPIS (Sensitivity 68.75%; Specificity 95.23%), Johanson (Sensitivity 67.69%; Specificity 95%). The positive TAC rate was 81.2%. The sensitivity for positive TAC with the serum procalcitonin level > 0.5 ng/ml was 51.8%. Conclusion VAP remains a considerable source of morbidity and mortality in modern intensive care units. The optimal diagnostic method remains unclear. Using HELICS criteria as the reference standard, CPIS had the greatest comparative diagnostic accuracy, whereas the sensitivity of the CDC/NHSN was only marginally better than a positive TAC plus serum procalcitonin > 0.5 ng/ml. Algorithm accuracy was improved by adding serum procalcitonin > 0.5 ng/ml, but not positive quantitative TAC. Trial Registration: Not indicated for this study type.

Download Full-text