Effect Of Cluster Intervention Strategy Combined with Targeted Nursing on Prevention of Ventilator-Associated Pneumonia in Icu Patients

2021 ◽  
Vol 7 (6) ◽  
pp. 6395-6401
Author(s):  
XueQin Li ◽  
XiuYing Chen
Keyword(s):  
Mechanical Ventilation ◽  
Detection Rate ◽  
Pathogenic Bacteria ◽  
Nursing Intervention ◽  
Apache Ii Score ◽  
Control Group ◽  
Study Group ◽  
Ventilator Associated Pneumonia ◽  
Icu Patients ◽  
Mechanical Ventilation Time

Background VAP is a common complication of ventilator maintenance therapy. The occurrence of VAP is related to many factors such as long duration of breathing, invasive operation, pollution of respiratory tubes and instruments, and low immunity of patients. The prevention of VAP in critically ill patients I the primary problem for clinical medical staff. Avoiding exogenous bacteria invading the respiratory tract and endogenous bacterial infection is the main method. Objective To investigate the value of optimized cluster nursing intervention combined with targeted nursing measures in reducing the incidence of ventilator-associated pneumonia (VAP) in patients with mechanical ventilation in intensive care unit (ICU). Methods 200 patients with mechanical ventilation in ICU of our institute from January 2017 to June 2020 were selected and randomly divided into study group and control group, with 100 cases in each group. The study group was treated with cluster nursing intervention combined with targeted nursing measures optimized by muItL criteria decision analysis method, and the control group was treated with targeted nursing measures. The incidence of VAP, the detection rate of pathogenic bacteria in sputum specimens and the effect of nursing execution were compared between the two groups. 200 patients were divided into VAP group and non-VAP group according to whether VAP occurred. Multivariate Logistic regression model analysis was used to explore the risk factors of VAP in AECOPD patients. Results A total of 4 strains were detected in the study group and 18 strains were detected in the control group. The detection rate of pathogenic bacteria in the study group was higher than that in the control group (y2=10.010, P=0.002<0.05). The incidence of VAP in the study group was 4.00% lower than 17.00% in the control group, and the difference was statistically significant (P<0.05). Compared with VAP group and non-VAP group, the proportion of patients with serum albumin<30g/L, diabetes mellitus rate, APACHE II score>15 points, tracheotomy rate and mechanical ventilation time≥5 days in VAP group were significantly higher than those in non-VAP group, which had statistical significance (P<0.05). The results of logistic regression model snowed that serum albumin ≥30g/L and optimized cluster nursing could effectively reduce the risk of VAP in ICU patients with mechanical ventilation (P<0.05). The risk of VAP in ICU patients with mechanical ventilation was increased by the combination of diabetes rate. APACHE II score≥15 points, tracheotomy and mechanical ventilation time ≥ 5 days (P<0.05). Conclusion The risk of VAP in ICU patients with mechanical ventilation is high, and the optimized cluster nursing intervention combined with targeted nursing measures can effectively reduce the incidence of VAP.

The effects of information platform-based nursing on preventing venous thromboembolism (VTE) in patients with hip fractures (Preprint)

2020 ◽  
Author(s):  
Yuan Gao ◽  
Xiaojie Fu ◽  
Mingxing Lei ◽  
Pengbin Yin ◽  
Qingmei Wang ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Hip Fractures ◽  
Subgroup Analysis ◽  
Nursing Intervention ◽  
Control Group ◽  
Study Group ◽  
Drug Compliance ◽  
Information Platform ◽  
The Difference ◽  
Length Of Hospitalization

BACKGROUND Mobile apps are becoming increasingly relevant to health care. Apps have been used to improve symptoms, quality of life, and adherence for oral drugs in patients with cancers, pregnancy, or chronic diseases, and the results were satisfying . OBJECTIVE This study aims to develop an information platform with the help of a mobile app and then evaluate whether information platform-based nursing can improve patient’s drug compliance and reduce the incidence of VTE in patients with hip fractures. METHODS We retrospectively analyzed hip fracture patients performed with traditional prevention and intervention of VTE (control group) between January 2008 and November 2012, and prospectively analyzed hip fracture patients conducted with nursing intervention based on the information platform (study group) between January 2016 and September 2017. The information platform can be divided into medical and nursing care end and the patient’s end. Based on the information platform, we could implement risk assessments, monitoring management and early warnings, preventions and treatments, health educations, follow-up and other aspects of nursing interventions for patients. We compared basic characteristics, outcomes including drug compliance, VTE occurrence, and mean length of hospitalization between the two groups. Besides, a subgroup analysis was performed in the study group according to different drug compliances. RESULTS Regarding baseline data, patients in the study group had more morbidities than those in the control group (P<0.05). The difference of drug compliance between the two groups was statistically significant (P<0.001): 64.7% of the patients in the control group had poor drug compliance and only 6.1% patients had poor drug compliance in the study group. In terms of VTE, 126 patients (10.7%) in the control group had VTE, while only 35 patients (7.1%) in the study group had VTE, and the difference was statistically significant (P=0.024). Moreover, the average length of hospitalization in the study group was also significantly lower than that in the control group (10.4 d vs. 13.7 d, P=0.000). Subgroup analysis of the study group showed that the incidence of VTE in patients with non-compliance, partial compliance, and good compliance was 56.7%, 5.8% and 2.8%, respectively (P=0.000). CONCLUSIONS Poor drug compliance leads to higher VTE occurrence. The information platform-based nursing can effectively improve the compliance of patients with hip fracture and thus significantly reduce the incidence of VTE.

scholarly journals The Impact of Intervention-Related Risk Factors on the Risk of Ventilator-Associated Pneumonia Is High in a Neurosurgical Intensive Care Unit

2020 ◽  
Vol 41 (S1) ◽  
pp. s407-s409
Author(s):  
Ksenia Ershova ◽  
Oleg Khomenko ◽  
Olga Ershova ◽  
Ivan Savin ◽  
Natalia Kurdumova ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
Negative Slope ◽  
Infection Prevention And Control ◽  
Ventilator Associated Pneumonia ◽  
Related Factors ◽  
Icu Patients ◽  
The Impact ◽  
Adf Test ◽  
Over Time

Background: Ventilator-associated pneumonia (VAP) represents the highest burden among all healthcare-associated infections (HAIs), with a particularly high rate in patients in neurosurgical ICUs. Numerous VAP risk factors have been identified to provide a basis for preventive measures. However, the impact of individual factors on the risk of VAP is unclear. The goal of this study was to evaluate the dynamics of various VAP risk factors given the continuously declining prevalence of VAP in our neurosurgical ICU. Methods: This prospective cohort unit-based study included neurosurgical patients who stayed in the ICU >48 consecutive hours in 2011 through 2018. The infection prevention and control (IPC) program was implemented in 2010 and underwent changes to adopt best practices over time. We used a 2008 CDC definition for VAP. The dynamics of VAP risk factors was considered a time series and was checked for stationarity using theAugmented Dickey-Fuller test (ADF) test. The data were censored when a risk factor was present during and after VAP episodes. Results: In total, 2,957 ICU patients were included in the study, 476 of whom had VAP. Average annual prevalence of VAP decreased from 15.8 per 100 ICU patients in 2011 to 9.5 per 100 ICU patients in 2018 (Welch t test P value = 7.7e-16). The fitted linear model showed negative slope (Fig. 1). During a study period we observed substantial changes in some risk factors and no changes in others. Namely, we detected a decrease in the use of anxiolytics and antibiotics, decreased days on mechanical ventilation, and a lower rate of intestinal dysfunction, all of which were nonstationary processes with a declining trend (ADF testP > .05) (Fig. 2). However, there were no changes over time in such factors as average age, comorbidity index, level of consciousness, gender, and proportion of patients with brain trauma (Fig. 2). Conclusions: Our evidence-based IPC program was effective in lowering the prevalence of VAP and demonstrated which individual measures contributed to this improvement. By following the dynamics of known VAP risk factors over time, we found that their association with declining VAP prevalence varies significantly. Intervention-related factors (ie, use of antibiotics, anxiolytics and mechanical ventilation, and a rate of intestinal dysfunction) demonstrated significant reduction, and patient-related factors (ie, age, sex, comorbidity, etc) remained unchanged. Thus, according to the discriminative model, the intervention-related factors contributed more to the overall risk of VAP than did patient-related factors, and their reduction was associated with a decrease in VAP prevalence in our neurosurgical ICU.Funding: NoneDisclosures: None

Analysis of Nursing Cooperation in Microscopic Pituitary Tumor Resection via Transsphenoidal Approach

2021 ◽  
Vol 7 (6) ◽  
pp. 6445-6452
Author(s):  
Haijuan Hu ◽  
Yishu Zhao ◽  
Jianhua Ma
Keyword(s):  
Statistical Significance ◽  
Tumor Resection ◽  
Nursing Intervention ◽  
Transsphenoidal Approach ◽  
Control Group ◽  
Mechanical Equipment ◽  
Study Group ◽  
Observation Group ◽  
The Difference ◽  
Better Than

To analyze the clinical effect of nursing cooperation in transsphenoidal approach microscopic hypophysectomy. From January 2017 to January 2020, 80 patients who underwent transsphenoidal microscopic hypophysectomy in our hospital were selected to participate in the analysis and study. They were divided into two groups according to the randomized allocation, namely the observation group and the control group. Among them, 40 patients in the observation group and 40 patients in the control group were given routine nursing care for the patients in the control group, and comprehensive nursing intervention was adopted for the patients in the observation group, and the overall nursing effect of the two groups of patients was compared. After taking different nursing methods, the condition of patients in both groups was effectively controlled, and the effective rate of patients in the observation group with comprehensive nursing intervention was significantly better than that of patients in the control group with conventional nursing methods, and the difference had certain statistical significance (P < 0.05); The satisfaction degree of patients in the study group was significantly better than that of patients in the control group, and the difference was statistically significant (P < 0.05). The degree of negative emotions of patients in the study group was significantly better than that of patients in the control group after receiving comprehensive nursing intervention, and the difference was statistically significant (P < 0.05), and the difference in the incidence of adverse events between the two groups was not statistically significant (P > 0.05); The scores of each index of SF-36 questionnaire of patients in both groups were higher than those before nursing, and the scores of each index of patients in observation group were higher than those of patients in control group, and the difference was statistically significant (P > 0.05). With adequate preoperative preparation and mastery of the use of mechanical equipment, comprehensive nursing intervention can effectively improve the treatment effect of patients, make patients more satisfied with the nursing work, and can soothe patients’ negative psychological mood, eliminate panic, improve patients' life confidence, enhance intraoperative cooperation, and ensure that the operation can be completed smoothly.

scholarly journals The effect of supportive nursing intervention on burden and coping strategies of cargivers of children with cancer

2018 ◽  
Vol 8 (7) ◽  
pp. 125
Author(s):  
Ghada Ahmed Hassan ◽  
Hanady Shaaban Ibrahim
Keyword(s):  
Coping Strategies ◽  
Nursing Intervention ◽  
Control Group ◽  
Study Group ◽  
Burden Of Care ◽  
Children With Cancer ◽  
Physical Burden ◽  
Coping Pattern ◽  
The Mean ◽  
And Coping

Background and objective: Cancer is a serious health problem. Children with cancer are in particular need of support and care due to its complications followed by chemotherapy. These children should be cared for at home by family caregivers, and this places great mental and physical burden on caregivers. Therefore, appropriate and effective nursing interventions are essential in order to decrease burden and improve their coping pattern. The aim of this study was to determine the effect of supportive nursing intervention on the burden of care and coping pattern in caregivers of children with cancer.Methods: Research design: A Quasi-study pre, immediately after, and 1 month after the intervention was used to test the study hypothesis and fulfill the aim of the study. Setting: The study was conducted at outpatient clinic in Specialized Pediatric Hospital at Benha City. Subjects: Sixty caregivers for children with cancer was chosen through convenient sampling method and divided by using table of random numbers into two groups, study and control group. Caregivers of the study group attended seven nursing intervention sessions. Tools: The tools used were (1) An inertviewing questionnaire which include two part; sociodemoghaphic date and medical history for child and thier caregivers (2) Zarit Burden Scale (3) Coping Health Inventory for caregivers parents (CHIP).Results: During the study period, burden decreased in the study group and increased in the control group. Mean burden of care score before, immediately after, and 1 month after the intervention was 42.2, 33.7, and 25.6, respectively, in the study group and 44.2, 46.1, and 48.5, respectively, in the control group. In addition, the mean burden score in the study group significantly decreased in comparison with the control group (p < .001). Also, coping strategies increased in the study group and decreased in the control group. Mean coping pattern score before, immediately after, and 1 month after the intervention was 32.8, 47.5, 53.6, respectively, in the study group and 34.7, 30.7 and 26.2, respectively, in the control group. In addition, the mean coping pattern score in the study group significantly improved in comparison with the control group (p < .001).Conclusions: The supportaive nursing intervention can decrease burden in caregivers of children with cancer and consequently improve their methods of coping.

scholarly journals The effectiveness of training given to nurses for reducing ventilator-associated pneumonia in intensive care patients

2019 ◽  
Vol 2 (2) ◽  
pp. 36-45
Author(s):  
Hatice Oner Cengiz ◽  
Nevin Kanan
Keyword(s):  
Intensive Care ◽  
Knowledge Score ◽  
Control Group ◽  
Study Group ◽  
Test Model ◽  
Ventilator Associated Pneumonia ◽  
Post Test ◽  
Quasi Experimental ◽  
The Difference ◽  
Effectiveness Of Training

Purpose The aim of this study it to determine the effect of training intensive care unit (ICU) nurses in reducing ventilator-associated pneumonia (VAP). Materials and methods A quasi-experimental (single group, pre-test–post-test) model was used. The study was conducted in 2015, in nine adult ICUs in Istanbul, where we observed the VAP rate and trained study group nurses. Sixty nurses were given two VAP training sessions (averaging 45 min each) at intervals of 6 months. Forty-nine nurses were in the control group. Data were collected with an Introductory Information Form, a VAP Information Test, and an Application Status of VAP Preventive/Reducing Initiatives Form. The incidences of VAP in 2014 and 2015 were also compared. Frequencies, percentages, means, standard deviations, t-tests, Wilcoxon tests, and χ2 tests were used to evaluate the data. The values of p less than .05 were considered significant. Results The mean-total-knowledge score increased significantly in the study group. The application of preventive/reducing initiatives also increased significantly in the study group, but in the last measurement, the difference between the groups was not statistically significant. The incidences of VAP decreased significantly in the study group. Conclusion The study showed that the VAP training given to intensive care nurses increased their knowledge level and decreased the incidence of VAP in their ICUs.

Surfactant Replacement Therapy for Meconium Aspiration Syndrome

PEDIATRICS ◽  
1996 ◽  
Vol 97 (1) ◽  
pp. 48-52 ◽  
Author(s):  
Richard D. Findlay ◽  
H. William Taeusch ◽  
Frans J. Walther
Keyword(s):  
Mechanical Ventilation ◽  
Replacement Therapy ◽  
Meconium Aspiration Syndrome ◽  
Control Group ◽  
Study Group ◽  
Term Infants ◽  
Meconium Aspiration ◽  
Air Leaks ◽  
Surfactant Replacement Therapy ◽  
Pulmonary Morbidity

Objective. The pathophysiology of meconium aspiration syndrome (MAS) is related not only to mechanical obstruction of the airways and chemical injury to the respiratory epithelium but also to surfactant inactivation by meconium. A randomized, controlled study was performed to determine whether high-dose surfactant therapy improves the pulmonary morbidity of term infants ventilated for MAS. Methods. Forty term infants receiving mechanical ventilation for MAS were enrolled in this trial, in which the infants in the study group (n = 20) received up to four doses of 150 mg (6 mL)/kg beractant (Survanta), instilled every 6 hours by continuous infusion for 20 minutes via a side hole endotracheal tube adapter, and the infants in the control group (n = 20) received 6 mL/kg air placebo. Results. Mean arterial-to-alveolar Po2 ratio values increased from 0.09 to 0.11 at 1 and 6 hours with a concomitant slight decrease in oxygenation index values from 23.7 to 19.7 at 1 hour and 20.7 at 6 hours after the first dose of surfactant. Oxygenation improved cumulatively after the second and third dose of surfactant, with mean arterial-to-alveolar Po2 ratios and oxygenation indices of 0.18 and 12.1 at 6 hours after the second dose of surfactant and 0.31 and 5.9 at 6 hours after the third dose of surfactant, eliminating the need for a fourth dose in any infant in the study group. After three doses of surfactant, persistent pulmonary hypertension had resolved in all but one of the infants in the study group versus none of the infants in the control group. No air leaks developed in any of the 20 infants in the study group after surfactant therapy, and only 1 infant required extracorporeal membrane oxygenation. Air leaks developed in 5 of the 20 infants in the control group, and 6 underwent extracorporeal poreal membrane oxygenation. The duration of mechanical ventilation, oxygen therapy, and admission was significantly shorter in the surfactant group than in the control group. Conclusion. Surfactant replacement therapy, if started within 6 hours after birth, improves oxygenation and reduces the incidence of air leaks, severity of pulmonary morbidity, and hospitalization time of term infants with MAS.

Analysis of the Effect of Advanced Nursing on the Quality of Life and the Prevention of Complications in Patients with Breast Cancer Undergoing PICC Chemotherapy

2021 ◽  
Vol 7 (5) ◽  
pp. 1558-1563
Author(s):  
Xiuzhen Hu ◽  
Qun Yang ◽  
Zhengyun Wang ◽  
Xuyun Hu
Keyword(s):  
Breast Cancer ◽  
Quality Of Life ◽  
Negative Emotion ◽  
Nursing Intervention ◽  
Psychological Status ◽  
Control Group ◽  
Study Group ◽  
Clinical Value ◽  
Significant Difference

Objective: To investigate the effect of advanced nursing on the quality of life and the prevention of complications in patients with breast cancer undergoing PICC (Peripherally Inserted Central Catheter) chemotherapy. Methods: From January 2017 to January 2020, 98 patients with breast cancer undergoing PICC chemotherapy in our hospital were divided into control group and study group by random sampling. The patients were given routine nursing and advanced nursing intervention on the basis of routine nursing. The psychological status, complications and quality of life of the patients were compared. Results: There was no significant difference in HAMA, HAMD score and QLQ-30 score before nursing (P > 0.05). The scores of HAMA and HAMD in the study group after nursing were lower than those in the control group (P < 0.05), the scores of QLQ-30 were higher than those in the control group (P < 0.05), and the complication rate was lower than that in the control group (P < 0.05). Conclusion: The intervention of advanced nursing mode in patients with breast cancer treated with PICC chemotherapy can effectively alleviate the influence of negative emotion on chemotherapy, reduce the occurrence of complications and improve the quality of life. This mode has high clinical value.

scholarly journals Spontaneous breathing test in the prediction of extubation failure in the pediatric population

2017 ◽  
Vol 15 (2) ◽  
pp. 162-166 ◽  
Author(s):  
Milena Siciliano Nascimento ◽  
Celso Moura Rebello ◽  
Luciana Assis Pires Andrade Vale ◽  
Érica Santos ◽  
Cristiane do Prado
Keyword(s):  
Mechanical Ventilation ◽  
Spontaneous Breathing ◽  
Pediatric Population ◽  
Test Group ◽  
Pediatric Intensive Care ◽  
Extubation Failure ◽  
Control Group ◽  
Respiratory Parameters ◽  
Lemeshow Test ◽  
Mechanical Ventilation Time

ABSTRACT Objective To assess whether the spontaneous breathing test can predict the extubation failure in pediatric population. Methods A prospective and observational study that evaluated data of inpatients at the Pediatric Intensive Care Unit between May 2011 and August 2013, receiving mechanical ventilation for at least 24 hours followed by extubation. The patients were classified in two groups: Test Group, with patients extubated after spontaneous breathing test, and Control Group, with patients extubated without spontaneous breathing test. Results A total of 95 children were enrolled in the study, 71 in the Test Group and 24 in the Control Group. A direct comparison was made between the two groups regarding sex, age, mechanical ventilation time, indication to start mechanical ventilation and respiratory parameters before extubation in the Control Group, and before the spontaneous breathing test in the Test Group. There was no difference between the parameters evaluated. According to the analysis of probability of extubation failure between the two groups, the likelihood of extubation failure in the Control Group was 1,412 higher than in the Test Group, nevertheless, this range did not reach significance (p=0.706). This model was considered well-adjusted according to the Hosmer-Lemeshow test (p=0.758). Conclusion The spontaneous breathing test was not able to predict the extubation failure in pediatric population.

scholarly journals Correlation of retinopathy of prematurity with bronchopulmonary dysplasia

Open Medicine ◽  
2018 ◽  
Vol 13 (1) ◽  
pp. 67-73 ◽  
Author(s):  
Wojciech Podraza ◽  
Beata Michalczuk ◽  
Karolina Jezierska ◽  
Hanna Domek ◽  
Agnieszka Kordek ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Preterm Infants ◽  
Bronchopulmonary Dysplasia ◽  
Significant Role ◽  
Retinopathy Of Prematurity ◽  
Clinical Severity ◽  
Control Group ◽  
Study Group ◽  
Blood Transfusions ◽  
Advanced Stages

AbstractRetinopathy of prematurity (ROP) and bronchopulmonary dysplasia (BPD) are diseases that occur only in preterm infants. The etiology of these disorders is multifactorial; however, it is believed that some of the factors in children presenting with BPD affect both the initiation and severity of ROP. The aim of the study was to evaluate the degree of clinical severity of ROP in infants with BPD compared to those without BPD.MethodologyInfants were divided into two groups: the BPD+ study group and BPD- control group. Parameters including the incidence of ROP and its severity were compared.ResultsIn neonates with BPD, more severe forms of ROP occurred significantly more frequently than in infants without BPD. Newborns with BPD required significantly longer use of mechanical ventilation; moreover, the number of days in which the concentration of oxygen in the respiratory mixture exceeded 50% was greater in BPD+ children . Children with BPD also received more blood transfusions compared to children without BPD.ConclusionsNewborns in the BPD+ study group showed advanced stages of ROP more often than newborns in the BPD- control group. The etiology of ROP and BPD is multifactorial; however, our findings suggest oxygen plays a significant role in the development of these diseases.

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