scholarly journals ADHERENCE TO VENTILATOR-ASSOCIATED PNEUMONIA PREVENTION MEASURES IN INTENSIVE CARE

2020 ◽  
Vol 6 ◽  
Author(s):  
Fabiola Alves Gomes ◽  
Denise Von Dolinger de Brito Röder ◽  
Thúlio Marquez Cunha ◽  
Geraldo Magela Cardoso Filho ◽  
Clesnan Mendes-Rodrigues ◽  
...  
Keyword(s):  
Intensive Care ◽  
Hospital Stay ◽  
Cuff Pressure ◽  
University Hospital ◽  
Ventilator Associated Pneumonia ◽  
Prevention Measures ◽  
Inclusion Criteria ◽  
Care Costs ◽  
Frequent Infection ◽  
Lower Adherence

Introduction: Ventilator-Associated Pneumonia (VAP) is a frequent infection in patients admitted to intensive care units. The occurrence of VAP prolongs hospital stay and increases health care costs. The objective of this study is to assess adherence of health professionals to a VAP prevention package of interventions (Bundle). Outline: Retrospective, documentary study performed in an intensive care unit of a university hospital. The sample consisted of patients hospitalized in the period from January to June 2014, who met the inclusion criteria. The data collection was carried out through examination of medical records. Results: Increase in hospital stay of patients with VAP and low adherence to Bundle items were verified. Proper cuff pressure and oral hygiene with standardized antiseptic were the items with lower adherence. Implications: The adherence to some Bundle VAP prevention measures was not different between groups of patients (with or without VAP) and showed low values of adherence.

scholarly journals Preventing ventilator-associated pneumonia—a mixed-method study to find behavioral leverage for better protocol adherence

2018 ◽  
Vol 39 (10) ◽  
pp. 1222-1229 ◽  
Author(s):  
Aline Wolfensberger ◽  
Marie-Theres Meier ◽  
Lauren Clack ◽  
Peter W. Schreiber ◽  
Hugo Sax
Keyword(s):  
Focus Group ◽  
Mixed Method ◽  
University Hospital ◽  
Mixed Method Study ◽  
Ventilator Associated Pneumonia ◽  
Theory Approach ◽  
Prevention Measures ◽  
Focus Group Interviews ◽  
Protocol Adherence ◽  
Group Interviews

AbstractObjectivePreventing ventilator-associated pneumonia (VAP) is an important goal for intensive care units (ICUs). We aimed to identify the optimal behavior leverage to improve VAP prevention protocol adherence.DesignMixed-method study using adherence measurements to assess 4 VAP prevention measures and qualitative analysis of semi-structured focus group interviews with frontline healthcare practitioners (HCPs).SettingThe 6 ICUs in the 900-bed University Hospital Zurich in Zurich, Switzerland.Patients and participantsAdherence to VAP prevention measures were assessed in patients with a device for invasive ventilation (ie, endotracheal tube, tracheostomy tube). Participants in focus group interviews included a convenience samples of ICU nurses and physicians.ResultsBetween February 2015 and July 2017, we measured adherence to 4 protocols: bed elevation showed adherence at 27% (95% confidence intervals [CI], 23%–31%); oral care at 41% (95% CI, 36%–45%); sedation interruption at 81% (95% CI, 74%–85%); and subglottic suctioning at 88% (95% CI, 83%–92%). Interviews were analyzed first inductively according a grounded theory approach then deductively against the behavior change wheel (BCW) framework. Main behavioral facilitators belonged to the BCW component ‘reflective motivation’ (ie, perceived seriousness of VAP and self-efficacy to prevent VAP). The main barriers belonged to ‘physical capability’ (ie, lack of equipment and staffing and side-effects of prevention measures). Furthermore, 2 primarily technical approaches (ie, ‘restructuring environment’ and ‘enabling HCP’) emerged as means to overcome these barriers.ConclusionsOur findings suggest that technical, rather than education-based, solutions should be promoted to improve VAP prevention. This theory-informed mixed-method approach is an effective means of guiding infection prevention efforts.

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.

scholarly journals Incidence and Risk Factors for Ventilator-Associated Pneumonia in Kathmandu University Hospital

2012 ◽  
Vol 9 (1) ◽  
pp. 28-31 ◽  
Author(s):  
S Ranjit ◽  
B Bhattarai
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Univariate Analysis ◽  
University Hospital ◽  
Ventilator Associated Pneumonia ◽  
Chi Square ◽  
H2 Blockers ◽  
Observational Cohort ◽  
Level Of Significance

Background Ventilator associated pneumonia is a major cause of morbidity in the intensive care unit. Difficulties in identification of the risk factors, in diagnosing and in prevention, have intensified the problem. Objectives To measure the incidence of ventilator associated pneumonia in intensive care unit and to identify the risk factors associated. Methods A prospective observational cohort study of 69 patients who were mechanically ventilated for more than 48 hours were evaluated to find out the development of nosocomial pneumonia and presence or absence of risk factors. Data were subjected to univariate analysis using chi-square and t-test. Level of significance was set at 0.05. Results Twenty two (31.88%) out of 69 patients developed ventilator associated pneumonia, majority of them between four days to 14 days. Reintubation, invasive lines, H2 blockers and low PaO2/FiO2 were identified as major risk factors in our study. Enteral feeding via nasogastric tube and use of steroids was not associated with development of ventilator associated pneumonia. The patients with ventilator associated pneumonia had significantly longer duration of mechanical ventilation (18.88±7.7 days vs 7.36±4.19 days) and stay (29±17.8 days vs 9.22±5.14 days). The morality was similar for both the groups with or without ventilator associated pneumonia. ConclusionThe incidence of ventilator pneumonia is high. Patients requiring prolonged ventilation, re-intubation, more invasive lines and H2 blockers, are at high risk and need special attention towards prevention.http://dx.doi.org/10.3126/kumj.v9i1.6258 Kathmandu Univ Med J 2011;9(1):28-31 

Prolongation of hospital stay and extra costs due to ventilator-associated pneumonia in an intensive care unit

1992 ◽  
Vol 11 (6) ◽  
pp. 504-508 ◽  
Author(s):  
I. Kappstein ◽  
G. Schulgen ◽  
U. Beyer ◽  
K. Geiger ◽  
M. Schumacher ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Hospital Stay ◽  
Ventilator Associated Pneumonia

scholarly journals Etiology, incidence and mortality in patients with ventilator-associated pneumonia in adult general surgery and cardiac surgery intensive care units in University Hospital Dubrava

2020 ◽  
Vol 39 (4) ◽  
pp. 124-128
Author(s):  
Andrea Karin ◽  
Andrej Šribar ◽  
Marko Pražetina ◽  
Katerina Bakran ◽  
Jasminka Peršec
Keyword(s):  
Cardiac Surgery ◽  
Intensive Care ◽  
Intensive Care Units ◽  
General Surgery ◽  
University Hospital ◽  
Ventilator Associated Pneumonia ◽  
Timely Initiation ◽  
Incidence And Mortality ◽  
Hospital Acquired Pneumonia ◽  
Hospital Acquired

Ventilator-associated pneumonia (VAP) and hospital acquired pneumonia (HAP) strongly contribute to morbidity and mortality in intensive care units. Hospital acquired pneumonia (HAP) is pneumonia occurring 48 hours upon admission and appears not to be incubating at the time of admission. Ventilator-associated pneumonia (VAP) is a type of HAP developing in intubated patients after more than 48 hours upon mechanical ventilation. HAP and VAP are common and serious complications present in hospitalized patients. Since the diagnosis of VAP and HAP are rarely documented, we wanted to assess the incidence of VAP in General Surgery and Cardiac Surgery Intensive Care Units in 2018 and analyse the patients and procedures related factors. Patients intubated and ventilated more than 96 hours during 2018 were included. Our findings have shown that incidence of VAP in two analysed ICUs in UH Dubrava is in line with VAP incidence found in literature due to successful preventive strategies and timely initiation of antimicrobial therapy and other adjunctive procedures.

scholarly journals Investigation on Risk Factors of Ventilator-Associated Pneumonia in Acute Cerebral Hemorrhage Patients in Intensive Care Unit

2017 ◽  
Vol 2017 ◽  
pp. 1-4 ◽  
Author(s):  
Li Chang ◽  
Yun Dong ◽  
Ping Zhou
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Coronary Heart Disease ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Heart Disease ◽  
Hospital Stay ◽  
Cerebral Hemorrhage ◽  
Chronic Obstructive ◽  
Ventilator Associated Pneumonia

Ventilator-associated pneumonia (VAP) is a predominant factor of pulmonary infection. We analyzed the risk factors of VAP with acute cerebral hemorrhage in intensive care unit (ICU) by univariate and multivariate logistic regression analyses. After comparison of 197 cases of the VAP and non-VAP patients, we found that age > 65 years (P=0.003), smoke (P=0.003), coronary heart disease (P=0.005), diabetes (P=0.001), chronic obstructive pulmonary disease (COPD) (P=0.002), ICU and hospital stay (P=0.01), and days on mechanical ventilation (P=0.01) were significantly different, indicating that they are risk factors of VAP. All the age > 65 years (OR = 3.350, 95% CI = 1.936–5.796, P≤0.001), smoke (OR = 3.206, 95% CI = 1.909–5.385, P≤0.001), coronary heart disease (OR = 3.179, 95% CI = 1.015–4.130, P=0.017), diabetes (OR = 5.042, 95% CI = 3.518–7.342, P≤0.001), COPD (OR = 1.942, 95% CI = 1.258–2.843, P=0.012), ICU and hospital stay (OR = 2.34, 95% CI = 1.145–3.892, P=0.038), and days on mechanical ventilation (OR = 1.992, 95% CI = 1.107–3.287, P=0.007) are independent risk factors of VAP. After observation of patients with 6 months of follow-up, the BI score was significantly lower in VAP than that in non-VAP, and the rebleeding rate and mortality rate were significantly higher in VAP than those in non-VAP. Thus, the prognosis of the patients with acute cerebral hemorrhage and VAP in ICU is poor.

scholarly journals Evaluation of a bundle to prevent ventilator-associated pneumonia in an intensive care unit

2014 ◽  
Vol 23 (3) ◽  
pp. 744-750 ◽  
Author(s):  
Sabrina Guterres da Silva ◽  
Raquel Kuerten de Salles ◽  
Eliane Regina Pereira do Nascimento ◽  
Kátia Cilene Godinho Bertoncello ◽  
Cibele D'Avila Kramer Cavalcanti
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Cuff Pressure ◽  
Oral Care ◽  
Ventilator Associated Pneumonia ◽  
Endotracheal Suctioning ◽  
Cross Sectional ◽  
Bed Elevation ◽  
Head Of Bed Elevation ◽  
Expected Compliance

We aimed at evaluating compliance with a bundle to prevent ventilator-associated pneumonia in an Intensive Care Unit. It is a quantitative, descriptive and cross-sectional study, conducted in a public hospital in the state of Santa Catarina. Data were collected in July and August of 2012. The sample consisted of 1,146 observations of the four elements that compose the bundle (head of bed elevation between 30-45°; endotracheal suctioning; cuff pressure between 20-30 cmH2O; and oral care with 0.12% chlorhexidine). Expected compliance was equal to a positivity rate ≥80%. Data analysis revealed overall bundle compliance of 794 (69.2%). When analyzed separately, two practices presented expected compliance (84.7%): oral care and suctioning. Head of bed elevation had the lowest compliance (55.5%), followed by cuff pressure (61.8%). We observed the need for strategies that promote the quality of all the elements that compose the bundle in order for its use to be effective.

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