scholarly journals Application of an Automatic Medical Information System to Implement Bundle Care for the Prevention of Ventilator-Associated Pneumonia

2021 ◽  
Vol 18 (21) ◽  
pp. 11128
Author(s):  
Hung-Hui Lee ◽  
Li-Ying Lin ◽  
Hsiu-Fen Yang ◽  
Yu-Yi Tang ◽  
Pei-Hern Wang
Keyword(s):  
Intensive Care Unit ◽  
Information System ◽  
Intensive Care ◽  
Oral Hygiene ◽  
Medical Information ◽  
Medical Information System ◽  
Care Bundle ◽  
Control Group ◽  
Ventilator Associated Pneumonia ◽  
Care Bundles

Ventilator-associated pneumonia is a common hospital-acquired infection. It causes patients to stay longer in the hospital and increases medical costs. This study explores the effect of applying an automatic medical information system to implement five-item prevention care bundles on the prevention of ventilator-related pneumonia. This study was a retrospective cohort study. This study was conducted from October 2017 to February 2018 and collected data from the intensive care unit of a medical center in southern Taiwan from January 2013 to May 2016. The control group (enrolled from January 2013 to June 2014) received oral hygiene. The experimental group (enrolled from July 2014 to December 2015) received five-item ventilator-associated pneumonia prevention care bundles, which consisted of (1) elevation of the head of the bed to 30–45°; (2) daily oral care with 0.12−0.2% chlorhexidine twice daily; (3) daily assessment of readiness to extubate; (4) daily sedative interruption; and (5) emptying water from the respirator tube. Results showed the incidence of ventilator-associated pneumonia in the bundle group was significantly less than the oral hygiene group (p = 0.029). The factors that significantly affected the incidence of ventilator-associated pneumonia were ventilator-associated pneumonia care bundle, ventilator-days, and intensive care unit length of stay. A significant reduction in ventilator-associated pneumonia rate in the bundle group compared to the oral hygiene group (OR = 0.366, 95% CI = 0.159–0.840) was observed, with 63.4% effectiveness. Application of an automatic medical information system to implement bundle care can significantly reduce the incidence of ventilator-associated pneumonia.

scholarly journals The clinical decision support system for sepsis as an important part of the medical and economic component of a hospital

2019 ◽  
Vol 47 (3) ◽  
pp. 204-211
Author(s):  
V. I. Gorban ◽  
M. Yu. Bakhtin ◽  
A. V. Shchegolev ◽  
Yu. V. Lobanova
Keyword(s):  
Intensive Care Unit ◽  
Septic Shock ◽  
Information System ◽  
Severe Sepsis ◽  
Intensive Care ◽  
Clinical Decision Support System ◽  
Medical Information ◽  
Clinical Decision ◽  
Medical Information System ◽  
Sepsis And Septic Shock

Aim: To evaluate an impact of a clinical decision support system (CDSS) in the clinical practice of a hospital on the quality and costs of treatment of patients with severe sepsis and septic shock.Materials and methods: We performed a retrospective analysis of the database in the medical information system qMS (SP.ARM, Russia, St. Petersburg) from 2015 to 2017 on 37,997 patients. In the first study period from January 2015 to June 2016, we analyzed the results of the conventional treatment regimen. From May to June 2016, the CDSS module was implemented into the qMS and the personnel was trained correspondingly. The data collected during the second study period mirrored the results of sepsis treatment with the use of CDSS. We assessed the average number of in-hospital days, duration of stay in the intensive care unit, number of septic shock cases, mortality, and treatment costs.Results: The diagnosis of sepsis was confirmed in 67 patients: in 1.4‰ (27/18,792) before the CDSS was implemented versus 2.1‰ (40/19,205) after the CDSS implementation (p < 0.01). It was found that the use of CDSS integrated into the hospital medical information system reduced the number of cases of septic shock development (p < 0.05). Lethality decreased by 10%. The sepsis-associated mortality showed a non-significant trend to decrease by 10% (p < 0.1). The implementation of the CDSS incorporated into the qMS helped to reduce the number of septic shock cases from 26% (7/27) to 7.5% (3/40) (p < 0.05). There was also a trend towards reduced duration of stay in intensive care unit, as well as towards decreased costs of sepsis treatment by 13% and efferent (extra-corporeal) treatments by 29%; however, the differences were not significant.Conclusion: The CDSS implementation for electronic monitoring of the patient's condition and changes in his/hers parameters allowed for an earlier diagnosis of sepsis. We identified some prerequisites for more rational utilization of medical resources, mainly due to early, targeted treatment of patients with severe sepsis and septic shock; however, additional studies are necessary.

scholarly journals Oral Care Effect on Intubated Patient with 0.2 per cent Chlorhexidine Gluconate and Tooth Brushing in Intensive Care Unit

2017 ◽  
Vol 8 (1-2) ◽  
pp. 26-33
Author(s):  
Mohammad Khan ◽  
Zeehaida Mohamed ◽  
Saedah Ali ◽  
Norkhafizah Saddki ◽  
Sam’an Malik Masudi ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Oral Care ◽  
Chlorhexidine Gluconate ◽  
Tooth Brushing ◽  
Control Group ◽  
Ventilator Associated Pneumonia ◽  
Statistical Software ◽  
Patient Screening ◽  
Experimental Group

Aims and Objectives: Ventilator-associated pneumonia is associated with increased morbidity and mortality. The aim of this pilot study was to determine the effectiveness of oral care with both tooth brushing and 0.2 per cent chlor-hexidine gluconate compared to 0.2 per cent chlorhexidine gluconate alone for the intubated patient in an intensive care unit (ICU). Materials and Methods: Patient screening was done over a period of two months. After taking informed consent, those ICU patients were divided into two groups. Only nine subjects were enrolled. During the study, the experimental group (N = 4) got oral care that consisted of both tooth brushing and 0.2 per cent chlorhexidine gluconate thrice a day. The control group got oral care with 0.2 per cent chlorhexidine gluconate alone thrice a day. The data were analysed by IBM statistical software SPPS, version 24. Results: Preliminary results suggest that the risk of ventilator-associated pneumonia in intubated patients can be reduced by maintaining thrice-daily oral care involving both tooth brushing and 0.2 per cent chlorhexidine gluconate. Conclusion: Thrice-daily oral care consisted of both tooth brushing and 0.2 per cent chlorhexidine gluconate might be a promise as a ventilator-associated pneumonia-reduction strategy in ICU. Furthermore, more studies are required for its application widely.

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 EFFECTIVENESS OF SUCTION ABOVE CUFF ENDOTRACHEAL TUBE (SACETT) IN PREVENTING VENTILATOR ASSOCIATED PNEUMONIA IN CRITICAL PATIENTS IN INTENSIVE CARE UNIT

2018 ◽  
Vol 4 (4) ◽  
pp. 380-389
Author(s):  
Arfiyan Sukmadi ◽  
Rr Sri Endang Pujiastuti ◽  
Aris Santjaka ◽  
Supriyadi Supriyadi
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Endotracheal Tube ◽  
Intervention Group ◽  
Control Group ◽  
Ventilator Associated Pneumonia ◽  
Mechanical Ventilator ◽  
Control Group Design ◽  
Bacterial Development ◽  
Critical Patients

Background: The mechanical ventilator is an indispensable breathing tool in the Intensive Care Unit (ICU). But the mechanical ventilator is associated with the risk of Ventilator Associated Penumonia (VAP). VAP occurs due to poor hygiene of the endotracheal tube (ETT). ETT hygiene should be maintained to inhibit bacterial development in the lungs using suction above cuff endotracheal tube (SACETT) to prevent VAP.Objective: To analyze the effectiveness of SACETT in preventing Ventilator Associated Pneumonia (VAP) in critical patients in the ICU.Methods: This was a quasy experimental study with posttest only with control group design with 15 samples in intervention group (SACETT and Chlorhexidine 0.2%) and 15 in control group (ETT, Open Suction, and Chlorhexidine 0.2%) with purposive technique sampling. The Simplified Clnical Pulmonary Infection Score (CPIS) was used to measure VAP.Results: This study illustrates that there was no VAP incidence in the intervention group, and as much as 13.3% VAP in the control group. SACETT was more effective in preventing VAP than in standard ETT on day 4 (p = 0.001).Conclusion: SACETT is more effective in preventing VAP than standard ETT in the fourth day in patients with neurological, cardiovascular, urinary, digestive, and immune system disorders.

#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 The effect of ventilator-associated pneumonia on the prognosis of intensive care unit patients within 90 days and 180 days

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Wenjuan Luo ◽  
Rui Xing ◽  
Canmin Wang
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Medical Information ◽  
Length Of Hospital Stay ◽  
Simplified Acute Physiology Score ◽  
Serum Lactate ◽  
Binary Logistic Regression Analysis ◽  
Ventilator Associated Pneumonia ◽  
Icu Patients

Abstract Background Mechanical ventilation (MV) is often applied in critically ill patients in intensive care unit (ICU) to protect the airway from aspiration, and supplement more oxygen. MV may result in ventilator-associated pneumonia (VAP) in ICU patients. This study was to estimate the 90-day and 180-day mortalities of ICU patients with VAP, and to explore the influence of VAP on the outcomes of ICU patients. Methods Totally, 8182 patients who aged ≥18 years and received mechanical ventilation (MV) in ICU from Medical Information Mart for Intensive Care III (MIMIC III) database were involved in this study. All subjects were divided into the VAP group (n = 537) and the non-VAP group (n = 7626) based on the occurrence of VAP. Clinical data of all participants were collected. The effect of VAP on the prognosis of ICU patients was explored by binary logistic regression analysis. Results The results delineated that the 90-day mortality of VAP patients in ICU was 33.33% and 180-day mortality was 37.62%. The 90-day and 180-day mortality rates were higher in the VAP group than in the non-VAP group. After adjusting the confounders including age, ethnicity, heart failure, septicemia, simplified acute physiology score II (SAPSII) score, sequential organ failure assessment (SOFA) score, serum lactate, white blood cell (WBC), length of ICU stay, length of hospital stay, length of ventilation, antibiotic treatment, Pseudomonas aeruginosa (P.aeruginosa), methicillin-resistant Staphylococcus aureus (MRSA), other pathogens, the risk of 90-day and 180-day mortalities in VAP patients were 1.465 times (OR = 1.465, 95%CI: 1.188–1.807, P < 0.001) and 1.635 times (OR = 1.635, 95%CI: 1.333–2.005, P < 0.001) higher than those in non-VAP patients, respectively. Conclusions Our study revealed that ICU patients with VAP had poorer prognosis than those without VAP. The results of this study might offer a deeper insight into preventing the occurrence of VAP.

scholarly journals Care bundle for ventilator-associated pneumonia in a medical intensive care unit in Northern Taiwan

2015 ◽  
Vol 35 (2) ◽  
pp. 68 ◽  
Author(s):  
Wen-Chii Tzeng ◽  
Bing-Hsiean Tzeng ◽  
Wen-Ping Zeng ◽  
Han Su ◽  
Chein-Wen Chen ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Medical Intensive Care Unit ◽  
Care Bundle ◽  
Ventilator Associated Pneumonia ◽  
Medical Intensive Care ◽  
Northern Taiwan

scholarly journals Nursing actions for the prevention of ventilator-associated pneumonia

2012 ◽  
Vol 25 (spe1) ◽  
pp. 101-107 ◽  
Author(s):  
Fernanda Alves Ferreira Gonçalves ◽  
Virginia Visconde Brasil ◽  
Luana Cássia Miranda Ribeiro ◽  
Anaclara Ferreira Veiga Tipple
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Observational Study ◽  
Oral Hygiene ◽  
Ventilator Associated Pneumonia ◽  
Mechanical Ventilator ◽  
Ventilator Circuit ◽  
Cross Sectional ◽  
Nursing Team ◽  
The One

OBJECTIVE: To identify prevention actions of the nursing team related to ventilator-associated pneumonia (VAP). METHOD: A cross-sectional, observational study conducted in an Intensive Care Unit of a teaching hospital in Goiania/GO. RESULTS: Hand hygiene occurred, mainly, after the procedures and most of care, such as elevating the head-of-bed, bronchial and oral hygiene, diet administration, also handlingmechanical ventilator circuits were not adequate and if experienced groups such as the one in the present study are not following the recommendations emerging from evidence, it may indicate that, for some reason, the learning is not being significant. CONCLUSION: Most recommendedmeasures to reduce VAP related to positioning the head-of-bed, bronchial and oral hygiene, administration of diet and handling mechanical ventilator circuit were not followed.

Prediction of Hypotension Events with Physiologic Vital Sign Signatures in The Intensive Care Unit

2020 ◽  
Author(s):  
Joo Heung Yoon ◽  
Vincent Jeanselme ◽  
Artur Dubrawski ◽  
Marilyn Hravnak ◽  
Michael R. Pinsky ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Risk Score ◽  
Medical Information ◽  
Characteristic Curve ◽  
Real Life ◽  
Vital Signs ◽  
Control Group ◽  
Alert System ◽  
And Performance

Abstract Background. Even brief hypotension is associated with increased morbidity and mortality. We developed a machine learning model to predict the initial hypotension event among intensive care unit (ICU) patients, and designed an alert system for bedside implementation. Materials and Methods. From the Medical Information Mart for Intensive Care III (MIMIC-3) dataset minute-by-minute vital signs were extracted. A hypotension event was defined as at least 5 measurements within a 10-minute period of systolic blood pressure ≤ 90 mmHg and mean arterial pressure ≤ 60 mmHg. A random forest (RF) classifier was used to predict hypotension, and performance was measured with area under the receiver operating characteristic curve (AUROC) and area under the precision recall curve (AUPRC). Hypotension alerts were generated using risk score thresholds, then a stacked RF model and a lock-out time were applied for real-life implementation. Results. We identified 1307 subjects (1580 ICU stays) as the case (hypotension) group and 1619 subjects (2279 ICU stays) as the control group. The RF model showed AUROC of 0.93 and 0.88 at 15 and 60 minutes respectively before hypotension, and AUPRC of 0.77 at 60 minutes before. Risk score trajectories revealed 80% and > 60% of cases predicted at 15 and 60 minutes before the hypotension, respectively. The stacked model with 15-minute lock-out produced on average 0.79 alerts/subject/hour (sensitivity 92.4%). Conclusion. Clinically significant hypotension events in the ICU can be predicted at least 1 hour before the initial hypotension episode. Developing a high-sensitive and reliable practical alert system is feasible, with low rate of alerts.

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