scholarly journals The Incidence of VAP after VAP Bundle Intervention Among Patients with Mechanical Ventilation

Jurnal NERS ◽  
2015 ◽  
Vol 10 (1) ◽  
pp. 138
Author(s):  
Diah Susmiarti ◽  
Harmayetty Harmayetty ◽  
Yulis Setiya Dewi
Keyword(s):  
Mechanical Ventilation ◽  
Nosocomial Infection ◽  
Sample Size ◽  
Late Onset ◽  
Ventilator Associated Pneumonia ◽  
Application Methods ◽  
Larger Sample ◽  
Vap Bundle

Introduction: Ventilator Associated Pneumonia (VAP) is a nosocomial infection in patients who use ventilator for more than 48 hours. The aimed of the study was to determine VAP incidence after VAP bundle application. Methods: This study used one-shot case study posttest only designed with samples of 6 individuals beginning on December 31, 2013 up to January 31, 2014. The totally score of CPIS assessment revealed that 4 of 6 patients was not diagnosed with VAP and 2 were diagnosed with VAP. Result: The results showed that the application of VAP bundle has infl uence in preventing VAP incidence. The totally score of CPIS assessment revealed that 4 of 6 patients was not diagnosed with VAP and 2 were diagnosed with VAP. Discussion: This study need to be backed up furthermore with a larger sample size and continuous CPIS assessment is needed to identify VAP caused by bacteria, especially the late-onset bacteria, in patients using mechanical ventilation in longer a time.Keywords: Ventilator Associated Pneumonia (VAP) Bundle, VAP incidence

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

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.

Sounds Affecting the Moments of Stuttering in Multilingualism: A Case Study

2016 ◽  
Vol 38 (3) ◽  
pp. 154-160 ◽  
Author(s):  
Taryn Morrish ◽  
Amy Nesbitt ◽  
Mia le Roux ◽  
Ursula Zsilavecz ◽  
Jeannie van der Linde
Keyword(s):  
Sample Size ◽  
Language Proficiency ◽  
Mixed Method ◽  
Interrater Reliability ◽  
Future Research ◽  
African Language ◽  
Mixed Method Design ◽  
Larger Sample

Research involving stuttering in multilingual individuals is limited. Speech-language therapists face the challenge of treating a diverse client base, which includes multilingual individuals. The aim of this study was to examine the stuttering moments across English, Afrikaans, and German in a multilingual speaker. A single multilingual adult with a severe developmental stutter participated in this study. A mixed-method design was implemented. The results were perceptually analyzed, and interrater reliability was determined. The results revealed that the voiceless plosive [k], the voiceless fricative [f], and the plosive-lateral approximant cluster [kl] caused stuttering moments across the languages. More stuttering moments occurred on consonants as opposed to vowels. The most prominent core behavior was prolongations. Language proficiency plays a role in the increase of the moments of stuttering in the least proficient language. Future research on a larger sample size is recommended. Research on African language speaking multilingual person who stutters (PWS) should be pursued.

scholarly journals Prevalence of Ventilator Associated Pneumonia in Neonates in A Tertiary Care Hospital in Western Nepal

2019 ◽  
Vol 57 (216) ◽  
Author(s):  
Anita Lamichhane ◽  
Aparna Mishra
Keyword(s):  
Sample Size ◽  
Neonatal Intensive Care ◽  
Tertiary Care Hospital ◽  
Late Onset ◽  
Tertiary Care ◽  
Cross Sectional Study ◽  
Point Estimate ◽  
Ventilator Associated Pneumonia ◽  
Care Hospital ◽  
Cross Sectional

Introduction: Ventilator-associated pneumonia is a serious problem which needs to be addressed for a better outcome of the ventilated babies. The present study is undertaken to find out the prevalence of ventilator-associated pneumonia in neonates in a tertiary care hospital in western Nepal.Methods: A descriptive cross-sectional study was carried out in a tertiary care hospital in the western region of Nepal from March 2016 to February 2019 after approval from the Institutional review committee. Sample size was calculated and convenience sampling was done to reach the sample size. Data were collected from hospital records and entered in Statistical Package for the Social Sciences, point estimate at 95% confidence interval was calculated along with frequency and proportion for binary data.Results: Out of 95 patients ventilated in neonatal intensive care unit in the last 3 years, 23 (24.01%) developed ventilator-associated pneumonia. Prevalence of ventilator-associated pneumonia is 23 (24.01%) at 95% (14%-34%). Late onset ventilator associated pneumonia was seen in 15 (15.78%) while early onset ventilator associated pneumonia was seen in 8 (8.42%). Conclusions: Prevalence of ventilator associated pneumonia in neonates in tertiary care hospital is high compared to other studies conducted in neonates.

scholarly journals Study of quantitative bacterial cultures of non-bronchoscopic samples in ventilator associated pneumonia

2018 ◽  
Vol 5 (5) ◽  
pp. 1837 ◽  
Author(s):  
Mohamed Azarudeen ◽  
B. S. Sharma ◽  
Pankaj Kumar Jain ◽  
Alok Kumar Goyal ◽  
Bharti Malhotra
Keyword(s):  
Mechanical Ventilation ◽  
Observational Study ◽  
Early Onset ◽  
Late Onset ◽  
Sampling Techniques ◽  
Ventilator Associated Pneumonia ◽  
Quantitative Culture ◽  
Gram Negative ◽  
Bacterial Cultures ◽  
Causative Agents

Background: Diagnosis of VAP based on non bronchoscopic samples-ETA, NB-BAL culture. The aim is to study quantitative culture of the non-bronchoscopic sampling techniques such as Blind Broncho-alveolar lavage (NB-BAL) and endotracheal aspirates (ETA)in Ventilator Associated Pneumonia. It is a hospital based, observational study conducted in SPMCHI, Jaipur from September 2015 to September 2016.Methods: Seventy patients who were under mechanical ventilation for more than 48 hours and clinically suspected for VAP were included in the study and divided into early and late onset VAP. The NB-BAL and ETA were obtained from these patients and quantitative cultures were performed.Results: Out of the 70 samples analysed, 60 patients were found positive in BAL and 61 positive in ETA. The agreement between NB-BAL and ETA is 86.8%. GNBs remain the main burden of both early and late onset VAP. Most common organisms isolated were Enterobacter and Acinetobacter in early onset and Pseudomonas and Acinetobacter in late onset VAP. All the GNB isolates were sensitive to Polymyxin and Colistin and were resistant to majority of routinely used antibiotics.Conclusions: The quantitative culture of   non-bronchoscopic samples is a useful alternative to bronchoscopy, in the diagnosis of VAP in resource deprived centers. MDR gram negative bacilli are the main causative agents of VAP. 

scholarly journals A study on poor prognostic factors associated with ventilator associated pneumonia at a tertiary care hospital

2020 ◽  
Vol 7 (6) ◽  
pp. 906
Author(s):  
Raveendra K. R. ◽  
Suraj S. Hegde
Keyword(s):  
Mechanical Ventilation ◽  
Prognostic Factors ◽  
Late Onset ◽  
Tertiary Care ◽  
Ventilator Associated Pneumonia ◽  
Care Hospital ◽  
Cross Sectional ◽  
Beta Lactamases ◽  
Factors Associated ◽  
Hospital Acquired

Background: Ventilator associated pneumonia (VAP) is a hospital acquired infection (HAI) seen among critically ill patients, on mechanical ventilation, due to various causes in intensive care units (ICUs). It is associated with increased morbidity and mortality which increases the cost of health care. The aim of this study was to determine the poor prognostic factors associated with VAP.Methods: In this cross-sectional prospective study,40 patients who developed features of ventilator associated pneumonia on a platform of mechanical ventilator for >48 hrs in ICU were included in the study. VAP was then diagnosed based on clinical pulmonary infection scoring system (CPIS) with a score of >=6. All patients were evaluated and correlated with different parameters for the treatment and outcome.Results: Most of the patients had late onset VAP (60.7%) with average number of days being around 8 days. Pseudomonas, Acinetobacter, Enterobacteriacea, Staphylococcus aureus were commonly isolated organisms. Polymicrobial infections were not detected. Antibiotics like colistin, tigecycline and beta-lactamases are the most commonly effective antibiotics. Of the 40 VAP patients,20 patients survived and  20 died with protocol line of treatment. Following poor prognostic factors were identified-Early onset VAP (42.5%), elderly patients (>65 years) (90%), Type 2 DM (80%), hypertension (70%), prior antibiotic therapy (65%), prolonged supine position (68%) and re-intubation (75%).Conclusions: Ventilator associated pneumonia is associated with a significant increase in length of stay in ICU, time of mechanical ventilation and different complications and certain risk factors further worsens the prognosis.

VENTILATOR ASSOCIATED PNEUMONIA-REVIEW ARTICLE

2021 ◽  
pp. 64-65
Author(s):  
Bharti Choudhary ◽  
Nishchint Sharma
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Review Article ◽  
Evidence Based ◽  
Ventilator Associated Pneumonia ◽  
Evidence Based Practices ◽  
Prolonged Duration ◽  
Vap Bundle

Ventilator-associated pneumonia (VAP) is one of the most frequent ICU-acquired infections and a leading cause of death among patients in Intensive Care Unit (ICU). VAP is associated with prolonged duration of mechanical ventilation and ICU stay. The estimated mortality of VAP is around 10%. There are many risk factors including host related, device related and personnel related. For prevention of VAP it is recommended to minimize the exposure to mechanical ventilation and encouraging early liberation. VAP bundle as a group of evidence-based practices that, results in decrease in the incidence of VAP should be used. Patients should be reassessed daily to conrm ongoing suspicion of disease, antibiotics should be guided by cultures reports, and clinicians should consider stopping antibiotics if cultures are 1 negative.

scholarly journals Spectrum of Early Onset and Late Onset Ventilator Associated Pneumonia (VAP) in a Tertiary Care Hospital of Bangladesh: A Prospective Cohort Study

2015 ◽  
Vol 3 (1) ◽  
pp. 9-13 ◽  
Author(s):  
Uzzwal Kumar Mallick ◽  
Mohammad Omar Faruq ◽  
ASM Areef Ahsan ◽  
Kaniz Fatema ◽  
Fatema Ahmed ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Early Onset ◽  
Prospective Cohort ◽  
Tertiary Care Hospital ◽  
Late Onset ◽  
Tertiary Care ◽  
Ventilator Associated Pneumonia ◽  
Care Hospital

Objective : To compare the outcome of critically ill patients developing early onset Ventilator-associated pneumonia (VAP) occurring within 96 h of ICU admission and late onset VAP occurring after 96 h of ICU admission in critically ill patients admitted in the ICU of BIRDEM General Hospital of Bangladesh.Study Design: Prospective cohort study.Material and Methods: Study data obtained over a period of 24 months (July 2012 - June 2014) in the ICU of a tertiary care hospital was prospectively analyzed. Subjects were classified by ventilator status: early onset VAP (< 96 hrs of mechanical ventilation) or late-onset VAP (?96 hrs of mechanical ventilation). Baseline demographics and bacterial etiology were analyzed according to the spectrum of status of VAP.Results: The incidence of VAP was 35.73 per 1,000 ventilator days. In our study 52% of the cases were early-onset VAP, while 48% were late-onset VAP. Acinetobacter was the commonest organism isolated from late-onset VAP (p = 0.029) while Pseudomonas was the commonest isolates obtained from early-onset VAP (p = 0.046). Klebsiella, MRSA and E. coli were almost identically distributed between groups (p > 0.05). There is significant difference of sensitivity pattern of Acinetobacter baumannii and pseudomonas aeruginosa in both early and late-onset VAP (p=0.01). The overall mortality rate in our study was 44%. The mortality was significantly higher in the late-onset VAP (62.5%) than that in the early-onset VAP (26.9%) (p=0.011).Conclusion: From this study we conclude that late-onset VAP had poor prognosis in terms of mortality as compared to the early-onset type. The higher mortality in the late-onset VAP could be attributed to older age, higher co-morbidities like diabetes mellitus, COPD and CKD. The findings are similar to findings of other international studiesBangladesh Crit Care J March 2015; 3 (1): 9-13

scholarly journals GAMBARAN PENGETAHUAN PERAWAT TENTANG INTERVENSI MANDIRI VENTILATOR ASSOCIATED PNEUMONIA BUNDLE CARE PADA PASIEN DENGAN VENTILASI MEKANIK DI UNIT PERAWATAN INTENSIF

2019 ◽  
Vol 3 (1) ◽  
pp. 1
Author(s):  
Ariza Widya Rahma ◽  
Suhartini Ismail
Keyword(s):  
Mechanical Ventilation ◽  
Critical Care ◽  
Intensive Care ◽  
Critical Care Nurses ◽  
Face Validity ◽  
Ventilator Associated Pneumonia ◽  
Evaluation Questionnaire ◽  
Level Of Knowledge ◽  
Vap Bundle ◽  
Nurses Knowledge

Risiko VAP pada pasien terintubasi ventilasi mekanik disebabkan oleh tabung endotrakeal yang terpasang invasive memungkinkan masuknya bakteri secara langsung ke saluran pernapasan bagian bawah. VAP Bundle Care terbukti dapat mengurangi VAP dan meningkatkan hasil positif bagi pasien. Pengetahuan perawat menjadi salah satu indikator keberhasilan VAP Bundle Care karena pengetahuan berpengaruh terhadap terbentuknya perilaku perawat. Penelitian ini bertujuan untuk mengidentifikasi tingkat pengetahuan perawat ICU tentang intervensi mandiri VAP Bundle Care. Desain penelitian ini adalah kuantitatif deskriptif dengan metode survey. Teknik sampling yang digunakan yaitu total sampling. Sebanyak 100 perawat ICU berpartisipasi. Pengambilan data menggunakan critical care nurses’ knowledge of evidence based guidelines for preventing ventilator associated pneumonia: an evaluation questionnaire. Face validity dan item validity telah dilakukan. Hasil reliabilitas kuesioner memiliki koefisien alpha 0,529. Analisis data yang digunakan yaitu analisis univariate dengan bentuk distribusi frekuensi. Hasil penelitian menunjukkan bahwa 65% perawat ICU memiliki pengetahuan sedang tentang intervensi mandiri VAP Bundle Care. Kesimpulan dari penelitian ini adalah lebih banyak perawat ICU yang memiliki pengetahuan sedang daripada perawat dengan pengetahuan kurang. Penelitian ini diharapkan dapat menjadi saran baik perawat, instansi rumah sakit, institusi pendidikan, peneliti selanjutnya untuk memaksimalkan pengetahuan tentang VAP Bundle Care. Kata kunci: Pengetahuan perawat, unit perawatan intensif, vap bundle care, ventilasi mekanik Abstract Analysis of nurse knowledge about mandiri intervention of associated pneumonia bundle care in patients with mechanical ventilation in intensive care units. Risks of ventilator-associated pneumonia (VAP) in intubated patients receiving mechanical ventilation is due to an invasive endotracheal tube that may enable bacteria to enter directly into the lower respiratory tract. VAP bundle care has been proven to reduce VAP and improve positive outcomes for patients. Nurses’ knowledge is one of the indicators of the success of VAP bundle care since it influences the formation of nurses’ behaviors. This study aimed to identify the knowledge level of ICU nurses about VAP bundle care independent intervention. This study employed a quantitative descriptive design with survey methods. A total of 100 ICU nurses recruited using total sampling participated in this study. The data were collected using the critical care nurses and ventilator-associated pneumonia: an evaluation questionnaire. The face validity and item validity tests were performed. The result of the reliability test obtained an alpha coefficient of 0.529. The collected data were analyzed using a univariate analysis in the form of frequency distribution. The results showed that 65% of the ICU nurses had a moderate level of knowledge about VAP bundle care independent intervention. This study concluded that more ICU nurses had a moderate level of knowledge than those who had an inadequate level of knowledge. This study is expected to be a suggestion for nurses, hospital agencies, educational institutions, and further researchers to optimize the knowledge of VAP bundle care Keywords: Intensive Care Unit, Nurses’ Knowledge, Mechanical Ventilation, VAP Bundle Care 

Incidence and Outcomes of Ventilator-Associated Pneumonia in Japanese Intensive Care Units: The Japanese Nosocomial Infection Surveillance System

2007 ◽  
Vol 28 (3) ◽  
pp. 307-313 ◽  
Author(s):  
Machi Suka ◽  
Katsumi Yoshida ◽  
Hideo Uno ◽  
Jun Takezawa
Keyword(s):  
Mechanical Ventilation ◽  
Intensive Care ◽  
Length Of Stay ◽  
Nosocomial Infection ◽  
Patient Outcomes ◽  
Ventilator Associated Pneumonia ◽  
Drug Resistant ◽  
Icu Patients ◽  
The Mean ◽  
The Impact

Objectives.To determine the incidence of ventilator-associated pneumonia (VAP) among intensive care unit (ICU) patients in Japan and to assess the impact of VAP on patient outcomes, including mortality, length of stay, and duration of mechanical ventilation.Design.Multicenter cohort study.Setting.Twenty-eight ICUs in multidisciplinary Japanese hospitals with more than 200 beds.Patients.A total of 21,909 patients 16 years or older who were admitted to an ICU between June 2002 and June 2004, stayed in the ICU for 24 to 1,000 hours, and were not transferred to another ICU.Results.The overall infection rates for nosocomial pneumonia and VAP were 6.5 cases per 1,000 patient-days and 12.6 cases per 1,000 ventilator-days, respectively. The standardized mortality rates for the patients with VAP was 1.3 (95% confidence interval [CI], 1.1-1.6): 1.1 (95% CI, 0.9-1.4) for the cases due to drug-susceptible pathogens and 1.5 (95% CI, 1.1-1.9) for the cases due to drug-resistant pathogens. After adjusting for Acute Physiology and Chronic Health Evaluation II score, the mean length of stay for the patients with VAP caused by drug-susceptible pathogens (15.2 days [95% CI, 14.6-15.8]) and by drug-resistant pathogens (17.8 days [95% CI, 17.0-18.6]) was significantly longer than that in the patients without nosocomial infection (6.8 days [95% CI, 6.7-6.9]). The mean duration of mechanical ventilation in the patients with VAP caused by drug-susceptible pathogens (12.0 days [95% CI, 11.5-12.5]) and drug-resistant pathogens (14.1 days [95% CI, 13.5-14.8]) was significantly longer than that in the patients without nosocomial infection (4.7 days [95% CI, 4.6-4:8]).Conclusion.The incidence of VAP is substantial among ICU patients in Japan. The potential impact of VAP on patient outcomes emphasizes the importance of preventive measures against VAP, especially for VAP caused by drug-resistant pathogens.

Epidemiology of Ventilator-Associated Pneumonia in a Long-Term Acute Care Hospital

2009 ◽  
Vol 30 (4) ◽  
pp. 319-324 ◽  
Author(s):  
Allan J. Walkey ◽  
Christine Campbell Reardon ◽  
Carol A. Sulis ◽  
R. Nicholas Nace ◽  
Martin Joyce-Brady
Keyword(s):  
Mechanical Ventilation ◽  
Length Of Stay ◽  
Acute Care ◽  
Acute Care Hospital ◽  
Ventilator Associated Pneumonia ◽  
Care Hospital ◽  
Specialty Hospital ◽  
Control And Prevention ◽  
Vap Bundle

Objective.To characterize the epidemiology and microbiology of ventilator-associated pneumonia (VAP) in a long-term acute care hospital (LTACH).Design.Retrospective study of prospectively identified cases of VAP.Setting.Single-center, 207-bed LTACH with the capacity to house 42 patients requiring mechanical ventilation, evaluated from April 1, 2006, through January 31, 2008.Methods.Data on the occurrence of VAP were collected prospectively as part of routine infection surveillance at Radius Specialty Hospital. After March 2006, Radius Specialty Hospital implemented a bundle of interventions for the prevention of VAP (hereafter referred to as the VAP-bundle approach). A case of VAP was defined as a patient who required mechanical ventilation at Radius Specialty Hospital for at least 48 hours before any symptoms of pneumonia appeared and who met the Centers for Disease Control and Prevention criteria for VAP. Sputum samples were collected from a tracheal aspirate if there was clinical suspicion of VAP, and these samples were semi-quantitatively cultured.Results.During the 22-month study period, 23 cases of VAP involving 19 patients were associated with 157 LTACH admissions (infection rate, 14.6%), corresponding to a rate of 1.67 cases per 1,000 ventilator-days, which is a 56% reduction from the VAP rate of 3.8 cases per 1,000 ventilator-days reported before the implementation of the VAP-bundle approach (P<.001). Microbiological data were available for 21 (91%) of 23 cases of VAP. Cases of VAP in the LTACH were frequently polymicrobial (mean number ± SD, 1.78 ± 1.0 pathogens per case of VAP), and 20 (95%) of 21 cases of VAP had at least 1 pathogen (Pseudomonas species, Acinetobacter species, gram-negative bacilli resistant to more than 3 antibiotics, or methicillin-resistant Staphylococcus aureus) cultured from a sputum sample. LTACH patients with VAP were more likely to have a neurological reason for ventilator dependence, compared with LTACH patients without VAP (69.6% of cases of VAP vs 39% of cases of respiratory failure; P = .014). In addition, patients with VAP had a longer length of LTACH stay, compared with patients without VAP (median length of stay, 131 days vs 39 days; P = .002). In 6 (26%) of 23 cases of VAP, the patient was eventually weaned from use of mechanical ventilation. Of the 19 patients with VAP, 1 (5%) did not survive the LTACH stay.Conclusions.The VAP rate in the LTACH is lower than the VAP rate reported in acute care hospitals. Cases of VAP in the LTACH were frequently polymicrobial and were associated with multidrug-resistant pathogens and increased length of stay. The guidelines from the Centers for Disease Control and Prevention that are aimed at reducing cases of VAP appear to be effective if applied in the LTACH setting.

Sign in / Sign up

Export Citation Format

Share Document