Underestimating the Impact of Ventilator-Associated Pneumonia by Use of Surveillance Data

We calculated rates of ventilator-associated pneumonia (VAP) by using surveillance data, clinical data, and coding data. Compared with the VAP rates calculated on the basis of surveillance data, the VAP rates calculated on the basis of coding data were significantly overestimated in 4 of 5 intensive, care units. Efforts to improve coding and clinical documentation will address much but not all of this discrepancy between surveillance and administrative data.

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The impact of the implementation of bundle in the prevention of ventilator-associated pneumonia in intensive care units

BMC Proceedings ◽

10.1186/1753-6561-5-s6-p70 ◽

2011 ◽

Vol 5 (S6) ◽

Author(s):

DP Cais ◽

R Mourão

Keyword(s):

Intensive Care ◽

Intensive Care Units ◽

Ventilator Associated Pneumonia ◽

The Impact

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High-Risk International Clones of Carbapenem-Nonsusceptible Pseudomonas aeruginosa Endemic to Indonesian Intensive Care Units: Impact of a Multifaceted Infection Control Intervention Analyzed at the Genomic Level

mBio ◽

10.1128/mbio.02384-19 ◽

2019 ◽

Vol 10 (6) ◽

Cited By ~ 6

Author(s):

Andreu Coello Pelegrin ◽

Yulia Rosa Saharman ◽

Aurélien Griffon ◽

Mattia Palmieri ◽

Caroline Mirande ◽

...

Keyword(s):

Pseudomonas Aeruginosa ◽

Intensive Care ◽

High Risk ◽

Infection Control ◽

Intensive Care Units ◽

Clinical Data ◽

Prevention Measures ◽

Content Type ◽

Control Intervention ◽

The Impact

ABSTRACT Infection control effectiveness evaluations require detailed epidemiological and microbiological data. We analyzed the genomic profiles of carbapenem-nonsusceptible Pseudomonas aeruginosa (CNPA) strains collected from two intensive care units (ICUs) in the national referral hospital in Jakarta, Indonesia, where a multifaceted infection control intervention was applied. We used clinical data combined with whole-genome sequencing (WGS) of systematically collected CNPA to infer the transmission dynamics of CNPA strains and to characterize their resistome. We found that the number of CNPA transmissions and acquisitions by patients was highly variable over time but that, overall, the rates were not significantly reduced by the intervention. Environmental sources were involved in these transmissions and acquisitions. Four high-risk international CNPA clones (ST235, ST823, ST375, and ST446) dominated, but the distribution of these clones changed significantly after the intervention was implemented. Using resistome analysis, carbapenem resistance was explained by the presence of various carbapenemase-encoding genes (blaGES-5, blaVIM-2-8, and blaIMP-1-7-43) and by mutations within the porin OprD. Our results reveal for the first time the dynamics of P. aeruginosa antimicrobial resistance (AMR) profiles in Indonesia and additionally show the utility of WGS in combination with clinical data to evaluate the impact of an infection control intervention. (This study has been registered at www.trialregister.nl under registration no. NTR5541). IMPORTANCE In low-to-middle-income countries such as Indonesia, work in intensive care units (ICUs) can be hampered by lack of resources. Conducting large epidemiological studies in such settings using genomic tools is rather challenging. Still, we were able to systematically study the transmissions of carbapenem-nonsusceptible strains of P. aeruginosa (CNPA) within and between ICUs, before and after an infection control intervention. Our data show the importance of the broad dissemination of the internationally recognized CNPA clones, the relevance of environmental reservoirs, and the mixed effects of the implemented intervention; it led to a profound change in the clonal make-up of CNPA, but it did not reduce the patients’ risk of CNPA acquisitions. Thus, CNPA epidemiology in Indonesian ICUs is part of a global expansion of multiple CNPA clones that remains difficult to control by infection prevention measures.

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Impact of the International Nosocomial Infection Control Consortium (INICC) multidimensional approach on rates of ventilator-associated pneumonia in intensive care units of two hospitals in Kuwait

Journal of Infection Prevention ◽

10.1177/1757177418759745 ◽

2018 ◽

Vol 19 (4) ◽

pp. 168-176 ◽

Cited By ~ 9

Author(s):

Haifaa Hassan Al-Mousa ◽

Abeer Aly Omar ◽

Víctor Daniel Rosenthal ◽

Mona Foda Salama ◽

Nasser Yehia Aly ◽

...

Keyword(s):

Logistic Regression ◽

Intensive Care ◽

Nosocomial Infection ◽

Infection Control ◽

Intensive Care Units ◽

Density Ratio ◽

Incidence Density ◽

Ventilator Associated Pneumonia ◽

Multidimensional Approach ◽

The Impact

Objective: To analyse the impact of the International Nosocomial Infection Control Consortium (INICC) multidimensional approach (IMA) on ventilator-associated pneumonia (VAP) rates in three intensive care units (ICUs) from two hospitals in Kuwait City from January 2014 to March 2015. Design: A prospective, before–after study on 2507 adult ICU patients. During baseline, we performed outcome surveillance of VAP applying CDC/NHSN definitions. During intervention, we implemented the IMA through the INICC Surveillance Online System (ISOS), which included: (1) a bundle of infection prevention interventions; (2) education; (3) outcome surveillance; and (4) feedback on VAP rates and consequences. Logistic regression analysis was performed to estimate the effect of the intervention on VAP, controlling for potential bias. Results: During baseline, 1990 mechanical ventilator (MV)-days and 14 VAPs were recorded, accounting for 7.0 VAPs per 1000 MV-days. During intervention, 9786 MV-days and 35 VAPs were recorded, accounting for 3.0 VAPs per 1000 MV-days. The VAP rate was reduced by 57.1% (incidence-density ratio = 0.51; 95% CI = 0.28–0.93; p = 0.042). Logistic regression showed a significant reduction in VAP rate during the intervention phase (OR = 0.39, 95% CI = 0.18–0.83), with 61% effectiveness. Conclusions: Implementing IMA through ISOS was associated with a significant reduction in the VAP rate in Kuwait ICUs.

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Impact of nursing guidelines on nurses’ knowledge and performance regarding to prevention of ventilator associated pneumonia in neonates

Journal of Nursing Education and Practice ◽

10.5430/jnep.v9n10p15 ◽

2019 ◽

Vol 9 (10) ◽

pp. 15

Author(s):

Safaa Abdel Fattah Abou Zed ◽

Amira Adel Mohammed

Keyword(s):

Mechanical Ventilation ◽

Intensive Care ◽

Intensive Care Units ◽

Neonatal Intensive Care ◽

Neonatal Intensive Care Units ◽

Ventilator Associated Pneumonia ◽

And Performance ◽

Nursing Guidelines ◽

The Impact ◽

Nurses Knowledge

Background: Ventilator Associated Pneumonia (VAP) is a common syndrome in pediatrics primarily in infants and early childhood. Mechanical ventilation is one of the leading supportive modalities of management in the intensive care unit, but it conveys a lot of threats and complications. This study aimed to assess the impact of nursing guidelines on nurses’ knowledge and performance regarding to prevention of ventilator associated pneumonia in neonates through the following: 1) Assessment of nurses’ knowledge and performance regarding to prevention of ventilator associated pneumonia in neonates. 2) Designing, implementing and evaluating the impact of nursing guidelines on nurses’ knowledge and performance regarding to prevention of ventilator associated pneumonia in neonates.Methods: Research design: A quasi-experimental design was utilized to conduct this study. Settings: The study was convoyed at Maternity & Gynecological and Children’s Hospitals affiliated to Ain shams University Hospitals from neonatal intensive care units. Sample: A convenient sample method of forty three (43) nurses, and fifty (50) neonates’ infants on mechanical ventilation was included in the study as a single study group. Tools: The questionnaire format, the observation checklist and implementation of nursing guidelines was assessed the nurses’ knowledge and performance regarding to prevention of ventilator associated pneumonia in neonates. The implementation of nursing guidelines was premeditated as reference guidelines for nurses.Results: There were statistically significant differences between mean scores of the pre and post test as regards nurses’ knowledge and performance regarding to prevention of ventilator associated pneumonia in neonates.Conclusions: Application of the nursing guidelines has a positive outcome on improving nurses’ knowledge and performance regarding to prevention of ventilator associated pneumonia in neonates. Recommendations: The current study recommended that directing a written protocol for prevention of ventilator associated pneumonia in neonates to support satisfactory knowledge, and competent practices are actually required at neonatal intensive care units.

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Ventilator-associated pneumonia in Iranian intensive care units

The Journal of Infection in Developing Countries ◽

10.3855/jidc.1212 ◽

2011 ◽

Vol 5 (04) ◽

pp. 286-293 ◽

Cited By ~ 10

Author(s):

Aziz Japoni ◽

Afsanah Vazin ◽

Mohammad Ali Davarpanah ◽

Mohammad Afkhami Ardakani ◽

Abdolvahab Alborzi ◽

...

Keyword(s):

Intensive Care ◽

Body Temperature ◽

Intensive Care Units ◽

Leukocyte Count ◽

Combined Treatment ◽

Attributable Mortality ◽

Ventilator Associated Pneumonia ◽

Reduce Mortality Rate ◽

Etiological Agents ◽

The Impact

Introduction: Nosocomial pneumonia (NP) and ventilator associated pneumonia (VAP) occur most frequently in intensive care units (ICU). This study seeks to determine the etiological agents of NP and VAP along with their antibacterial susceptibility patterns, and to evaluate the factors contributing to patient mortality. The impact of appropriate therapy in terms of three parameters (body temperature, PaO2/FiO2 ratio and leukocyte count) was also assessed. Methodology: This study involved 836 adult patients admitted to ICUs at the Nemazee Hospital, Shiraz, Iran, over nine months during 2008 and 2009. The inclusion criterion was the commencement of infection at least 48 hours following hospital admission. Clinical parameters including core temperature, leukocyte count. and PaO2/FiO2 ratio were evaluated. Antibiotic sensitivities of the isolated bacteria to a panel of antibiotics were determined using E-test. Results: Of 836 cases, only 58 (6.9 %) cases of NP were diagnosed, of which 42 (72 %) were VAP. A. baumannii, MRSA, P. aeruginosa and MSSA were the most prevalent bacteria. Significant correlations between previous antibiotic therapy (p = 0.04), use of corticosteroids (p = 0.02) and attributable mortality were found. A strong correlation between fever abatement and the ratio of PaO2/FiO2 with responses to treatment and outcomes was also evident. Conclusions: Combined treatment with meropenem/imipenem, ciprofloxacin and vancomycin seems to be appropriate and could cover all possible infective agents. To reduce mortality rate, reasonable prescription of antibiotics and corticosteroids could be effective. Furthermore, adopting a strategy to reduce body temperature and PaO2/FiO2 ratio could be beneficial in patients' outcomes.

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Bundle de prevenção da pneumonia associada à ventilação mecânica: revisão integrativa

Revista Recien - Revista Científica de Enfermagem ◽

10.24276/rrecien2358-3088.2020.10.29.48-57 ◽

2020 ◽

Vol 10 (29) ◽

pp. 48-57

Author(s):

Eliana Brugin Serra ◽

Isaura Leticia Tavares Palmeira Rolim ◽

Aline Sharlon Maciel Batista Ramos ◽

Rafael Mondego Fontenele

Keyword(s):

Mechanical Ventilation ◽

Intensive Care ◽

Intensive Care Units ◽

Health Sciences ◽

Integrative Review ◽

Ventilator Associated Pneumonia ◽

Terapia Intensiva ◽

Multidisciplinary Staff ◽

The Impact

Trata-se de uma revisão integrativa que tem como objetivo destacar o impacto do bundle na prevenção de pneumonia associada à ventilação mecânica (PAVM) em unidades de terapia intensiva, utilizando descritores em ciências da saúde (DeSC): Pneumonia, Protocolos e Unidades de Terapia Intensiva. A busca pelos artigos foi efetuada nas bases de dados SciELO, e BVS (LILACS e BDENF). Obtiveram-se 179 estudos, sendo selecionados 7 artigos para análise nesta revisão. As medidas mais comuns na constituição dos bundles encontradas foram: higiene oral com clorexidina, elevação da cabeceira e verificação da pressão do cuff, sendo que uma maior adesão às bundles resulta numa diminuição da taxa de pneumonia associada à ventilação. Os bundles de prevenção de PAVM têm sido recomendados para substituir as medidas isoladas de prevenção, mas requer adesão e treinamento periódico da equipe multidisciplinar para que possam ser considerados indicadores de qualidade.Descritores: Pneumonia, Protocolos, Unidades de Terapia Intensiva. Bundle to prevent ventilator-associated pneumonia: an integrative reviewAbstract: This work is an integrative review wich the main objective is highlighting the impact of bundle in the prevention of pneumonia associated to the mechanical ventilation (PAVM) in intesive care units using descriptors in health sciences (DeSC): Pneumonia, Protocols and Intensive Care Units. This search for articles was based on SciELO and BVS (LILACS and BDENF). Through one hundred seventy-nine (179) studies, seven (7) articles were selected to be analyzed in this review. The most common arregement found in the constitution of bundles were: oral cleanliness with Clorexidina, headboard elevation and pressure verification of cuff, considering that a greater adhesion to the bundles results in a decrease of pneumonia tax associated to ventilation. The prevention bundles of PAVM have been recomended to replace the isolated arrangements of prevention, but it is necessary periodical adhesion and practice by the multidisciplinary staff to be considered quality indicators.Descriptors: Pneumonia, Protocols, Intensive Care Units. Bundle de prevención de neumonía asociada a ventilación mecánica: revisión integrativaResumen: Se trata de una revisión integrativa que tiene como objetivo resaltar el impacto del bundles en la prevención de la neumonía asociada a la ventilación mecánica (VAP) en la unidad de cuidados intensivos utilizando descriptores de ciencias de la salud (DeSC): Neumonía, Protocolos y unidades de Cuidados Intensivos. La búsqueda de artículos se realizó en las bases de datos SciELO y BVS (LILACS y BDENF). Se obtuvieron 179 estudios y se seleccionaron 7 artículos para análisis en esta revisión. Las medidas más comunes en la constitución de bundles encontradas en los estudios fueron: higiene oral de clorhexidina, elevación de la cabeza y verificación de la presión del cuff, y una mayor adherencia a los bundles resulta en una disminución en la tasa de neumonía asociada al ventilador. Se han recomendado bundles de prevención de VAP para reemplazar las medidas de prevención aisladas, pero requieren adherencia y capacitación periódica del equipo multidisciplinario para ser considerados indicadores de calidad.Descriptores: Neumonía, Protocolos, Unidades de Cuidados Intensivos.

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