A qualitative assessment of the diagnosis and management of ventilator-associated pneumonia among critical care clinicians exploring opportunities for diagnostic stewardship

Abstract Background: Prompt diagnosis and intervention for ventilator-associated pneumonia (VAP) is critical but can lead to overdiagnosis and overtreatment. Objectives: We investigated healthcare provider (HCP) perceptions and challenges associated with VAP diagnosis, and we sought to identify opportunities for diagnostic stewardship. Methods: We conducted a qualitative study of 30 HCPs at a tertiary-care hospital. Participants included attending physicians, residents and fellows (trainees), advanced practice providers (APPs), and pharmacists. Interviews were composed of open-ended questions in 4 sections: (1) clinical suspicion and thresholds for respiratory culture ordering, (2) preferences for respiratory sample collection, (3) culture report interpretation, and (4) VAP diagnosis and treatment. Interviews transcripts were analyzed using Nvivo 12 software, and responses were organized into themes. Results: Overall, 10 attending physicians (75%) and 16 trainees (75%) trainees and APPs believed they were overdiagnosing VAP; this response was frequent among HCPs in practice 5–10 years (91%, n = 12). Increased identification of bacteria as a result of frequent respiratory culturing, misinterpretation of culture data, and fear of missing diagnosis were recognized as drivers of overdiagnosis and overtreatment. Although most HCPs rely on clinical and radiographic changes to initiate work-up, the fear of missing a diagnosis leads to sending cultures even in the absence of those changes. Conclusions: HCPs believe that VAP overdiagnosis and overtreatment are common due to fear of missing diagnosis, overculturing, and difficulty distinguishing colonization from infection. Although we identified opportunities for diagnostic stewardship, interventions influencing the ordering of cultures and starting antimicrobials will need to account for strongly held beliefs and ICU practices.

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Epidemiology and clinical outcome of ventilator-associated events at a tertiary care hospital from North India

Tropical Doctor ◽

10.1177/0049475520982457 ◽

2020 ◽

pp. 004947552098245

Author(s):

Pooja Kumari ◽

Priya Datta ◽

Satinder Gombar ◽

Deepak Sharma ◽

Jagdish Chander

Keyword(s):

Mechanical Ventilation ◽

Tertiary Care Hospital ◽

Late Onset ◽

Tertiary Care ◽

Control Measures ◽

North India ◽

Ventilator Associated Pneumonia ◽

Care Hospital ◽

Infection Control Measures ◽

Utilisation Rate

The aim of our study was to determine the incidence, microbiological profile, risk factors and outcomes of patients diagnosed with ventilator-associated events in our tertiary care hospital. In this prospective study, intensive care patients put on mechanical ventilation for >48 h were enrolled and monitored daily for ventilator-associated event according to Disease Centre Control guidelines. A ventilator-associated event developed in 33/250 (13.2%); its incidence was 3.5/100 mechanical ventilation days. The device utilisation rate was 0.86, 36.4% of patients had early and 63.6% late-onset ventilator-associated pneumonia whose most common causative pathogen was Acinetobacter sp. (63.6%). Various factors were significantly associated with a ventilator-associated event: male gender, COPD, smoking, >2 underlying diseases, chronic kidney disease and elevated acute physiological and chronic health evaluation II scores. Therefore, stringent implementation of infection control measures is necessary to control ventilator-associated pneumonia in critical care units.

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Study of Bacteriological Profile and Antibiogram in Patients with Ventilator Associated Pneumonia in an Intensive Care Unit of a Tertiary Care Hospital

Indian Journal of Medical Microbiology ◽

10.1016/j.ijmmb.2021.08.176 ◽

2021 ◽

Vol 39 ◽

pp. S51

Author(s):

Bushra Afreen ◽

Manoj kumar ◽

A.K. Sharma

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Ventilator Associated Pneumonia ◽

Care Hospital ◽

Bacteriological Profile

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Turn Around Time for Clinical Biochemistry Laboratory: A Vital and Effective Parameter for Patient Care

JOURNAL FOR CLINICAL AND DIAGNOSTIC RESEARCH ◽

10.7860/jcdr/2021/46385.14517 ◽

2021 ◽

Author(s):

Mitul Navinchandra Chhatriwala ◽

Dharmik Savjibhai Patel ◽

Divyal Patel ◽

Hitesh N Shah

Keyword(s):

Clinical Biochemistry ◽

Tertiary Care ◽

Cross Sectional Study ◽

Care Hospital ◽

Sample Collection ◽

Diagnostic Laboratory ◽

Cross Sectional ◽

Entire Interval ◽

Turn Around Time ◽

Analytical Errors

Introduction: Clinical laboratories are judged by its validity, reliability, genuineness or authenticity and its timeliness in reports generating. Repetitively, patients and physicians complain about the time taken by the laboratory for the investigation. The total Turn Around Time (TAT) for laboratory tests includes the entire interval from the order of the test to the awareness of the result by the clinicians. The evaluation and improvement of TAT is crucial for the management of laboratory quality and the satisfaction of patients. Aim: To observe the TAT of common biochemical investigations, to identify reasons for increased TAT and to formulate a plan to rectify increased TAT. Materials and Methods: A hospital based cross-sectional study was conducted at the Clinical Biochemistry Section of the Central Diagnostic Laboratory of Tertiary Care Hospital. TAT data from April 2014 to September 2015 were included in the study. The laboratory technicians and the resident doctors of biochemistry recorded the reasons for the delay of those specimens exceeding the TAT. Data were analysed with the help of statistical software Epi Info 7. Results: The total number of samples received in the biochemistry laboratory were 1,85,658. Out of this, Out Patient Department (OPD) samples were 1,35,022 and Intensive Care Unit (ICU) samples were 50,636. Pre-analytical errors were observed in 670 of ICU samples, which was 1.32% of total samples received and it was higher than the post-analytical errors. In the pre-analytical phase, the most common cause was inaccurate procedures of sample collection. Conclusion: This study demonstrates that the main culprit of increased TAT was delay in the sample transportation and Haemolysed samples. TAT minimisation is a constant procedure for any facility. Every laboratory needs to develop a decent approach for reducing the TAT.

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Incidence of ventilator associated pneumonia in tracheostomised and non tracheostomised patients

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20183264 ◽

2018 ◽

Vol 6 (8) ◽

pp. 2754

Author(s):

David D. M. Rosario ◽

Anitha Sequeira

Keyword(s):

Mechanical Ventilation ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Ventilator Associated Pneumonia ◽

Care Hospital ◽

Early Tracheostomy ◽

Hospital Acquired Infection ◽

Total Incidence ◽

Hospital Acquired Pneumonia ◽

Hospital Acquired

Background: Pneumonia is the most common hospital acquired infection in the intensive care unit. One of the causes for hospital acquired pneumonia is ventilator associated pneumonia. Tracheostomy is known to prevent occurrence of ventilator associated pneumonia as it decreases the respiratory dead space, assists in better clearance of secretions and prevents chances of aspiration. Generally, tracheostomy is done after 2 weeks of endotracheal intubation to prevent tracheal complications. The aim of this study is to identify the incidence of ventilator associated pneumonia in tracheostomised and non tracheostomised patients and to see if early tracheostomy can prevent development of ventilator associated pneumonia.Methods: The study was conducted at a tertiary care hospital during a period of four years. 100 patients who were on mechanical ventilation for more than 7 days where taken up for the study. APACHE 4 scoring system was used. The incidence of Ventilator associated pneumonia in tracheostomised and non tracheostomised patients was studied.Results: In our study the total incidence of VAP was 44 %. In our study out of the 42 patients who had undergone tracheostomy 13 (30.95%) patients had ventilator associated pneumonia. Among the non-tracheostomised patients 31 (53.44%) out of 58 patients developed ventilator associated pneumonia. In our study the incidence of ventilator associated pneumonia was much lesser (12%) in patients who underwent tracheostomy in the period 7 to 10 days after mechanical ventilation, whereas in those who underwent tracheostomy after 11 days incidence of ventilator associated pneumonia was much higher.Conclusions: Our study showed that the incidence of ventilator associated pneumonia was much higher among non tracheostomised patients compared to patients who underwent tracheostomy. Hence patients undergoing earlier tracheostomy had a clear advantage than those undergoing tracheostomy late or non tracheostomised patients in preventing ventilator associated pneumonia.

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