Collaborative Cohort Study of an Intervention to Reduce Ventilator-Associated Pneumonia in the Intensive Care Unit

2011 ◽  
Vol 32 (4) ◽  
pp. 305-314 ◽  
Author(s):  
Sean M. Berenholtz ◽  
Julius C. Pham ◽  
David A. Thompson ◽  
Dale M. Needham ◽  
Lisa H. Lubomski ◽  
...  
Keyword(s):  
Intensive Care ◽  
Confidence Interval ◽  
Multifaceted Intervention ◽  
Care Bundle ◽  
Evidence Based ◽  
Ventilator Associated Pneumonia ◽  
Improve Compliance ◽  
Rate Ratios ◽  
Ventilator Care ◽  
The Impact

Objective.To evaluate the impact of a multifaceted intervention on compliance with evidence-based therapies and ventilator-associated pneumonia (VAP) rates.Design.Collaborative cohort before-after study.Setting.Intensive care units (ICUs) predominantly in Michigan.Interventions.We implemented a multifaceted intervention to improve compliance with 5 evidence-based recommendations for mechanically ventilated patients and to prevent VAP. A standardized CDC definition of VAP was used and maintained at each site, and data on the number of VAPs and ventilator-days were obtained from the hospital's infection preventionists. Baseline data were reported and postimplementation data were reported for 30 months. VAP rates (in cases per 1,000 ventilator-days) were calculated as the proportion of ventilator-days per quarter in which patients received all 5 therapies in the ventilator care bundle. Two interventions to improve safety culture and communication were implemented first.Results.One hundred twelve ICUs reporting 3,228 ICU-months and 550,800 ventilator-days were included. The overall median VAP rate decreased from 5.5 cases (mean, 6.9 cases) per 1,000 ventilator-days at baseline to 0 cases (mean, 3.4 cases) at 16–18 months after implementation (P < .001) and 0 cases (mean, 2.4 cases) at 28-30 months after implementation (P < .001). Compared to baseline, VAP rates decreased during all observation periods, with incidence rate ratios of 0.51 (95% confidence interval, 0.41–0.64) at 16–18 months after implementation and 0.29 (95% confidence interval, 0.24–0.34) at 28–30 months after implementation. Compliance with evidence-based therapies increased from 32% at baseline to 75% at 16–18 months after implementation (P < .001) and 84% at 28–30 months after implementation (P < .001).Conclusions.A multifaceted intervention was associated with an increased use of evidence-based therapies and a substantial (up to 71%) and sustained (up to 2.5 years) decrease in VAP rates.

scholarly journals Use of Ventilator Care Bundle to Prevent Ventilator-Associated Pneumonia: The Impact of Using Echinacea as a Complementary Modality

2020 ◽  
Vol 88 (3) ◽  
pp. 277-284
Author(s):  
JEHAN A. EL-KHOLY, M.D.; IMAN A. FOUAD, M.D. ◽  
AKRAM S. EL-ADAWY, M.D.; HEBA F. SHAFEI, M.D. ◽  
MONA S. ALLAM, M.Sc.
Keyword(s):  
Care Bundle ◽  
Ventilator Associated Pneumonia ◽  
Ventilator Care ◽  
The Impact

scholarly journals Knowledge and practice of ventilator care bundle for preventing ventilator associated pneumonia by ICU nurses of tertiary care hospitals of Lahore

2020 ◽  
Vol 24 (4) ◽  
Author(s):  
Zunaira Aziz ◽  
Samina Kausar ◽  
Saima Zahid ◽  
Samina Farooqi ◽  
Zara Aziz ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Nosocomial Infection ◽  
Clinical Data ◽  
Tertiary Care ◽  
Care Bundle ◽  
Ventilator Associated Pneumonia ◽  
Knowledge And Practice ◽  
Ventilator Care ◽  
Tertiary Care Hospitals

Ventilator associated pneumonia (VAP) is the most common nosocomial infection acquired by patients in an intensive care unit (ICU). However, there is scarce clinical data, particularly from Pakistani ICUs, regarding existing practices to prevent it.

scholarly journals Preventing Ventilator-Associated Pneumonia: Educating Emergency Room Nurses

2014 ◽  
Author(s):  
Dana Ferrazzano
Keyword(s):  
Intensive Care ◽  
Emergency Room ◽  
Oral Care ◽  
Evidence Based ◽  
Ventilator Associated Pneumonia ◽  
Preventative Measures ◽  
Emergency Room Nurses ◽  
Evidence Based Guidelines ◽  
The Impact ◽  
Nurses Knowledge

<p>Ventilator-associated pneumonia (VAP) is the second most common hospital acquired infection and is primarily found in the intensive care units. The presence of an endotracheal tube is the primary risk factor for developing VAP. Many times the process of intubation occurs pre-hospital, in the emergency room (ER) or in the operating room. Ventilator associated pneumonia is associated with increased hospital stay and costs. Evidence-based guidelines have been developed to decrease the occurrence of VAP and decrease patient mortality. Preventative measures are initiated on the intensive care unit once the patient is transferred. The purpose of this study was to evaluate the impact of an educational program on ER nurses knowledge of VAP and preventative measures to decrease VAP.</p> <p>The study took place at Rhode Island Hospital, a level 1 trauma center located in Providence, RI. Participants were ER nurses who worked in the critical care area of the ER. A pre-intervention-posttest design was used to evaluate emergency room nurses knowledge regarding VAP. The intervention consisted of a posterboard and study guide that provided information regarding evidence-based guidelines that could be implemented in the ER such as oral care, and head of bed elevation. The overall results on the pre and posttest demonstrated that ER nurses were unaware that oral care and the use of chlorhexidine were important interventions to reduce the incidence of developing VAP. Recommendations and implications for advanced practice nursing and the need for future research are discussed.</p>

scholarly journals Reducing errors in the administration of medication with infusion pumps in the intensive care department: A lean approach

2019 ◽  
Vol 7 ◽  
pp. 205031211882262
Author(s):  
Alexander F van der Sluijs ◽  
Eline R van Slobbe-Bijlsma ◽  
Astrid Goossens ◽  
Alexander PJ Vlaar ◽  
Dave A Dongelmans
Keyword(s):  
Intensive Care Unit ◽  
Patient Safety ◽  
Intensive Care ◽  
Confidence Interval ◽  
Medication Errors ◽  
Infusion Pump ◽  
Baseline Measurement ◽  
Infusion Pumps ◽  
Improvement Measures ◽  
The Impact

Background: Medication errors occur frequently and may potentially harm patients. Administering medication with infusion pumps carries specific risks, which lead to incidents that affect patient safety. Objective: Since previous attempts to reduce medication errors with infusion pumps failed in our intensive care unit, we chose the Lean approach to accomplish a 50% reduction of administration errors in 6 months. Besides improving quality of care and patient safety, we wanted to determine the effectiveness of Lean in healthcare. Methods: We conducted a before-and-after observational study. After baseline measurement, a value stream map (a detailed process description, used in Lean) was made to identify important underlying causes of medication errors. These causes were discussed with intensive care unit staff during frequent stand-up sessions, resulting in small improvement cycles and bottom-up defined improvement measures. Pre-intervention and post-intervention measurements were performed to determine the impact of the improvement measures. Infusion pump syringes and related administration errors were measured during unannounced sequential audits. Results: Including the baseline measurement, 1748 syringes were examined. The percentage of errors concerning the administration of medication by infusion pumps decreased from 17.7% (95% confidence interval, 13.7–22.4; 55 errors in 310 syringes) to 2.3% (95% confidence interval, 1–4.6; 7 errors in 307 syringes) in 18 months (p < 0.0001). Conclusion and Relevance: The Lean approach proved to be helpful in reducing errors in the administration of medication with infusion pumps in a high complex intensive care environment.

scholarly journals The nursing workload assessed through the Nursing Activities Score as a predictor for the occurrence of ventilator-associated pneumonia in an adult intensive care unit

2019 ◽  
Vol 9 (9) ◽  
pp. 104
Author(s):  
Fabiola Alves Gomes ◽  
Denise Von Dolinger de Brito Röder ◽  
Thúlio Marquez Cunha ◽  
Rosângela De Oliveira Felice ◽  
Guilherme Silva Mendonça ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Hospital Costs ◽  
University Hospital ◽  
Nursing Workload ◽  
Ventilator Associated Pneumonia ◽  
Adult Intensive Care Unit ◽  
Icu Admission ◽  
Stay Time ◽  
The Impact

Objective: Evaluate the relation of nursing workload, evaluated by the Nursing Activities Score (NAS), with the occurrence of Ventilator-associated Pneumonia (VAP) in an Intensive Care Unit (ICU) and the impact of VAP on hospitalization costs.Methods: Retrospective cohort study in Adult ICU of a high complexity Brazilian university hospital. The profile, outcomes, costs, and daily NAS from patients were collected. We also proposed some workload indicators based on NAS daily evaluation.Results: The study included 195 patients, 27.17% diagnosed with VAP. VAP was more prevalent in patients diagnosed with trauma on admission. The total costs of care were higher for VAP patients. In all multivariate models tested were predictive for VAP: the patient's intubation that occurs in days prior of the ICU admission day (higher risk if occurs in days prior the ICU admission day) and ventilation time prior ICU (higher risk if higher time). We found others predictors, but these were dependent on the model tested. Additional risk predictors were tracheostomy, propofol use, neuromuscular blocker use and the higher NAS from admission. The protective factors found were the percentage of adequacy of the assignment based in NAS that measure if the workload measured by the NAS was offered and the increment in NAS during the ventilation time.Conclusions: The offering of an adequate nursing work scale (adequate number of professionals for the care), as a function of the nursing workload measured by the NAS, could be effective in the reduction of VAP, hospital stay time and hospital costs.

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