scholarly journals The importance of oral hygiene in reducing the incidence of ventilator-associated pneumonia

2019 ◽  
Vol 3 (1) ◽  
pp. 103-111
Author(s):  
Ema Buković ◽  
Biljana Kurtović
Keyword(s):  
Intensive Care ◽  
Incidence Rate ◽  
Oral Hygiene ◽  
Oral Care ◽  
Public Health Problem ◽  
Preventive Measure ◽  
Incidence Rates ◽  
Major Public Health Problem ◽  
Ventilator Associated Pneumonia ◽  
Pubmed Database

Introduction. Healthcare-associated infections (HCAIs) represent a major public health problem. Inadequate oral hygiene in intensive care units has been recognized as a critical issue for the occurrence of one of these infections – ventilator-associated pneumonia (VAP). Although literature suggests diverse oral care measures for ICU patients, the effectiveness of each is still a subject for further trials. Aim. The purpose of this paper is to determine the association between diverse oral care measures and the incidence of ventilator associated pneumonia. Methods. A systematic review of literature in the PubMed database that evaluates the performance of diverse oral care measures and their impact in reducing the incidence of VAP. The keywords used as search terms were: oral hygiene, ventilator-associated pneumonia, intensive care unit and nursing. Results. Four articles in total were taken into consideration in accordance with the availability of full-text articles and years of publication between 2009 and 2019. Performance results of diverse oral care measures haven’t shown statistically significant differences, but the implementation of oral care as a preventive measure against VAP showed a significant role in lower incidence rates. Conclusion. The results of the systematic literature review confirmed the importance of oral care in lowering the incidence rate of VAP. However, significant differences have been noted between the efficiency of diverse oral care measures and the incidence rate of VAP.

#52: Role of Good Oral Hygiene in Reducing and Preventing Ventilator-associated Pneumonia (VAP) in the Intensive Care Unit (ICU) in a Tertiary Care Hospital

2021 ◽  
Vol 10 (Supplement_1) ◽  
pp. S20-S20
Author(s):  
Mansoor Asma ◽  
Sohani Komal
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Oral Hygiene ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Oral Care ◽  
Chlorhexidine Gluconate ◽  
Ventilator Associated Pneumonia ◽  
Care Hospital ◽  
Vap Bundle

Abstract Background Ventilator-associated pneumonia (VAP) is when a patient who received mechanical ventilation for at least 48 hours develops pneumonia. According to the literature, the prevalence rate of VAP in patients experiencing mechanical ventilation is 9%–68%, its resulting mortality is 30%–70%, it also extends hospital and ICU stay by 6–7 days, raises healthcare costs by $40,000 per patient. VAP is a serious complication in the critically ill one factor causing VAP is an aspiration of oral colonization which may result from poor oral hygiene care. Oral hygiene care using either a mouth rinse or with help of forceps and gauze or combination together with the aspiration of secretion can reduce the risk of VAP in these critically ill patients. Method The main aim of this study was to evaluate the effect of strengthening oral hygiene practices and develop cost-effective and easy to use protocols of oral hygiene for ventilator-dependent patients. This study is an observational study conducted in all intensive care unit at tertiary care hospital, 41 bedded inpatient critical care area including high dependency unit (HDU)/coronary care unit (CCU), medical intensive care unit (MICU), surgical intensive care unit (SICU), neonate intensive care unit (NICU) and pediatric intensive care unit (PICU). Approximately 500 patients were admitted monthly to the intensive care unit. All ventilated patients admitted to the intensive care unit are included. Intervention is done in three phases: firstly, VAP device-associated infection (DAI’s) surveillance initiated according to the CDC guideline. HAI’s surveillance was done on daily basis. Secondly, educate staff regarding DAI’s surveillance, VAP bundle, Oral care and suction technique of ventilated patient). Ongoing training and hands-on practice on mannequin and also perform sign-off on the patient first under supervision of Nurse instructor and infection control officers. Finally, VAP bundle was initiated which include elevation of head, daily sedation vacation, and assessment of readiness to extubate, daily oral hygiene care, and assessment of stress ulcer and deep venous thrombosis prophylaxis. Result Before implementation, we just calculate all pneumonia rates together not using proper guidelines. But after we follow CDC guideline for DAI’s surveillance, we trained more than 50% of critical care staff out of 93 staffs, and 90% to 95% compliance of using chlorhexidine gluconate for oral care at least per shift and also as per patient needed observed in ventilated patients. Conclusion The implementation of these changes in practices along with using chlorhexidine gluconate products has made it possible to achieve goal and staff perform work according to the best practice guideline. Oral care hygiene using chlorhexidine gluconate (CHG) as an element of the ventilator bundle is supposed to decontaminate the mouth, avoid aspiration of contaminated secretion into the respiratory tract and prevent VAP.

scholarly journals Suicides in Belgrade, Serbia in the period 2009-2018

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
S Miltenovic ◽  
M Vujetic
Keyword(s):  
Public Health ◽  
Incidence Rate ◽  
Health Problem ◽  
Causes Of Death ◽  
Age Groups ◽  
Public Health Problem ◽  
Incidence Rates ◽  
Major Public Health Problem ◽  
Health It ◽  
Icd 10

Abstract Background Suicides fall in violent deaths and more recently have shown an increasing trend in developed and developing countries. This is a major public health problem that could and should be prevented. Unfortunately, it is among the top twenty leading causes of death worldwide. This public health problem exists in Belgrade and Serbia, as well. Methods An analysis of death certificates shows an insight into the causes of death of inhabitants of Belgrade. The paper presents data from the Database of deceased persons in Belgrade, for the period 2009- 2018. Data are analyzed using frequencies and incidence rates by sex, age groups, month of death, day of death, and municipality of residence of deceased. Results In Belgrade, from 2009 to 2018 the incidence rate of suicides is decreasing. The standardized suicide rate was highest in 2009 (12/100.000). Men often committed suicides at all observed years, and the rates are usually higher as in women. The highest number of suicides occur in April, July and June and observing days within a week Wednesday and Tuesday lead. The average age of men who committed suicide was 57 years and women 59.5 years. The most common method of carrying out the suicide was 'by hanging, strangulation and suffocation' (X70 according to ICD-10) and frequency was 45.2%. Conclusions The incidence rate of suicides at Belgrade territory shows the trend of decline in the observed period, between 2009 and 2018. Besides that, other attributes indicate that age-sex-manner of suicides could be changed, as for being targeted for prevention. Preventing suicides is a new challenge for public health and all public sectors have to be involved in prevention. Considering ageing of a population, migration and other negative demographic trends in Belgrade and Serbia, it is necessary to raise our competencies in inhibition of these unfortunate events. Key messages Preventing suicides is a challenge for public health. It is necessary to raise competencies in order to prevent suicides.

Systematic Literature Review of Oral Hygiene Practices for Intensive Care Patients Receiving Mechanical Ventilation

2007 ◽  
Vol 16 (6) ◽  
pp. 552-562 ◽  
Author(s):  
Angela M. Berry ◽  
Patricia M. Davidson ◽  
Janet Masters ◽  
Kaye Rolls
Keyword(s):  
Mechanical Ventilation ◽  
Intensive Care ◽  
Randomized Controlled Trials ◽  
Oral Hygiene ◽  
Oral Care ◽  
Controlled Trials ◽  
Ventilator Associated Pneumonia ◽  
Intensive Care Patients ◽  
Randomized Controlled ◽  
Hygiene Practices

Background Oropharyngeal colonization with pathogenic organisms contributes to the development of ventilator-associated pneumonia in intensive care units. Although considered basic and potentially nonessential nursing care, oral hygiene has been proposed as a key intervention for reducing ventilator-associated pneumonia. Nevertheless, evidence from randomized controlled trials that could inform best practice is limited. Objective To appraise the peer-reviewed literature to determine the best available evidence for providing oral care to intensive care patients receiving mechanical ventilation and to document a research agenda for this important activity in optimizing patients’ outcomes. Methods Articles published from 1985 to 2006 in English and indexed in the CINAHL, MEDLINE, Joanna Briggs Institute, Cochrane Library, EMBASE, and DARE databases were searched by using the key terms oral hygiene, oral hygiene practices, oral care, mouth care, mouth hygiene, intubated, mechanically ventilated, intensive care, and critical care. Reference lists of retrieved journal articles were searched for publications missed during the primary search. Finally, the Google search engine was used to do a comprehensive search of the World Wide Web to ensure completeness of the search. The search strategy was verified by a health librarian. Results The search yielded 55 articles: 11 prospective controlled trials, 20 observational studies, and 24 descriptive reports. Methodological issues and the heterogeneity of samples precluded meta-analysis. Conclusions Despite the importance of providing oral hygiene to intensive care patients receiving mechanical ventilation, high-level evidence from rigorous randomized controlled trials or high-quality systematic reviews that could inform clinical practice is scarce.

scholarly journals Fragility Fractures and Imminent Fracture Risk in the Spanish Population: A Retrospective Observational Cohort Study

2021 ◽  
Vol 10 (5) ◽  
pp. 1082
Author(s):  
Maria-José Montoya-García ◽  
Mercè Giner ◽  
Rodrigo Marcos ◽  
David García-Romero ◽  
Francisco-Jesús Olmo-Montes ◽  
...  
Keyword(s):  
Cohort Study ◽  
Incidence Rate ◽  
Public Health Problem ◽  
Osteoporotic Fractures ◽  
Fragility Fractures ◽  
Population Based ◽  
High Morbidity ◽  
Major Public Health Problem ◽  
Skeletal Site ◽  
Mortality Incidence

Fragility fractures constitute a major public health problem worldwide, causing important high morbidity and mortality rates. The aim was to present the epidemiology of fragility fractures and to assess the imminent risk of a subsequent fracture and mortality. This is a retrospective population-based cohort study (n = 1369) with a fragility fracture. We estimated the incidence rate of index fragility fractures and obtained information on the subsequent fractures and death during a follow-up of up to three years. We assessed the effect of age, sex, and skeletal site of index fracture as independent risk factors of further fractures and mortality. Incidence rate of index fragility fractures was 86.9/10,000 person-years, with highest rates for hip fractures in women aged ≥80 years. The risk of fracture was higher in subjects with a recent fracture (Relative Risk(RR), 1.80; p < 0.01). Higher age was an independent risk factor for further fracture events. Significant excess mortality was found in subjects aged ≥80 years and with a previous hip fracture (hazard ratio, 3.43 and 2.48, respectively). It is the first study in Spain to evaluate the incidence of major osteoporotic fractures, not only of the hip, and the rate of imminent fracture. Our results provide further evidence highlighting the need for early treatment.

scholarly journals Oral care and nosocomial pneumonia: a systematic review

2015 ◽  
Vol 13 (2) ◽  
pp. 290-296 ◽  
Author(s):  
Maria Carolina Nunes Vilela ◽  
Gustavo Zanna Ferreira ◽  
Paulo Sérgio da Silva Santos ◽  
Nathalie Pepe Medeiros de Rezende
Keyword(s):  
Systematic Review ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Nosocomial Pneumonia ◽  
Oral Hygiene ◽  
Oral Care ◽  
Control Group ◽  
Level Of Evidence ◽  
Grade Of Recommendation ◽  
Minimal Bias

To perform a systematic review of the literature on the control of oral biofilms and the incidence of nosocomial pneumonia, in addition to assessing and classifying studies as to the grade of recommendation and level of evidence. The review was based on PubMed, LILACS, and Scopus databases, from January 1st, 2000 until December 31st, 2012. Studies evaluating oral hygiene care related to nosocomial infections in patients hospitalized in intensive care units were selected according to the inclusion criteria. Full published articles available in English, Spanish, or Portuguese, which approached chemical or mechanical oral hygiene techniques in preventing pneumonia, interventions performed, and their results were included. After analysis, the articles were classified according to level of evidence and grade of recommendation according to the criteria of the Oxford Centre for Evidence-Based Medicine. A total of 297 abstracts were found, 14 of which were full articles that met our criteria. Most articles included a study group with chlorhexidine users and a control group with placebo users for oral hygiene in the prevention of pneumonia. All articles were classified as B in the level of evidence, and 12 articles were classified as 2B and two articles as 2C in grade of recommendation. It was observed that the control of oral biofilm reduces the incidence of nosocomial pneumonia, but the fact that most articles had an intermediate grade of recommendation makes clear the need to conduct randomized controlled trials with minimal bias to establish future guidelines for oral hygiene in intensive care units.

scholarly journals Spatio-temporal dynamics of schistosomiasis in Rwanda between 2001 and 2012: impact of the national Neglected Tropical Disease control programme

2017 ◽  
Vol 12 (1) ◽  
Author(s):  
Elias Nyandwi ◽  
Tom Veldkamp ◽  
Frank Badu Osei ◽  
Sherif Amer
Keyword(s):  
Temporal Dynamics ◽  
Public Health Problem ◽  
Incidence Rates ◽  
Control Programme ◽  
Scan Statistics ◽  
Major Public Health Problem ◽  
Implementation Phase ◽  
Incidence Data ◽  
Spatio Temporal ◽  
The Impact

Schistosomiasis is recognised as a major public health problem in Rwanda. We aimed to identify the spatio-temporal dynamics of its distribution at a fine-scale spatial resolution and to explore the impact of control programme interventions. Incidence data of Schistosoma mansoni infection at 367 health facilities were obtained for the period 2001-2012. Disease cluster analyses were conducted using spatial scan statistics and geographic information systems. The impact of control interventions was assessed for three distinct sub-periods. Findings demonstrated persisting, emerging and re-emerging clusters of schistosomiasis infection across space and time. The control programme initially caused an abrupt increase in incidence rates during its implementation phase. However, this was followed by declining and disappearing clusters when the programme was fully in place. The findings presented should contribute to a better understanding of the dynamics of schistosomiasis distribution to be used when implementing future control activities, including prevention and elimination efforts.

A multi-state spatio-temporal Markov model for categorized incidence of meningitis in sub-Saharan Africa

2012 ◽  
Vol 141 (8) ◽  
pp. 1764-1771 ◽  
Author(s):  
L. AGIER ◽  
M. STANTON ◽  
G. SOGA ◽  
P. J. DIGGLE
Keyword(s):  
Positive Predictive Value ◽  
Predictive Value ◽  
Public Health Problem ◽  
Incidence Rates ◽  
Sub Saharan Africa ◽  
Major Public Health Problem ◽  
Temporal Dependence ◽  
Spatio Temporal ◽  
Sub Saharan ◽  
Annual Scale

SUMMARYMeningococcal meningitis is a major public health problem in the African Belt. Despite the obvious seasonality of epidemics, the factors driving them are still poorly understood. Here, we provide a first attempt to predict epidemics at the spatio-temporal scale required for in-year response, using a purely empirical approach. District-level weekly incidence rates for Niger (1986–2007) were discretized into latent, alert and epidemic states according to pre-specified epidemiological thresholds. We modelled the probabilities of transition between states, accounting for seasonality and spatio-temporal dependence. One-week-ahead predictions for entering the epidemic state were generated with specificity and negative predictive value >99%, sensitivity and positive predictive value >72%. On the annual scale, we predict the first entry of a district into the epidemic state with sensitivity 65·0%, positive predictive value 49·0%, and an average time gained of 4·6 weeks. These results could inform decisions on preparatory actions.

Nurses’ Implementation of Guidelines for Ventilator-Associated Pneumonia From the Centers for Disease Control and Prevention

2007 ◽  
Vol 16 (1) ◽  
pp. 28-37 ◽  
Author(s):  
Carolyn L. Cason ◽  
Tracy Tyner ◽  
Sue Saunders ◽  
Lisa Broome
Keyword(s):  
Intensive Care ◽  
Disease Control ◽  
Intensive Care Units ◽  
Oral Care ◽  
The United States ◽  
Hand Washing ◽  
Ventilator Associated Pneumonia ◽  
Care Protocol ◽  
Control And Prevention ◽  
Centers For Disease Control

• Background Ventilator-associated pneumonia accounts for 47% of infections in patients in intensive care units. Adherence to the best nursing practices recommended in the 2003 guidelines for the prevention of ventilator-associated pneumonia from the Centers for Disease Control and Prevention should reduce the risk of ventilator-associated pneumonia. • Objective To evaluate the extent to which nurses working in intensive care units implement best practices when managing adult patients receiving mechanical ventilation. • Methods Nurses attending education seminars in the United States completed a 29-item questionnaire about the type and frequency of care provided. • Results Twelve hundred nurses completed the questionnaire. Most (82%) reported compliance with hand-washing guidelines, 75% reported wearing gloves, half reported elevating the head of the bed, a third reported performing subglottic suctioning, and half reported having an oral care protocol in their hospital. Nurses in hospitals with an oral care protocol reported better compliance with hand washing and maintaining head-of-bed elevation, were more likely to regularly provide oral care, and were more familiar with rates of ventilator-associated pneumonia and the organisms involved than were nurses working in hospitals without such protocols. • Conclusions The guidelines for the prevention of ventilator-associated pneumonia from the Centers for Disease Control and Prevention are not consistently or uniformly implemented. Practices of nurses employed in hospitals with oral care protocols are more often congruent with the guidelines than are practices of nurses employed in hospitals without such protocols. Significant reductions in rates of ventilator-associated pneumonia may be achieved by broader implementation of oral care protocols.

scholarly journals Spatial and temporal trend analysis of bovine brucellosis in Brazil, 2014 to 2018

2020 ◽  
Vol 41 (4) ◽  
pp. 1279
Author(s):  
Claudia Mello Ribeiro ◽  
Jonas Lotufo Brant de Carvalho ◽  
Paula Andrea de Santis Bastos ◽  
Rodrigo Guerrero Mendes ◽  
Satie Katagiri ◽  
...  
Keyword(s):  
Incidence Rate ◽  
Animal Health ◽  
Health Information System ◽  
Temporal Distribution ◽  
Public Health Problem ◽  
Secondary Data ◽  
Incidence Rates ◽  
Prevention Measures ◽  
Bovine Brucellosis ◽  
Mato Grosso

Bovine brucellosis, a zoonotic disease endemic to Brazil, is a serious public health problem. It is a notifiable disease that, like tuberculosis, is regulated through a national control and eradication program. The epidemiological status of bovine brucellosis must be characterized in order to direct measures aimed at controlling the disease. This study focused on analyzing the spatial and temporal distribution of bovine brucellosis in Brazil. An ecological and time series study was conducted based on secondary data reported by the National Animal Health Information System for cases of bovine brucellosis diagnosed in Brazil (2014 - 2018). The gross and average incidence rate of brucellosis was estimated per state. Joinpoint regression was applied to calculate the annual percentage change (APC) in incidence and to identify states with significant trend changes. Spatial analysis of animals with brucellosis was performed using Kernel density estimation. A total of 19,631 animals with bovine brucellosis were confirmed, and the average incidence rate varied from 0.03 to 33.93/100,000 cattle in Brazil. The highest density of positive animals was found in the states of Santa Catarina and Paraná, which can be considered areas of greater transmission of Brucella abortus. Reductions in gross incidence rates were observed in Paraná (APC: -13.2; 95% confidence interval [CI]: -20.3 – -5.4; p=0.01), Rondônia (APC: -44.7; 95%CI: -62.0 - -19.4; p=0.01), Mato Grosso do Sul (APC: -59.0; 95%CI: -77.7 - -24.5; p=0.01), Acre (APC: -40.0; 95%CI: -50.0 - -28.0; p=0.00), and Ceará (APC: -37.9; 95%CI: -50.9 - -21.4; p=0.00). The incidence rate significantly increased in Tocantins (APC: 122.1; 95%CI: 4.5 - 372.2; p=0.04). The findings of this study will be helpful in guiding surveillance and prevention measures aimed at reducing the incidence of bovine brucellosis in Brazil.

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