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Singh C, Abdullah R. Impact of Ventilator-Associated Pneumonia Preventative Measures and Ventilator Bundle Care in a Tertiary Care Hospital's Adult Intensive Care Unit. Cureus 2024; 16:e59877. [PMID: 38854202 PMCID: PMC11157479 DOI: 10.7759/cureus.59877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 05/07/2024] [Indexed: 06/11/2024] Open
Abstract
BACKGROUND The mitigation of ventilator-associated pneumonia (VAP) is a vital undertaking in safeguarding patient well-being. The research aimed to evaluate the impact of a multidisciplinary, comprehensive monitoring approach on VAP incidence in a tertiary medical-surgical-trauma critical care unit. METHODOLOGY The research was conducted within an adult medical-surgical ICU from June 2021 to December 2022. VAP data were collected by prospective targeted surveillance in accordance with the guidelines provided by the National Healthcare Safety Network (NHSN) and the Centers for Disease Control and Prevention. In contrast, a cross-sectional design was used to gather bundle data, according to the defined methodology of the Institute for Healthcare Improvement (IHI), and the rate of variation in admission prior to the bundle's installation was evaluated. RESULT The features of ventilated patients in adult medical-surgical ICUs were studied between 2021 and 2022. Regarding demographics, men comprised 42.6% and 45.3% of VAP patients and 65.3% and 50.7% of bundle care patients, respectively. Notably, 33.1% of patients in VAP and 54.5% in bundle care were over 60 years old. Clinical indicators such as median age (12.6 vs. 8 months for non-VAP vs. VAP patients), antibiotic usage (65% vs. 99% for non-VAP vs. VAP patients), and risk factors like trauma diagnosis (HR: 2.59, 95% CI: 2.07-3.23), and accidental extubation (HR: 4.11, 95% CI: 1.93-8.73) differed significantly between the bundle and non-bundle care groups. A significant increase in bundle compliance was seen from 90% in 2021 to 97% in 2022 (P-value <0.001), which helped to lower VAP rates and highlight the need for ongoing quality improvement in ICU treatment. CONCLUSION The use of ventilator bundles at a tertiary care hospital resulted in improvements in ventilator utilization, with an approximate increase of 20% and VAP rates of over 70% for adult critical patients.
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Affiliation(s)
- Chandni Singh
- Department of Cardiac Anaesthesia, Laxmipat Singhania Institute of Cardiology, Kanpur, IND
| | - Rashid Abdullah
- Department of Anaesthesiology and Critical Care, Chandni Hospital, Kanpur, IND
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Turkistani R, Aghashami AS, Badhduoh SS, Fadhel RT, Albaity AO, Malli IA, Osman S, Alshehri RA, Aldabbagh MA. The Effect of Ventilator-Associated Pneumonia on the Time-to-Extubation in Adult and Pediatric Intensive Care Unit Patients Requiring Mechanical Ventilation: A Retrospective Cohort Study. Cureus 2024; 16:e52070. [PMID: 38213942 PMCID: PMC10782147 DOI: 10.7759/cureus.52070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2024] [Indexed: 01/13/2024] Open
Abstract
INTRODUCTION Ventilator-associated pneumonia (VAP) ranks as a prominent hospital-acquired infection. VAP has been shown to have a detrimental impact on patients and healthcare facilities, leading to extended hospital stays, increased demands on medical resources, and higher financial expenses. This study aims to assess the influence of VAP on time-to-extubation and length of hospital stay (LOS) in patients requiring mechanical ventilation for more than 48 hours in pediatric and adult intensive care units (ICU). METHODS This retrospective cohort study included adult and pediatric ICU patients admitted to King Abdul-Aziz Medical City in Jeddah, Saudi Arabia, from June 2016 to May 2020. The study encompassed ICU patients who required mechanical ventilation for more than 48 hours. Time-to-extubation and LOS were measured in days and compared between those who developed VAP and those who did not. A Kaplan-Meier curve was employed to estimate and compare both groups' survival functions (time-to-event). RESULTS The study involved 367 subjects, with 226 adults and 141 pediatric patients. Among the 367 mechanically ventilated patients, 33 (8.99%) developed VAP during their ICU stay, with 9 of them being children. VAP patients experienced a significantly longer time to extubation than non-VAP patients (13.5 vs. six days, p<0.0001). Likewise, ICU stays for VAP patients were significantly longer than those for non-VAP patients (19.5 vs. 13 days, p<0.002). However, the mortality rate at 28 days from intubation did not exhibit significant differences between the VAP and non-VAP groups (36.36% vs. 27.54%, p=0.283). CONCLUSION This study underscores that VAP patients face a substantial delay in time-to-extubation and an increased length of ICU stay compared to non-VAP patients. Such findings substantially impact the cost of hospital care and the risk of exposure to other infection-related complications while under mechanical ventilation. Enhanced preventive measures are warranted to reduce the occurrence and consequences of VAP.
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Affiliation(s)
- Raneem Turkistani
- Medical Intern, King Saud Bin Abdulaziz University for Health Sciences College of Medicine, Jeddah, SAU
| | - Afnan S Aghashami
- Medical Intern, King Saud Bin Abdulaziz University for Health Sciences College of Medicine, Jeddah, SAU
| | - Shatha S Badhduoh
- Medical Intern, King Saud Bin Abdulaziz University for Health Sciences College of Medicine, Jeddah, SAU
| | - Rowaida T Fadhel
- Medical Intern, King Saud Bin Abdulaziz University for Health Sciences College of Medicine, Jeddah, SAU
| | - Amani O Albaity
- Medical Intern, King Saud Bin Abdulaziz University for Health Sciences College of Medicine, Jeddah, SAU
| | - Israa A Malli
- Basic Medical Sciences, King Saud Bin Abdulaziz University for Health and Sciences College of Medicine, Jeddah, SAU
| | - Sara Osman
- Department of Pediatrics, King Abdulaziz Medical City, Jeddah, SAU
| | | | - Mona A Aldabbagh
- Department of Pediatrics, Division of Infectious Diseases, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, SAU
- Institutional Review Board, King Abdullah International Medical Research Center, Jeddah, SAU
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
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Abdalla JS, Albarrak M, Alhasawi A, Al-Musawi T, Alraddadi BM, Al Wali W, Elhoufi A, Habashy N, Hassanien AM, Kurdi A. Narrative Review of the Epidemiology of Hospital-Acquired Pneumonia and Ventilator-Associated Pneumonia in Gulf Cooperation Council Countries. Infect Dis Ther 2023:10.1007/s40121-023-00834-w. [PMID: 37389707 PMCID: PMC10390449 DOI: 10.1007/s40121-023-00834-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 06/07/2023] [Indexed: 07/01/2023] Open
Abstract
Hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) are the most common healthcare-associated infections, with rates varying between countries. Antimicrobial resistance (AMR) among common HAP/VAP pathogens has been reported, and multidrug resistance (MDR) is of further concern across Middle Eastern countries. This narrative review summarizes the incidence and pathogens associated with HAP/VAP in hospitals across Gulf Cooperation Council (GCC) countries. A PubMed literature search was limited to available data on HAP or VAP in patients of any age published within the past 10 years. Reviews, non-English language articles, and studies not reporting HAP/VAP data specific to a GCC country were excluded. Overall, 41 articles, a majority of which focused on VAP, were selected for inclusion after full-text screening. Studies conducted over multiple years showed a general reduction in VAP rates over time, with Gram-negative bacteria the most commonly reported pathogens. Gram-negative isolates reported across GCC countries included Acinetobacter baumannii, Pseudomonas aeruginosa, and Klebsiella pneumoniae. Rates of AMR varied widely among studies, and MDR among A. baumannii, K. pneumoniae, Escherichia coli, P. aeruginosa, and Staphylococcus aureus isolates was commonly reported. In Saudi Arabia, between 2015 and 2019, rates of carbapenem resistance among Gram-negative bacteria were 19-25%; another study (2004-2009) reported antimicrobial resistance rates in Acinetobacter species (60-89%), P. aeruginosa (13-31%), and Klebsiella species (100% ampicillin, 0-13% other antimicrobials). Although limited genotype data were reported, OXA-48 was found in ≥ 68% of patients in Saudi Arabia with carbapenem-resistant Enterobacteriaceae infections. Ventilator utilization ratios varied across studies, with rates up to 0.9 reported in patients admitted to adult medical/surgical intensive care units in both Kuwait and Saudi Arabia. VAP remains a burden across GCC countries albeit with decreases in rates over time. Evaluation of prevention and treatment measures and implementation of a surveillance program could be useful for the management of HAP and VAP.
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Affiliation(s)
| | - May Albarrak
- Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | | | - Tariq Al-Musawi
- Al Salam Hospital, Al Khobar, Saudi Arabia.
- Royal College of Surgeons in Ireland-Medical University of Bahrain (RCSI-MUB), Busaiteen, Bahrain.
| | - Basem M Alraddadi
- King Faisal Specialist Hospital & Research Center, Jeddah, Saudi Arabia
| | - Walid Al Wali
- Hamad General Hospital, Doha, Qatar
- Al Wakra Hospital, Al Wakra, Qatar
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Alshammari MK, Alotaibi MA, AlOtaibi AS, Alosaime HT, Aljuaid MA, Alshehri BM, AlOtaibi YB, Alasmari AA, Alasmari GA, Mohammed MH, Althobaiti SM, Almuhaya RA, Alkhoshi TA, Alosaimi AS, Alotaibi AA. Prevalence and Etiology of Community- and Hospital-Acquired Pneumonia in Saudi Arabia and Their Antimicrobial Susceptibility Patterns: A Systematic Review. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59040760. [PMID: 37109718 PMCID: PMC10143967 DOI: 10.3390/medicina59040760] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 03/30/2023] [Accepted: 04/10/2023] [Indexed: 04/29/2023]
Abstract
(1) Background and Objectives: Pneumonia is a major cause of morbidity and mortality worldwide, including in Saudi Arabia, and the prevalence and etiology of the disease varies depending on the setting. The development of effective strategies can help reduce the adverse impact of this disease. Therefore, this systematic review was conducted to explore the prevalence and etiology of community-acquired and hospital-acquired pneumonia in Saudi Arabia, as well as their antimicrobial susceptibility. (2) Materials and Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 recommendations were followed for this systematic review. Several databases were used to perform a thorough literature search, and papers were then assessed for eligibility by two independent reviewers. The Newcastle-Ottawa Scale (NOS) was used to extract the data from the relevant research and evaluate its quality. (3) Results: This systematic review included 28 studies that highlighted the fact that gram-negative bacteria, particularly Acinetobacter spp. and Pseudomonas aeruginosa, were the common cause of hospital-acquired pneumonia, while Staphylococcus aureus and Streptococcus spp. were responsible for community-acquired pneumonia in children. The study also found that bacterial isolates responsible for pneumonia showed high resistance rates against several antibiotics, including cephalosporins and carbapenems. (4) Conclusions: In conclusion, the study found that different bacteria are responsible for community- and hospital-acquired pneumonia in Saudi Arabia. Antibiotic resistance rates were high for several commonly used antibiotics, highlighting the need for rational antibiotic use to prevent further resistance. Moreover, there is a need to conduct more regular multicenter studies to assess etiology, resistance, and susceptibility patterns of pneumonia-causing pathogens in Saudi Arabia.
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Affiliation(s)
| | | | | | | | | | | | | | - Asma Ali Alasmari
- Clinical Pharmacy & Pharmacology Department, Ibn Sina National College for Medical Studies, Jeddah 22421, Saudi Arabia
| | - Ghadi Ali Alasmari
- Department of Ambulatory Care Pharmacy, International Medical Center, Jeddah 23214, Saudi Arabia
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Alves D, Grainha T, Pereira MO, Lopes SP. Antimicrobial materials for endotracheal tubes: A review on the last two decades of technological progress. Acta Biomater 2023; 158:32-55. [PMID: 36632877 DOI: 10.1016/j.actbio.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 12/21/2022] [Accepted: 01/03/2023] [Indexed: 01/11/2023]
Abstract
Ventilator-associated pneumonia (VAP) is an unresolved problem in nosocomial settings, remaining consistently associated with a lack of treatment, high mortality, and prolonged hospital stay. The endotracheal tube (ETT) is the major culprit for VAP development owing to its early surface microbial colonization and biofilm formation by multiple pathogens, both critical events for VAP pathogenesis and relapses. To combat this matter, gradual research on antimicrobial ETT surface coating/modification approaches has been made. This review provides an overview of the relevance and implications of the ETT bioburden for VAP pathogenesis and how technological research on antimicrobial materials for ETTs has evolved. Firstly, certain main VAP attributes (definition/categorization; outcomes; economic impact) were outlined, highlighting the issues in defining/diagnosing VAP that often difficult VAP early- and late-onset differentiation, and that generate misinterpretations in VAP surveillance and discrepant outcomes. The central role of the ETT microbial colonization and subsequent biofilm formation as fundamental contributors to VAP pathogenesis was then underscored, in parallel with the uncovering of the polymicrobial ecosystem of VAP-related infections. Secondly, the latest technological developments (reported since 2002) on materials able to endow the ETT surface with active antimicrobial and/or passive antifouling properties were annotated, being further subject to critical scrutiny concerning their potentialities and/or constraints in reducing ETT bioburden and the risk of VAP while retaining/improving the safety of use. Taking those gaps/challenges into consideration, we discussed potential avenues that may assist upcoming advances in the field to tackle VAP rampant rates and improve patient care. STATEMENT OF SIGNIFICANCE: The use of the endotracheal tube (ETT) in patients requiring mechanical ventilation is associated with the development of ventilator-associated pneumonia (VAP). Its rapid surface colonization and biofilm formation are critical events for VAP pathogenesis and relapses. This review provides a comprehensive overview on the relevance/implications of the ETT biofilm in VAP, and on how research on antimicrobial ETT surface coating/modification technology has evolved over the last two decades. Despite significant technological advances, the limited number of gathered reports (46), highlights difficulty in overcoming certain hurdles associated with VAP (e.g., persistent colonization/biofilm formation; mechanical ventilation duration; hospital length of stay; VAP occurrence), which makes this an evolving, complex, and challenging matter. Challenges and opportunities in the field are discussed.
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Affiliation(s)
- Diana Alves
- CEB - Centre of Biological Engineering, University of Minho, 4710-057 Braga, Portugal; LABBELS - Associate Laboratory, Braga/Guimarães, Portugal.
| | - Tânia Grainha
- CEB - Centre of Biological Engineering, University of Minho, 4710-057 Braga, Portugal; LABBELS - Associate Laboratory, Braga/Guimarães, Portugal.
| | - Maria Olívia Pereira
- CEB - Centre of Biological Engineering, University of Minho, 4710-057 Braga, Portugal; LABBELS - Associate Laboratory, Braga/Guimarães, Portugal.
| | - Susana Patrícia Lopes
- CEB - Centre of Biological Engineering, University of Minho, 4710-057 Braga, Portugal; LABBELS - Associate Laboratory, Braga/Guimarães, Portugal.
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Lin T, Yao Y, Xu Y, Huang HB. Neuromuscular Blockade for Cardiac Arrest Patients Treated With Targeted Temperature Management: A Systematic Review and Meta-Analysis. Front Pharmacol 2022; 13:780370. [PMID: 35685629 PMCID: PMC9171045 DOI: 10.3389/fphar.2022.780370] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 05/02/2022] [Indexed: 12/29/2022] Open
Abstract
Background: Neuromuscular-blocking agents (NMBA) are often administered to control shivering in comatose cardiac arrest (CA) survivors during targeted temperature management (TTM) management. Thus, we performed a systematic review and meta-analysis to investigate the effectiveness and safety of NMBA in such a patient population. Methods: We searched for relevant studies in PubMed, Embase, and the Cochrane Library until 15 Jul 2021. Studies were included if they reported data on any of the predefined outcomes in adult comatose CA survivors managed with any NMBA regimens. The primary outcomes were mortality and neurological outcome. Results were expressed as odds ratio (OR) or mean difference (MD) with an accompanying 95% confidence interval (CI). Heterogeneity, sensitivity analysis, and publication bias were also investigated to test the robustness of the primary outcome. Data Synthesis: We included 12 studies (3 randomized controlled trials and nine observational studies) enrolling 11,317 patients. These studies used NMBA in three strategies: prophylactic NMBA, bolus NMBA if demanded, or managed without NMBA. Pooled analysis showed that CA survivors with prophylactic NMBA significantly improved both outcomes of mortality (OR 0.74; 95% CI 0.64-0.86; I 2 = 41%; p < 0.0001) and neurological outcome (OR 0.53; 95% CI 0.37-0.78; I 2 = 59%; p = 0.001) than those managed without NMBA. These results were confirmed by the sensitivity analyses and subgroup analyses. Only a few studies compared CA survivors receiving continuous versus bolus NMBA if demanded strategies and the pooled results showed no benefit in the primary outcomes between the two groups. Conclusion: Our results showed that using prophylactic NMBA strategy compared to the absence of NMBA was associated with improved mortality and neurologic outcome in CA patients undergoing TTM. However, more high-quality randomized controlled trials are needed to confirm our results.
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Affiliation(s)
- Tong Lin
- Department of Reproductive Endocrinology, Hospital of Traditional Chinese Medicine, Zhaoqing, China
| | - Yan Yao
- Department of Critical Care Medicine, School of Clinical Medicine, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, China
| | - Yuan Xu
- Department of Critical Care Medicine, School of Clinical Medicine, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, China
| | - Hui-Bin Huang
- Department of Critical Care Medicine, School of Clinical Medicine, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, China
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Assessing the Impact of Gender and COPD on the Incidence and Mortality of Hospital-Acquired Pneumonia. A Retrospective Cohort Study Using the Spanish National Discharge Database (2016-2019). J Clin Med 2021; 10:jcm10225453. [PMID: 34830733 PMCID: PMC8625205 DOI: 10.3390/jcm10225453] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 11/19/2021] [Accepted: 11/20/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND We aim to analyze incidence and outcomes of patients hospitalized with hospital-acquired pneumonia (HAP) according to chronic obstructive pulmonary disease (COPD) status and sex in Spain (2016-2019). METHODS We conducted a retrospective cohort study using national hospital discharge data of patients ≥40 years with a primary diagnosis of HAP, using the specific diagnostics of non-ventilator (NV)-HAP and ventilator-associated pneumonia (VAP). RESULTS We identified 37,029 patients with HAP ((NV)-HAP 87.28%, VAP 12.72%), 13.40% with COPD. HAP incidence increased over time, but only in subjects without COPD (p < 0.001). In women, incidence of HAP and (NV)-HAP was similar regardless of COPD status, but VAP incidence was lower in COPD women (p = 0.007). In men, the incidence of (NV)-HAP was significantly higher in those with COPD, while VAP incidence was lower in COPD men (p < 0.001). The in-hospital mortality (IHM) was similar in men and women with and without COPD. The risk of dying in hospital increased with age, congestive heart failure, cancer, and dialysis among men and women with COPD. Men that underwent surgery had a lower risk of IHM. VAP increased 2.58-times the probability of dying in men and women. Finally, sex was not associated with IHM among COPD patients. CONCLUSIONS Incidence of HAP was significantly higher in COPD patients than in those without COPD, at the expense of (NV)-HAP but not of VAP. When stratifying by sex, we found that the difference was caused by men. IHM was similar in COPD and non-COPD patients, with no significant change overtime. In addition, sex was not associated with IHM.
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Madhuvu A, Endacott R, Plummer V, Morphet J. Healthcare professional views on barriers to implementation of evidence-based practice in prevention of ventilator-associated events: A qualitative descriptive study. Intensive Crit Care Nurs 2021; 68:103133. [PMID: 34756476 DOI: 10.1016/j.iccn.2021.103133] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 07/26/2021] [Accepted: 08/09/2021] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To explore health professional views of barriers to the use of evidence-based practice to prevent ventilator-associated events in intensive care units. DESIGN A qualitative descriptive study was conducted with nurses and doctors with more than six months experience caring for mechanically ventilated patients. SETTING The study was conducted in two intensive care units, in large metropolitan health services in Victoria, Australia. METHODS Individual semi-structured interviews were undertaken with 20 participants (16 nurses and 4 doctors) in 2019. Purposive sampling method was used until data saturation was reached. The interviews were held at the hospital in a private room away from their place of employment. The interview data were analysed using thematic analysis. FINDINGS Four major themes were inductively identified from nine subthemes: i) prioritising specific situations, ii) inadequate use of evidence to underpin practice, iii) perception of inadequate staffing and equipment and, iv) inadequate training and knowledge of evidence-based guidelines. CONCLUSIONS These themes helped to explain previously reported deficits in nurses' knowledge of and adherence to evidence-based practice in intensive care. Findings suggest the need for a well-established policy to underpin practice. The barriers faced by nurses and doctors in preventing ventilator associated events need to be addressed to optimise quality of patient care in intensive care units.
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Affiliation(s)
- Auxillia Madhuvu
- School of Nursing and Midwifery, Monash University, McMahons Road, Frankston, Victoria, Australia; Monash Health, Dandenong Hospital, 135 David Street, Dandenong, Victoria, Australia. https://twitter.com/@AuxilliaMadhuvu
| | - Ruth Endacott
- School of Nursing and Midwifery, Monash University, McMahons Road, Frankston, Victoria, Australia; Plymouth University/Royal Devon and Exeter Hospital Clinical School, Drake Circus, Plymouth, Devon PL4 8AA, United Kingdom
| | - Virginia Plummer
- School of Nursing and Midwifery, Monash University, McMahons Road, Frankston, Victoria, Australia; School of Nursing and Healthcare Professions, Federation University Australia, Australia
| | - Julia Morphet
- School of Nursing and Midwifery, Monash University, McMahons Road, Frankston, Victoria, Australia; Monash Health, Dandenong Hospital, 135 David Street, Dandenong, Victoria, Australia
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Maebed AZM, Gaber Y, Bakeer W, Dishisha T. Microbial etiologies of ventilator-associated pneumonia (VAP) in intensive care unit of Beni-Suef University's Hospital. BENI-SUEF UNIVERSITY JOURNAL OF BASIC AND APPLIED SCIENCES 2021; 10:41. [PMID: 34341765 PMCID: PMC8319904 DOI: 10.1186/s43088-021-00130-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 07/17/2021] [Indexed: 11/22/2022] Open
Abstract
Background Ventilator-associated pneumonia (VAP) is a major health problem for people intubated in intensive care units (ICUs), leading to increased mortality rates, hospital stay, and treatment costs. In the present study, the core pathogens causing VAP in Beni-Suef University's Hospital, Egypt, was investigated over a study period of 2 years (2017–2019). Results Of a total of 213 patients subjected to mechanical ventilation, 60 have developed VAP during their stay in the ICU. The mortality rate reached 41.7% among VAP patients. Sixty bacteria were isolated from an endotracheal aspirate of hospitalized patients. The different isolates were cultured followed by running biochemical tests, sensitivity assays, and automated VITEK®2 System analysis. Unexpectedly, all the isolates were Gram-negative bacteria. Klebsiella pneumoniae were the main pathogen encountered (27/60 isolates) followed by Acientobacter baumannnii (7/60) and other microorganisms belonging to the genera Moraxella, Escherichia, and Pseudomonas (11/60). Antibiotic sensitivity testing was performed via the VITEK®2 System using up to 16 different antibiotics representing 8 different antibiotic classes and subclasses (aminoglycosides, carbapenems, fluoroquinolones, penicillin/β-lactamase inhibitor, extended-spectrum cephalosporins, aminopenicillins, aminopenicillins/β-lactamase inhibitor, folic acid synthesis inhibitor). Majority of the isolates (28/60) showed a remarkable extensive drug resistance (XDR) pattern, while 15 isolates were multi-drug resistant (MDR) and only 6 were pan-drug resistant (PDR) with regard to antibiotics under evaluation. Conclusion The association of VAP with multi-drug-resistant bacteria is alarming, and rapid management is crucial. Identification of core pathogens is essential for identifying the most appropriate technique for infection control.
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Affiliation(s)
- Al Zahraa M Maebed
- Department of Microbiology and Immunology, Faculty of Pharmacy, Nahda University, Beni Suef, Egypt
| | - Yasser Gaber
- Department of Microbiology and Immunology, Faculty of Pharmacy, Beni-Suef University, Beni Suef, Egypt.,Department of Pharmaceutics and Pharmaceutical Technology, College of Pharmacy, Mutah University, Kerak, 61710 Jordan
| | - Walid Bakeer
- Department of Microbiology and Immunology, Faculty of Pharmacy, Beni-Suef University, Beni Suef, Egypt
| | - Tarek Dishisha
- Department of Microbiology and Immunology, Faculty of Pharmacy, Beni-Suef University, Beni Suef, Egypt
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Al-Sayaghi KM. Critical care nurses' compliance and barriers toward ventilator-associated pneumonia prevention guidelines: cross-sectional survey. J Taibah Univ Med Sci 2021; 16:274-282. [PMID: 33897334 PMCID: PMC8046945 DOI: 10.1016/j.jtumed.2020.12.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 11/23/2020] [Accepted: 12/02/2020] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVES This study aims to determine the compliance of critical care nurses with the ventilator-associated pneumonia prevention guidelines and the factors that affect their compliance. We also explored the barriers faced by the nurses in the implementation of these guidelines. METHODS A cross-sectional descriptive survey was conducted using a self-administered questionnaire containing 17 recommended strategies to prevent ventilator-associated pneumonia and 15 possible barriers. All critical care nurses of varying qualifications, levels of experience, and nationalities working in adult ICUs were invited. Between January and March 2018, the questionnaire was distributed to 283 nurses at eight ICUs in five public hospitals in Almadinah Almunawwarah, KSA. RESULTS A total of 229 invitees responded to the questionnaire. The mean compliance score was 85.9%. More than half (54%) of the sample had a high or acceptable compliance level. The lowest compliance rate was reported for the suctioning of subglottic secretions. The main reported barriers were the shortage of nursing staff, forgetfulness, and hospital cost control policies. Working in general ICUs with the capacity of 10-15 beds or prior education related to ventilator-associated pneumonia prevention influenced the nurses' compliance. CONCLUSION In our study, the overall compliance of the critical care nurses with the ventilator-associated pneumonia prevention guidelines is acceptable. Shortage of nursing staff, forgetfulness, and cost control policies were the main reported barriers to compliance.
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Affiliation(s)
- Khaled M. Al-Sayaghi
- Medical Surgical Nursing Department, College of Nursing, Taibah University, Almadinah Almunawwarah, KSA
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Takiguchi T, Ohbe H, Nakajima M, Sasabuchi Y, Tagami T, Matsui H, Fushimi K, Yokobori S, Yasunaga H. Intermittent versus continuous neuromuscular blockade during target temperature management after cardiac arrest: A nationwide observational study. J Crit Care 2021; 62:276-282. [PMID: 33508762 DOI: 10.1016/j.jcrc.2021.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 12/27/2020] [Accepted: 01/05/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE Whether intermittent or continuous neuromuscular-blocking agents (NMBAs) would be appropriate during target temperature management (TTM) after cardiac arrest remains unclear. MATERIALS AND METHODS In this retrospective cohort study, we utilized the Japanese Diagnosis Procedure Combination inpatient database from July 2010 to March 2018 and identified patients who received NMBAs during TTM after cardiac arrest on the day of admission. We compared the in-hospital mortality between the propensity-score-matched intermittent and continuous NMBA groups. RESULTS We identified 5584 eligible patients; 1488 received intermittent NMBAs and 4096 received continuous NMBAs. After propensity score matching, there was no significant difference in the in-hospital mortality between the intermittent and continuous NMBA groups (32.9% vs. 33.1%; odds ratio, 0.98; 95% confidence interval, 0.82-1.18). In subgroup analyses, in-hospital mortality of the continuous NMBA group was significantly higher than that of the intermittent NMBA group in patients aged ≥65 years (p for interaction = 0.021). CONCLUSIONS This large retrospective study did not suggest that intermittent NMBAs may be inferior to continuous NMBAs in terms of mortality reduction in the overall population receiving TTM for cardiac arrest. However, continuous NMBAs may be inferior to intermittent NMBAs for reducing mortality in elderly patients.
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Affiliation(s)
- Toru Takiguchi
- Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan.
| | - Hiroyuki Ohbe
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Mikio Nakajima
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan; Emergency and Critical Care Center, Tokyo Metropolitan Hiroo Hospital, Tokyo, Japan
| | | | - Takashi Tagami
- Department of Emergency and Critical Care Medicine, Nippon Medical School Musashikosugi Hospital, Kanagawa, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
| | - Shoji Yokobori
- Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
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12
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Alsulami OA, Konkar AE, Alalyani AA, Alghamdi MS, Eid SM, Alsulami HA, Al-Ebrahim KE. Postoperative Pneumonia Following Open Heart Surgery. Cureus 2020; 12:e10320. [PMID: 33052281 PMCID: PMC7546606 DOI: 10.7759/cureus.10320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Objectives This study aimed to measure the incidence and record the relations between risk factors of postoperative pneumonia (POP) among patients who underwent open heart surgery in a single hospital in Saudi Arabia. Methods This retrospective cohort study was conducted in June 2019 at King Abdulaziz University hospital in Saudi Arabia. Data including general information, comorbidities, lab investigations, preoperative risk factors, intraoperative considerations, and postoperative elements were collected and analyzed. Results A total of 255 cardiac surgeries were performed from November 2014 to June 2019. Two hundred of the 255 cardiac surgeries were analyzed as open-heart surgeries. Only five patients were diagnosed with POP after open heart surgery with an incidence of 2.5%. The mean age of these patients was 47±18 years, more than half of them were smokers, three were hypertensive, four were classified as ASA 4, and three underwent the operation electively. The mean bypass time was 100.3 ± 24.5 min, the mean duration of operation was 199 ± 86.2 min, the mean postoperative intensive care unit (ICU) stay was 97.4 ± 83.4 hours, and the mean overall hospital stay was 10.4 ± 7.2 days. We observed significant differences in only the following correlations: amount of blood transfusion with ICU stay and with the overall hospital stay. Conclusion The incidence of developing postoperative pneumonia in patients undergoing open heart surgery in the King Abdulaziz University hospital from November 2014 to June 2019 was 2.5%, indicating a high-quality level of surgical technique and proper infection control.
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Affiliation(s)
| | | | | | | | - Siraj M Eid
- Medicine, King Abdulaziz University, Jeddah, SAU
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13
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Ten-year resistance trends in pathogens causing healthcare-associated infections; reflection of infection control interventions at a multi-hospital healthcare system in Saudi Arabia, 2007-2016. Antimicrob Resist Infect Control 2020; 9:21. [PMID: 32000850 PMCID: PMC6993320 DOI: 10.1186/s13756-020-0678-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 01/09/2020] [Indexed: 01/13/2023] Open
Abstract
Background Studying temporal changes in resistant pathogens causing healthcare-associated infections (HAIs) is crucial in improving local antimicrobial and infection control practices. The objective was to describe ten-year trends of resistance in pathogens causing HAIs in a tertiary care setting in Saudi Arabia and to compare such trends with those of US National Health Surveillance Network (NHSN). Methods Pooled analysis of surveillance data that were prospectively collected between 2007 and 2016 in four hospitals of Ministry of National Guard Health Affairs. Definitions and methodology of HAIs and antimicrobial resistance were based on NHSN. Consecutive NHSN reports were used for comparisons. Results A total 1544 pathogens causing 1531 HAI events were included. Gram negative pathogens (GNP) were responsible for 63% of HAIs, with a significant increasing trend in Klebsiella spp. and a decreasing trend in Acinetobacter. Methicillin-resistant Staphylococcus aureus (27.0%) was consistently less frequent than NHSN. Vancomycin-resistant Enterococci (VRE, 20.3%) were more than doubled during the study, closing the gap with NHSN. Carbapenem resistance was highest with Acinetobacter (68.3%) and Pseudomonas (36.8%). Increasing trends of carbapenem resistance were highest in Pseudomonas and Enterobacteriaceae, closing initial gaps with NHSN. With the exception of Klebsiella and Enterobacter, multidrug-resistant (MDR) GNPs were generally decreasing, mainly due to the decreasing resistance towards cephalosporins, fluoroquinolones, and aminoglycosides. Conclusion The findings showed increasing trends of carbapenem resistance and VRE, which may reflect heavy use of carbapenems and vancomycin. These findings may highlight the need for effective antimicrobial stewardship programs, including monitoring and feedback on antimicrobial use and resistance.
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14
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Using flexible methods to determine risk factors for ventilator-associated pneumonia in the Netherlands. PLoS One 2019; 14:e0218372. [PMID: 31220122 PMCID: PMC6586305 DOI: 10.1371/journal.pone.0218372] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 06/02/2019] [Indexed: 01/15/2023] Open
Abstract
Seven hospitals participated in the Dutch national surveillance for ventilator-associated pneumonia (VAP) and its risk factors. We analysed time-independent and time-dependent risk factors for VAP using the standard Cox regression and the flexible Weighted Cumulative Effects method (WCE) that evaluates both current and past exposures. The prospective surveillance of intensive care patients aged ≥16 years and ventilated ≥48 hours resulted in the inclusion of 940 primary ventilation periods, comprising 7872 ventilation days. The average VAP incidence density was 10.3/1000 ventilation days. Independent risk factors were age (16–40 years at increased risk: HR 2.42 95% confidence interval 1.07–5.50), COPD (HR 0.19 [0.04–0.78]), current sedation score (higher scores at increased risk), current selective oropharyngeal decontamination (HR 0.19 [0.04–0.91]), jet nebulizer (WCE, decreased risk), intravenous antibiotics for selective decontamination of the digestive tract (ivSDD, WCE, decreased risk), and intravenous antibiotics not for SDD (WCE, decreased risk). The protective effect of ivSDD was afforded for 24 days with a delay of 3 days. For some time-dependent variables, the WCE model was preferable over standard Cox proportional hazard regression. The WCE method can furthermore increase insight into the active time frame and possible delay herein of a time-dependent risk factor.
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15
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Kanafani ZA, El Zakhem A, Zahreddine N, Ahmadieh R, Kanj SS. Ten-year surveillance study of ventilator-associated pneumonia at a tertiary care center in Lebanon. J Infect Public Health 2019; 12:492-495. [PMID: 30737129 DOI: 10.1016/j.jiph.2019.01.057] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 01/15/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Ventilator-associated pneumonia (VAP) is associated with significant adverse outcomes in critically-ill patients admitted to the Intensive Care Unit (ICU). Systematic data from Lebanon on VAP are not available and large epidemiological studies from the region are scarce. METHODS We conducted a retrospective study over a 10-year period at the American University of Beirut Medical Center (AUBMC), a tertiary referral center in Lebanon in order to describe the incidence, microbiology, and temporal trends of VAP in the medical/surgical ICU. RESULTS A total of 162 patients developed VAP over the study period and the overall incidence of VAP was 7.9 per 1000 ventilator-days. There was a statistically significant decrease over time in the incidence of VAP, from 13.1 in 2008 to 1.1 per 1000 ventilator-days in 2017. Multidrug-resistant (MDR) Acinetobacter spp. was the predominant pathogen, both in early- as well as late-onset VAP, followed by Pseudomonas aeruginosa. CONCLUSIONS Following significant efforts from the Infection Control and Prevention Program, a considerable reduction in the incidence of VAP was achieved at AUBMC. The predominance of MDR Acinetobacter spp. should be taken into consideration when deciding on empirical therapy in patients with VAP.
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Affiliation(s)
- Zeina A Kanafani
- Division of Infectious Diseases, American University of Beirut Medical Center, Beirut, Lebanon; Infection Control and Prevention Program, American University of Beirut Medical Center, Beirut, Lebanon
| | - Aline El Zakhem
- Division of Infectious Diseases, American University of Beirut Medical Center, Beirut, Lebanon
| | - Nada Zahreddine
- Infection Control and Prevention Program, American University of Beirut Medical Center, Beirut, Lebanon
| | - Rihab Ahmadieh
- Infection Control and Prevention Program, American University of Beirut Medical Center, Beirut, Lebanon
| | - Souha S Kanj
- Division of Infectious Diseases, American University of Beirut Medical Center, Beirut, Lebanon; Infection Control and Prevention Program, American University of Beirut Medical Center, Beirut, Lebanon.
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16
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Koulenti D, Parisella FR, Xu E, Lipman J, Rello J. The relationship between ventilator-associated pneumonia and chronic obstructive pulmonary disease: what is the current evidence? Eur J Clin Microbiol Infect Dis 2019; 38:637-647. [PMID: 30680576 DOI: 10.1007/s10096-019-03486-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 01/10/2019] [Indexed: 02/06/2023]
Abstract
Chronic obstructive pulmonary disease (COPD) affects approximately 65 million people from which > 25% will require intensive care unit (ICU) admission. Ventilator-associated pneumonia (VAP) is the commonest ICU infection and results in increased morbidity/mortality and costs. The literature on the interaction between COPD and VAP is scarce and controversial. The project aimed to search the literature in order to address the following: (i) Is COPD a risk factor for VAP development? (ii) Does COPD impact the outcome of patients with VAP? (iii) Does VAP development impact the outcome of COPD patients? (iv) Does COPD impact the aetiology of VAP? Current evidence on the topic is controversial. Regarding the impact of VAP on COPD patients, the majority of the existing limited number of studies suggests that VAP development results in higher mortality and longer duration of mechanical ventilation and ICU stay. Also, the majority of the studies exploring the impact of COPD on VAP outcomes suggest that COPD is independently associated with a decrease in survival, although the number of such studies is limited. Regarding the aetiology, Pseudomonas aeruginosa is the most frequent pathogen in VAP patients with COPD. Noteworthy, one study suggests that P. aeruginosa is higher in COPD patients even in the early-onset VAP subgroup. This manuscript provides a comprehensive overview of the available literature on the interaction between COPD and VAP, highlighting the differences and limitations that may have led to controversial results, and it may act as a platform for further research with important clinical implications.
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Affiliation(s)
- Despoina Koulenti
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Royal Brisbane Clinical Unit, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- 2nd Critical Care Department, Attikon University Hospital, Athens, Greece
| | - Francesca Romana Parisella
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia.
| | - Elena Xu
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Jeffrey Lipman
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Royal Brisbane Clinical Unit, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Jordi Rello
- Vall d'Hebron Institute of Research (VHIR) & CIBERES, Instituto Salud Carlos III, Barcelona, Spain
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17
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Arabi YM, Al Aseri Z, Alaama T, Alqahtani A, Alharthy A, Almotairi A, Al Qasim E, Alzahrani AA, Al Qarni M, Abdukahil SAI, Al-Hameed FM, Mandourah Y, Maghrabi K, Ghamdi A, Almekhalfi G, Mady A, Qureshi AS, Qushmaq I, Alshahrani MS, Alkatheri M, Saawi A, AlHazme RH, Berenholtz SM, Latif A, Al-Moamary MS, Mohrij S. National Approach to Standardize and Improve Mechanical Ventilation. Ann Thorac Med 2019; 14:101-105. [PMID: 31007760 PMCID: PMC6467017 DOI: 10.4103/atm.atm_63_19] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
NASAM (National Approach to Standardize and Improve Mechanical Ventilation) is a national collaborative quality improvement project in Saudi Arabia. It aims to improve the care of mechanically ventilated patients by implementing evidence-based practices with the goal of reducing the rate of ventilator-associated events and therefore reducing mortality, mechanical ventilation duration and intensive care unit (ICU) length of stay. The project plans to extend the implementation to a total of 100 ICUs in collaboration with multiple health systems across the country. As of March 22, 2019, a total of 78 ICUs have registered from 6 different health sectors, 48 hospitals, and 27 cities. The leadership support in all health sectors for NASAM speaks of the commitment to improve the care of mechanically ventilated patients across the kingdom.
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Affiliation(s)
- Yaseen M Arabi
- Department of Intensive Care, King Abdulaziz Medical City, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Zohair Al Aseri
- Emergency and Intensive Care Departments, Medical City, King Saud University, Adult Intensive Care Development Program Ministry of Health, Riyadh, Saudi Arabia
| | - Tareef Alaama
- Deputyship of Curative Services, Ministry of Health, King Saud Medical City, Riyadh, Saudi Arabia
| | - Abdulrahman Alqahtani
- National Emergency Medicine Development Program, Ministry of Health, King Saud Medical City, Riyadh, Saudi Arabia
| | | | - Abdullah Almotairi
- Department of Pulmonary and Critical Care Medicine, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Eman Al Qasim
- Department of Intensive Care, King Abdulaziz Medical City, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Abdullah A Alzahrani
- Department of Quality and Patient Safety, King Abdulaziz Medical City, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Mohammed Al Qarni
- Department of Quality and Patient Safety, King Abdulaziz Medical City, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Sheryl Ann I Abdukahil
- Department of Intensive Care, King Abdulaziz Medical City, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Fahad M Al-Hameed
- Department of Intensive Care, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Madinah, Saudi Arabia
| | - Yasser Mandourah
- Military Medical Services, Ministry of Defense, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Khalid Maghrabi
- Department of Intensive Care, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Adnan Ghamdi
- Department of Intensive Care Services, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Ghaleb Almekhalfi
- Department of Intensive Care Services, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Ahmed Mady
- Department of Intensive Care, King Saud Medical City, Riyadh, Saudi Arabia
| | - Ahmed S Qureshi
- Prince Mohammed Bin Abdul Aziz Hospital, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Madinah, Saudi Arabia
| | - Ismael Qushmaq
- Department of Medicine, Medical and Clinical Affairs, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Mohammed S Alshahrani
- Department of Emergency and Critical Care Medicine, College of Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University (M.S.A.), Dammam, Saudi Arabia
| | - Mufareh Alkatheri
- Department of Quality and Patient Safety, King Abdulaziz Medical City, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Abdulmohsen Saawi
- Department of Quality and Patient Safety, King Abdulaziz Medical City, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Raed H AlHazme
- Department of Health Informatics, College of Public Health and Health Informatics, King Saud Bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Riyadh, Saudi Arabia.,College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, Florida, USA
| | - Sean M Berenholtz
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Asad Latif
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Mohamed S Al-Moamary
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Development and Quality Management, Medical Services King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Saad Mohrij
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
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18
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Ibrahim ME. High antimicrobial resistant rates among Gram-negative pathogens in intensive care units. A retrospective study at a tertiary care hospital in Southwest Saudi Arabia. Saudi Med J 2018; 39:1035-1043. [PMID: 30284588 PMCID: PMC6201019 DOI: 10.15537/smj.2018.10.22944] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 08/22/2018] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES To determine the distribution and resistance profiles of Gram-negative bacteria (GNB) in intensive care units (ICUs) at King Abdullah Hospital in Bisha, Saudi Arabia. Methods: A record based retrospective study was conducted from December 2016 to January 2018. In total, 3736 non-duplicate clinical specimens from the general intensive care unit (ICU), neonatal ICU (NICU), and coronary CU (CCU) were analyzed for pathogens. Results: Of 3736 specimens, 9.6% (358) were positive for pathogens, and GNB constituted the majority (290/358; 81%). Acinetobacter is predominant in the general ICU, whereas Klebsiella pneumoniae is common in the NICU and CCU. Overall, GNB revealed a high resistance rate for cefuroxime (75.8%) trimethoprim/sulfamethoxazole (73.4%), cefotaxime (72.9%), aztreonam (64.6%), piperacillin (62.1%), and ciprofloxacin (61.5%). Acinetobacter revealed a high resistance (93.4% to 97.5%) to all antimicrobials except colistin (4%). Klebsiella pneumoniae showed a high resistance to trimethoprim/sulfamethoxazole (71.8%), cefotaxime (71.4%) and aztreonam (65.2%). Pseudomonas aeruginosa showed good activity for aminoglycosides but increasing resistance for cephalosporins and meropenem. GNB exhibited a high rate of multi-drug-resistant (MDR) phenotypes (67.9%) with a higher level among Acinetobacter spp. (97.5%). There were no significant differences in the resistance rates of GNB from different ICUs except for imipenem (p=0.002) and ciprofloxacin (p=0.003). Conclusions: Increased antimicrobial resistance with high proportions of MDR patterns were found among GNB from ICUs. Comprehensive surveillance programs are needed to track the origins and emergence pathways of resistant pathogens.
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Affiliation(s)
- Mutasim E Ibrahim
- Department of Medical Microbiology and Parasitology, College of Medicine, University of Bisha, Bisha, Kingdom of Saudi Arabia. E-mail.
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19
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Al-Abdely HM, Khidir Mohammed Y, Rosenthal VD, Orellano PW, ALazhary M, Kaid E, Al-Attas A, Hawsawi G, Kelany A, Hussein B, Esam B, Altowerqi R, Alkamaly MA, Tawfic NA, Cruzpero E, Al Rashidi RM, Thomas R, Molano AM, Al Enazy HA, Al Adwani FM, Casuyon Pahilanga AM, Alatawi S, Nakhla R, Al Adwani FM, Gasmin Aromin R, Balon Ubalde E, Hanafy Diab H, Kader NA, Hassan Assiry IY, Sawan FA, Ammari HE, Mashiakhy AM, Santiago EB, Chua CM, Dalis IM, Arishi HM, Lozada R, Al-Zaydani Asiri IA, Ahmed H, Jarie A, Al-Qathani AS, Al-Alkami HY, AlDalaton M, Alih SJ, Alaliany MJ, Helali NJ, Sindayen G, Malificio AA, Al Dossari HB, Algethami AG, Mohamed D, Yanne L, Tan A, Babu S, Abduljabbar SM, Rushdi H, Fernandez J, Hussain WM, Rajavel RD, Bukhari SZ, Turkistani AA, Mushtaq JJ, Albeladi E, Aboushoushah S, Qushmaq N, Shyrine L, Philipose J, Raees M, AbdulKhalik NS, Madco M, Abdulghany M, Manao A, Acostan C, Safwat R, Halwani M, Abdul Aal NA, Thomas A, Abdulatif SM, Ariola NC, Mutwalli AH, Ariola N, Bohlega E, Simon S, Damlig E, Elsherbini SG, Krishne IT, Abraham S, Ali Karrar MA, Gosn NA, Al Hindi AA, Jaha RN, AlQahtani SM, Abdul Aziz AO, Demaisip NL, Laungayan Cortez E, Cabato AF, Gonzales Celiz JM, Al Raey MA, Al Darani SA, Aziz MR, Manea BA, Samy E, Briones S, Krishnan R, Raees SS, Tabassum K, Ghalilah KM, Alradady M, Al Qatri A, Chaouali M, Elsisi M, Aldossary HA, Al-Suliman S, Al Talib AA, Albaghly N, Haqlre Mia ME, Al-Gethamy MM, Alamri DM, Al-Saadi AS, Ayugat EP, Al Hazazi NA, Al Hussain MI, Caminade Y, Santos AJ, Abdulwahab MH, Al-Garni BT. Impact of the International Nosocomial Infection Control Consortium (INICC)’s multidimensional approach on rates of ventilator-associated pneumonia in intensive care units in 22 hospitals of 14 cities of the Kingdom of Saudi Arabia. J Infect Public Health 2018; 11:677-684. [DOI: 10.1016/j.jiph.2018.06.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 01/09/2018] [Accepted: 06/05/2018] [Indexed: 01/30/2023] Open
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Device-associated nosocomial infection in general hospitals, Kingdom of Saudi Arabia, 2013-2016. J Epidemiol Glob Health 2017; 7 Suppl 1:S35-S40. [PMID: 29801591 PMCID: PMC7386443 DOI: 10.1016/j.jegh.2017.10.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 09/23/2017] [Accepted: 10/24/2017] [Indexed: 12/02/2022] Open
Abstract
Healthcare-associated infections (HAIs) including device-associated HAI (DA-HAI) are a serious patient safety issue in hospitals worldwide, affecting 5–10% of hospitalized patients and deadly for patients in intensive care units (ICUs). (Vincent, 2003; Al-Tawfiq et al., 2013; Hu et al., 2013). DA-HAIs account for up to 23% of HAIs in ICUs and about 40% of all hospital infections (i.e. central line-associated blood stream infections [CLABSI], ventilator-associated pneumonia [VAP], and catheter-associated urinary tract infections [CAUTI]). This study aims to identify DA-HAI rates among a group of selected hospitals in the Kingdom of Saudi Arabia (KSA), 2013–2016. Secondary data was analyzed from 12 medical/surgical intensive care units (M/SICUs) and two cardiac care units (CCUs) from 12 Ministry of Health (MoH) hospitals from different regions in KSA. These data were reported by infection control practitioners to the MoH via electronic International Nosocomial Infection Control Consortium (INICC) systems in each hospital. Among 6178 ICU patients with 13,492 DA-HAIs during 2013–2016, the average length of stay (LOS) was 10.7 days (range 0–379 days). VAP was the most common DA-HAI (57.4%), followed by CAUTI (28.4%), and CLABSI (14.2%). In CCUs there were no CLABSI cases; CAUTI was reported from 1 to 2.6 per 1000 device-days; and VAP did not occur in Hospital B but occurred 8.1 times per 1000 device-days in the CCU in Hospital A. In M/SICUs, variations occurred among time periods, hospitals, and KSA provinces. CLABSI varied between hospitals from 2.2 to 10.5 per 1000 device-days. CAUTI occurred from 2.3 to 4.4 per 1000 device-days, while VAP had the highest rates, from 8.9 to 39.6 per 1000 device-days. Most hospitals had high device-utilization ratios (DURs) (from the 75th to 90th percentile of National Healthcare Safety Network (NHSN)’s standard and the 50th to 75th percentile of INICC’s). This study showed higher device-associated infection rates and higher device-utilization ratios in the study’s CCUs and M/SICUs than NHSN benchmarks. To reduce the rates of infection, ongoing monitoring of infection control practices and comprehensive education are required. Furthermore, a sensitive and specific national healthcare safety network is needed in KSA.
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Gao F, Yang LH, He HR, Ma XC, Lu J, Zhai YJ, Guo LT, Wang X, Zheng J. The effect of reintubation on ventilator-associated pneumonia and mortality among mechanically ventilated patients with intubation: A systematic review and meta-analysis. Heart Lung 2017; 45:363-71. [PMID: 27377334 DOI: 10.1016/j.hrtlng.2016.04.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Revised: 04/28/2016] [Accepted: 04/29/2016] [Indexed: 01/11/2023]
Abstract
OBJECTIVES This meta-analysis summarized the risks that reintubation impose on ventilator-associated pneumonia (VAP) and mortality. BACKGROUND Extubation failure increases the probability of poor clinical outcomes pertaining to mechanical ventilation. METHODS Literature published during a 15-year period was retrieved from PubMed, Web of Knowledge databases, the Embase (Excerpa Medica database), and the Cochrane Library. Data involving reintubation, VAP, and mortality were extracted for a meta-analysis. RESULTS Forty-one studies involving 29,923 patients were enrolled for the analysis. The summary odds ratio (OR) between VAP and reintubation was 7.57 (95% confidence interval [CI] = 3.63-15.81). The merged ORs for mortality in hospital and intensive care unit were 3.33 (95% CI = 2.02-5.49) and 7.50 (95% CI = 4.60-12.21), respectively. CONCLUSIONS Reintubation can represent a threat to survival and increase the risk of VAP. The risk of mortality after reintubation differs between planned and unplanned extubation. Extubation failure is associated with a higher risk of VAP in the cardiac surgery population than in the general population.
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Affiliation(s)
- Fan Gao
- Clinical Research Center, The First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta West Road, Xi'an, Shaanxi, China
| | - Li-Hong Yang
- Clinical Research Center, The First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta West Road, Xi'an, Shaanxi, China
| | - Hai-Rong He
- Clinical Research Center, The First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta West Road, Xi'an, Shaanxi, China
| | - Xian-Cang Ma
- Clinical Research Center, The First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta West Road, Xi'an, Shaanxi, China; Department of Psychiatry, The First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta West Road, Xi'an, Shaanxi, China
| | - Jun Lu
- Clinical Research Center, The First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta West Road, Xi'an, Shaanxi, China
| | - Ya-Jing Zhai
- Department of Pharmacy, The First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta West Road, Xi'an, Shaanxi, China
| | - Li-Tao Guo
- Department of Critical Care Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta West Road, Xi'an, Shaanxi, China
| | - Xue Wang
- Department of Critical Care Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta West Road, Xi'an, Shaanxi, China
| | - Jie Zheng
- Clinical Research Center, The First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta West Road, Xi'an, Shaanxi, China.
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Banjar A, Felemban M, Dhafar K, Gazzaz Z, Al Harthi B, Baig M, Al Khatib K, Zakaria J, Hawsawi K, Isahac L, Akbar A. Surveillance of preventive measures for ventilator associated pneumonia (VAP) and its rate in Makkah Region hospitals, Saudi Arabia. Turk J Med Sci 2017; 47:211-216. [PMID: 28263492 DOI: 10.3906/sag-1510-105] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 06/05/2016] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND/AIM The present study aimed to assess the VAP rate and to identify VAP prevention activities in public sector hospitals situated in the Makkah Region, Saudi Arabia (SA). MATERIALS AND METHODS In this cross-sectional study, the VAP data from 13 public sector hospitals were collected from January to December 2013 and analyzed using SPSS 16. RESULTS The overall VAP rate in Makkah Region hospitals was 6.89 cases per 1000 ventilator-days. There was a significant difference in VAP rate among the hospitals of the Makkah Region (P < 0.001). There was no significant difference in the VAP rate among hospitals, which were using only one, two, or all three VAP preventive approaches (P = 0.26) accredited by the Joint Commission International (JCI) and Central Board for Accreditation of Health Care Institution (CBAHI) (P = 0.12), and using the form in intensive care units (ICUs) (P = 0.85). There was a significant difference in the VAP rate among hospitals having different bed capacities (P < 0.001), data regularly collected (P = 0.03), and had a team to supervise the VAP project (P = 0.04). CONCLUSION The VAP rate in Makkah Region hospitals is 6.89 cases per 1000 ventilator-days.
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Affiliation(s)
- Ahmad Banjar
- Department of Thoracic Surgery, Al Noor Specialist Hospital, Makkah, Saudi Arabia
| | - Mohammed Felemban
- Department of Quality Management and Patient Safety, Makkah Region, Saudi Arabia
| | - Khalid Dhafar
- Department of General Surgery, Al Noor Specialist Hospital, Makkah, Saudi Arabia
| | - Zohair Gazzaz
- Department of Medicine, Faculty of Medicine, Rabigh, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Badr Al Harthi
- Department of Medicine, King Faisal Specialist Hospital, Taif, Saudi Arabia
| | - Mukhtiar Baig
- Department of Clinical Biochemistry, Faculty of Medicine, Rabigh, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Kasim Al Khatib
- Department of ICU, Al Noor Specialist Hospital, Makkah, Saudi Arabia
| | - Jameela Zakaria
- Department of Quality Management and Patient Safety, Makkah Region, Saudi Arabia
| | - Kawther Hawsawi
- Department of Nursing, King Faisal Hospital, Makkah, Saudi Arabia
| | - Lilma Isahac
- Department of Nursing, Al Noor Specialist Hospital, Makkah, Saudi Arabia
| | - Arbi Akbar
- Department of Nursing, Hera General Hospital, Makkah, Saudi Arabia
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23
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Althaqafi AO, Matar MJ, Moghnieh R, Alothman AF, Alenazi TH, Farahat F, Corman S, Solem CT, Raghubir N, Macahilig C, Haider S, Stephens JM. Burden of methicillin-resistant Staphylococcus aureus pneumonia among hospitalized patients in Lebanon and Saudi Arabia. Infect Drug Resist 2017; 10:49-55. [PMID: 28203096 PMCID: PMC5298302 DOI: 10.2147/idr.s97416] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objectives The objective of this study is to describe the real-world treatment patterns and burden of suspected or confirmed methicillin-resistant Staphylococcus aureus (MRSA) pneumonia in Saudi Arabia and Lebanon. Methods A retrospective chart review study evaluated 2011–2012 data from hospitals in Saudi Arabia and Lebanon. Patients were included if they had been discharged with a diagnosis of MRSA pneumonia, which was culture proven or suspected based on clinical criteria. Hospital data were abstracted for a random sample of patients to capture demographics (eg, age and comorbidities), treatment patterns (eg, timing and use of antimicrobials), hospital resource utilization (eg, length of stay), and clinical outcomes (eg, clinical status at discharge and mortality). Descriptive results were reported using frequencies or proportions for categorical variables and mean and standard deviation for continuous variables. Results Chart-level data were collected for 93 patients with MRSA pneumonia, 50 in Saudi Arabia and 43 in Lebanon. The average age of the patients was 56 years, and 60% were male. The most common comorbidities were diabetes (39%), congestive heart failure (30%), coronary artery disease (29%), and chronic obstructive pulmonary disease (28%). Patients most frequently had positive cultures from pulmonary (87%) and blood (27%) samples. All isolates were sensitive to vancomycin, teicoplanin, and linezolid, and only one-third of the isolates tested were sensitive to ciprofloxacin. Beta-lactams (inactive therapy for MRSA) were prescribed 21% of the time across all lines of therapy, with 42% of patients receiving first-line beta-lactams. Fifteen percent of patients did not receive any antibiotics that were considered to be MRSA active. The mean hospital length of stay was 32 days, and in-hospital mortality was 30%. Conclusion The treatment for MRSA pneumonia in Saudi Arabia and Lebanon may be suboptimal with inactive therapy prescribed a substantial proportion of the time. The information gathered from this Middle East sample provides important perspectives on the current treatment patterns.
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Affiliation(s)
- Abdulhakeem O Althaqafi
- Department of Infection Prevention and Control, King Abdullah International Medical Research Center, King Saud bin AbdulAziz University for Health Sciences, Jeddah, Kingdom of Saudi Arabia
| | - Madonna J Matar
- Department of Infectious Disease, Notre Dame de Secours University Hospital, Byblos
| | - Rima Moghnieh
- Makassed General Hospital, Beirut, Lebanese Republic
| | - Adel F Alothman
- Department of Medicine, King Abdulaziz Medical City, Central Region, Ministry of National Guard Health Affairs
| | - Thamer H Alenazi
- Infection Prevention & Control Department, King Abdulaziz Medical City-Riyadh (KAMC), Kingdom of Saudi Arabia
| | - Fayssal Farahat
- Department of Infection Prevention and Control, King Abdullah International Medical Research Center, King Saud bin AbdulAziz University for Health Sciences, Jeddah, Kingdom of Saudi Arabia
| | - Shelby Corman
- Real World Evidence: Data Analytics Center of Excellence, Pharmerit International, Bethesda, MD
| | - Caitlyn T Solem
- Real World Evidence: Data Analytics Center of Excellence, Pharmerit International, Bethesda, MD
| | | | | | - Seema Haider
- Outcomes & Evidence, Global Health and Value, Pfizer, Groton, CT, USA
| | - Jennifer M Stephens
- Real World Evidence: Data Analytics Center of Excellence, Pharmerit International, Bethesda, MD
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24
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Khan RM, Aljuaid M, Aqeel H, Aboudeif MM, Elatwey S, Shehab R, Mandourah Y, Maghrabi K, Hawa H, Khalid I, Qushmaq I, Latif A, Chang B, Berenholtz SM, Tayar S, Al-Harbi K, Yousef A, Amr AA, Arabi YM. Introducing the Comprehensive Unit-based Safety Program for mechanically ventilated patients in Saudi Arabian Intensive Care Units. Ann Thorac Med 2017; 12:11-16. [PMID: 28197216 PMCID: PMC5264166 DOI: 10.4103/1817-1737.197765] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Over the past decade, there have been major improvements to the care of mechanically ventilated patients (MVPs). Earlier initiatives used the concept of ventilator care bundles (sets of interventions), with a primary focus on reducing ventilator-associated pneumonia. However, recent evidence has led to a more comprehensive approach: The ABCDE bundle (Awakening and Breathing trial Coordination, Delirium management and Early mobilization). The approach of the Comprehensive Unit-based Safety Program (CUSP) was developed by patient safety researchers at the Johns Hopkins Hospital and is supported by the Agency for Healthcare Research and Quality to improve local safety cultures and to learn from defects by utilizing a validated structured framework. In August 2015, 17 Intensive Care Units (ICUs) (a total of 271 beds) in eight hospitals in the Kingdom of Saudi Arabia joined the CUSP for MVPs (CUSP 4 MVP) that was conducted in 235 ICUs in 169 US hospitals and led by the Johns Hopkins Armstrong Institute for Patient Safety and Quality. The CUSP 4 MVP project will set the stage for cooperation between multiple hospitals and thus strives to create a countrywide plan for the management of all MVPs in Saudi Arabia.
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Affiliation(s)
- Raymond M Khan
- Department of Intensive Care, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Maha Aljuaid
- Department of Intensive Care, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Hanan Aqeel
- Department of Intensive Care, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Mohammed M Aboudeif
- Department of Critical Care, International Extended Care Center, Jeddah, Saudi Arabia
| | - Shaimaa Elatwey
- Department of Critical Care, International Extended Care Center, Jeddah, Saudi Arabia
| | - Rajeh Shehab
- Department of Critical Care, International Extended Care Center, Jeddah, Saudi Arabia
| | - Yasser Mandourah
- Department of Intensive Care, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Khalid Maghrabi
- Department of Intensive Care, King Faisal Hospital and Research Center, Riyadh, Saudi Arabia
| | - Hassan Hawa
- Department of Intensive Care, King Faisal Hospital and Research Center, Riyadh, Saudi Arabia
| | - Imran Khalid
- Department of Medicine, Section of Critical Care Medicine, King Faisal Hospital and Research Center- Gen Org., Jeddah, Saudi Arabia
| | - Ismael Qushmaq
- Department of Medicine, Section of Critical Care Medicine, King Faisal Hospital and Research Center- Gen Org., Jeddah, Saudi Arabia
| | - Asad Latif
- Department of Anesthesia and Critical Care Medicine, Johns Hopkins Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Bickey Chang
- Department of Anesthesia and Critical Care Medicine, Johns Hopkins Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Sean M Berenholtz
- Department of Anesthesia and Critical Care Medicine, Johns Hopkins Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Sultan Tayar
- Department of Intensive Care, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Khloud Al-Harbi
- Department of Intensive Care, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Amin Yousef
- Department of Intensive Care, Al-Emam Abdulrahman Al-Faisal Hospital, Riyadh, Saudi Arabia
| | - Anas A Amr
- Department of Intensive Care, Al-Emam Abdulrahman Al-Faisal Hospital, Riyadh, Saudi Arabia
| | - Yaseen M Arabi
- Department of Intensive Care, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
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25
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Okgün Alcan A, Demir Korkmaz F, Uyar M. Prevention of ventilator-associated pneumonia: Use of the care bundle approach. Am J Infect Control 2016; 44:e173-e176. [PMID: 27388264 DOI: 10.1016/j.ajic.2016.04.237] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 04/21/2016] [Accepted: 04/21/2016] [Indexed: 01/04/2023]
Abstract
BACKGROUND The ventilator-associated pneumonia (VAP) care bundle consists of evidence-based practices to improve the outcomes of patients receiving mechanical ventilatory therapy. This study aimed to investigate the implementation of the care bundle on VAP rates in this quasiexperimental study. METHODS The protocol of this study consisted of 3 phases. In the initial phase, observations were made to determine the VAP care bundle adherence of intensive care unit (ICU) nurses. In the second phase, education was provided to ICU nurses on the subject of the VAP care bundle. For the third phase, the effect of VAP care bundle adherence on the VAP rates after education was investigated. RESULTS The nurses' VAP care bundle adherence improved after education from 10.8% (n = 152) to 89.8% (n = 1,324) and showed statistically significant improvement (P = .0001 and P < .05). In this study, the VAP rates were determined as 15.91/103 ventilator-days before education and 8.50/103 ventilator days after education. It was found that the VAP rates after the education period were significantly lower than the VAP rates before education. CONCLUSION VAP care bundle implementation with education prepared according to evidence-based guidelines decreased VAP rates. Thus, implementation of the VAP care bundle on mechanically ventilated patients care is recommended.
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26
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El-Saed A, Al-Jardani A, Althaqafi A, Alansari H, Alsalman J, Al Maskari Z, El Gammal A, Al Nasser W, Al-Abri SS, Balkhy HH. Ventilator-associated pneumonia rates in critical care units in 3 Arabian Gulf countries: A 6-year surveillance study. Am J Infect Control 2016; 44:794-8. [PMID: 27040565 DOI: 10.1016/j.ajic.2016.01.042] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2015] [Revised: 01/17/2016] [Accepted: 01/21/2016] [Indexed: 12/01/2022]
Abstract
BACKGROUND Data estimating the rates of ventilator-associated pneumonia (VAP) in critical patients in Gulf Cooperation Council (GCC) countries are very limited. The aim of this study was to estimate VAP rates in GCC hospitals and to compare rates with published reports of the U.S. National Healthcare Safety Network (NHSN) and International Nosocomial Infection Control Consortium (INICC). METHODS VAP rates and ventilator utilization between 2008 and 2013 were calculated from aggregate VAP surveillance data using NHSN methodology pooled from 6 hospitals in 3 GCC countries: Saudi Arabia, Oman, and Bahrain. The standardized infection ratios of VAP in GCC hospitals were compared with published reports of the NHSN and INICC. RESULTS A total of 368 VAP events were diagnosed during a 6-year period covering 76,749 ventilator days and 134,994 patient days. The overall VAP rate was 4.8 per 1,000 ventilator days (95% confidence interval, 4.3-5.3), with an overall ventilator utilization of 0.57. The VAP rates showed a wide variability between different types of intensive care units (ICUs) and were decreasing over time. After adjusting for the differences in ICU type, the risk of VAP in GCC hospitals was 217% higher than NHSN hospitals and 69% lower than INICC hospitals. CONCLUSIONS The risk of VAP in ICU patients in GCC countries is higher than pooled U.S. VAP rates but lower than pooled rates from developing countries participating in the INICC.
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Affiliation(s)
- Aiman El-Saed
- Infection Prevention and Control Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia; Gulf Cooperation Council States and World Health Organization Collaborating Center for Infection Prevention & Control, Saudi Arabia; Community Medicine Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Amina Al-Jardani
- Gulf Cooperation Council States and World Health Organization Collaborating Center for Infection Prevention & Control, Saudi Arabia; Infection Prevention and Control, Royal Hospital, Muscat, Oman
| | - Abdulhakeem Althaqafi
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; Infection Prevention and Control, King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - Huda Alansari
- Infection Prevention and Control, Salmaniya Medical Complex, Manama, Bahrain
| | - Jameela Alsalman
- Gulf Cooperation Council States and World Health Organization Collaborating Center for Infection Prevention & Control, Saudi Arabia; Infection Prevention and Control, Salmaniya Medical Complex, Manama, Bahrain
| | | | - Ayman El Gammal
- Infection Prevention and Control, King Abdulaziz Hospital, Al hassa, Saudi Arabia
| | - Wafa Al Nasser
- Infection Prevention and Control, Imam Abdulrahman bin Faisal Hospital, Dammam, Saudi Arabia
| | - Seif S Al-Abri
- Gulf Cooperation Council States and World Health Organization Collaborating Center for Infection Prevention & Control, Saudi Arabia; Infection Prevention and Control, Royal Hospital, Muscat, Oman
| | - Hanan H Balkhy
- Infection Prevention and Control Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia; Gulf Cooperation Council States and World Health Organization Collaborating Center for Infection Prevention & Control, Saudi Arabia; King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
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27
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The impact of implementing multifaceted interventions on the prevention of ventilator-associated pneumonia. Am J Infect Control 2016; 44:320-6. [PMID: 26940595 DOI: 10.1016/j.ajic.2015.09.025] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Revised: 09/21/2015] [Accepted: 09/22/2015] [Indexed: 11/20/2022]
Abstract
BACKGROUND Ventilator-associated pneumonia (VAP) is a frequent hospital acquired infections among intensive care unit patients. The Institute for Healthcare Improvement has suggested a "care bundle" approach for the prevention of VAP. This report describes the effects of implementing this strategy on VAP rates. METHODS All mechanically ventilated patients admitted to the intensive care unit between 2008 and 2013 were prospectively followed for VAP development according to the National Healthcare Safety Network criteria. In 2011, a 7-element care bundle was implemented, including head-of-bed elevation 30°-45°, daily sedation vacation and assessment for extubation, peptic ulcer disease prophylaxis, deep vein thrombosis prophylaxis, oral care with chlorhexidine, endotracheal intubation with in-line suction and subglottic suctioning, and maintenance of endotracheal tube cuff pressure at 20-30 mmHg. The bundle compliance and VAP rates were then followed. RESULTS A total of 3665 patients received mechanical ventilation, and there were 9445 monitored observations for bundle compliance. The total bundle compliance before and after initiation of the VAP team was 90.7% and 94.2%, respectively (P < .001). The number of VAP episodes decreased from 144 during 2008-2010 to only 14 during 2011-2013 (P < .0001). The rate of VAP decreased from 8.6 per 1000 ventilator-days to 2.0 per 1000 ventilator-days (P < .0001) after implementation of the care bundle. CONCLUSIONS This study suggests that systematic implementation of a multidisciplinary team approach can reduce the incidence of VAP. Further sustained improvement requires persistent vigilant inspections.
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28
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Al-Dorzi HM, Asiri AM, Shimemri A, Tamim HM, Al Johani SM, Al Dabbagh T, Arabi YM. Impact of empirical antimicrobial therapy on the outcome of critically ill patients with Acinetobacter bacteremia. Ann Thorac Med 2015; 10:256-62. [PMID: 26664563 PMCID: PMC4652291 DOI: 10.4103/1817-1737.164302] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
RATIONALE: Empirical antimicrobial therapy (EAT) for Acinetobacter infections may not be appropriate as it tends to be multidrug-resistant. This study evaluated the relationship between appropriate EAT and the outcomes of Intensive Care Unit (ICU) patients with Acinetobacter bacteremia. METHODS: This is a retrospective study of patients admitted to a medical-surgical ICU (2005-2010) and developed Acinetobacter bacteremia during the stay. Patients were categorized according to EAT appropriateness, defined as administration of at least one antimicrobial agent to which the Acinetobacter was susceptible before susceptibility results were known. The relation between EAT appropriateness and outcomes was evaluated. RESULTS: Sixty patients developed Acinetobacter bacteremia in the 6-year period (age = 50 ± 19 years; 62% males; Acute Physiology and Chronic Health Evaluation II score = 28 ± 9; 98.3% with central lines; 67% in shock and 59% mechanically ventilated) on average on day 23 of ICU and day 38 of hospital stay. All isolates were resistant to at least three of the tested antimicrobials. Appropriate EAT was administered to 60% of patients, mostly as intravenous colistin. Appropriate EAT was associated with lower ICU mortality risk (odds ratio: 0.15; 95% confidence interval: 0.03-0.96) on multivariate analysis. CONCLUSIONS: In this 6-year cohort, Acinetobacter bacteremia was related to multidrug-resistant strains. Appropriate EAT was associated with decreased ICU mortality risk.
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Affiliation(s)
- Hasan M Al-Dorzi
- Department of Intensive Care, King Abdulaziz Medical City, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Abdulaziz M Asiri
- Department of Intensive Care, King Abdulaziz Medical City, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Abdullah Shimemri
- Department of Intensive Care, King Abdulaziz Medical City, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Hani M Tamim
- Department of Epidemiology and Biostatistics, King Abdulaziz Medical City, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Sameera M Al Johani
- Department of Pathology and Laboratory Medicine, King Abdulaziz Medical City, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Tarek Al Dabbagh
- Department of Intensive Care, King Abdulaziz Medical City, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Yaseen M Arabi
- Department of Intensive Care, King Abdulaziz Medical City, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
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29
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Hamele M, Stockmann C, Cirulis M, Riva-Cambrin J, Metzger R, Bennett TD, Bratton SL. Ventilator-Associated Pneumonia in Pediatric Traumatic Brain Injury. J Neurotrauma 2015. [PMID: 26203702 DOI: 10.1089/neu.2015.4004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Ventilator-associated pneumonia (VAP) is a common occurrence among intubated pediatric traumatic brain injury (TBI) patients. However, little is known about the epidemiology, risk factors, and microbiology of VAP in pediatric TBI. We reviewed a cohort of 119 pediatric moderate-to-severe TBI patients and identified 42 with VAP by positive protected bronchial brush specimens. Location of intubation, severity of injury, and antibiotic administration within 2 days after injury were not associated with VAP. Most treatments for elevated intracranial pressure were associated with increased risk of VAP; however, in a multi-variable analysis barbiturate coma (hazard ratio [HR], 3.2; 95% confidence interval [CI] 1.4-7.3), neuromuscular blockade (NMBA; HR, 3.4; 95% CI 1.6-7.3), and use of a cooling blanket for euthermia (HR 2.4; 95% CI 1.1-5.5) remained independently associated with VAP. Most VAP (55%) occurred prior to hospital Day 4 and only 7% developed VAP after Day 7. Methicillin-sensitive Staphylococcus aureus (34%), Haemophilus influenzae (22%), and Streptococcus pneumoniae (15%) were the most common organisms, comprising 71% of isolated pathogens (36% of infections were polymicrobial). Patients with VAP had significantly longer intensive care unit and hospital stays, as well as increased risk of chronic care needs after discharge, but not mortality. VAP is a common occurrence in pediatric TBI patients, and early empiric therapy for patients requiring barbiturate infusion, NMBA, or use of a cooling blanket could mitigate morbidity.
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Affiliation(s)
- Mitchell Hamele
- 1 Department of Pediatrics, University of Utah School of Medicine , Salt Lake City, Utah
| | - Chris Stockmann
- 1 Department of Pediatrics, University of Utah School of Medicine , Salt Lake City, Utah
| | - Meghan Cirulis
- 1 Department of Pediatrics, University of Utah School of Medicine , Salt Lake City, Utah
| | - Jay Riva-Cambrin
- 2 Department of Neurosurgery, University of Utah School of Medicine , Salt Lake City, Utah
| | - Ryan Metzger
- 3 Division of Pediatric Surgery, University of Utah School of Medicine , Salt Lake City, Utah
| | - Tellen D Bennett
- 4 Pediatric Critical Care, University of Colorado School of Medicine , Aurora, Colorado
| | - Susan L Bratton
- 1 Department of Pediatrics, University of Utah School of Medicine , Salt Lake City, Utah
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30
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Koulenti D, Blot S, Dulhunty JM, Papazian L, Martin-Loeches I, Dimopoulos G, Brun-Buisson C, Nauwynck M, Putensen C, Sole-Violan J, Armaganidis A, Rello J. COPD patients with ventilator-associated pneumonia: implications for management. Eur J Clin Microbiol Infect Dis 2015; 34:2403-11. [PMID: 26407622 DOI: 10.1007/s10096-015-2495-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 09/18/2015] [Indexed: 10/23/2022]
Abstract
Data on the occurrence and outcome of patients with chronic obstructive pulmonary disease (COPD) and ventilator-associated pneumonia (VAP) are quite limited. The aim of this study was to determine if COPD intensive care unit (ICU) patients have a higher rate of VAP development, different microbiological aetiology or have worse outcomes than other patients without VAP. A secondary analysis of a large prospective, observational study conducted in 27 European ICUs was carried out. Trauma patients were excluded. Of 2082 intubated patients included in the study, 397 (19.1%) had COPD; 79 (19.9%) patients with COPD and 332 (19.7%) patients without COPD developed VAP. ICU mortality increased by 17% (p < 0.05) when COPD patients developed VAP, remaining an independent predictor of mortality [odds ratio (OR) 2.28; 95% confidence interval (CI) 1.35-3.87]. The development of VAP in COPD patients was associated with a median increase of 12 days in the duration of mechanical ventilation and >13 days in ICU stay (p < 0.05). Pseudomonas aeruginosa was more common in VAP when COPD was present (29.1% vs. 18.7%, p = 0.04) and was the most frequent isolate in COPD patients with early-onset VAP, with a frequency 2.5 times higher than in patients without early-onset VAP (33.3% vs. 13.3%, p = 0.03). COPD patients are not more predisposed to VAP than other ICU patients, but if COPD patients develop VAP, they have a worse outcome. Antibiotic coverage for non-fermenters needs to be included in the empiric therapy of all COPD patients, even in early-onset VAP.
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Affiliation(s)
- D Koulenti
- 2nd Critical Care Department, Attikon University Hospital, Athens, Greece.,Burns Trauma and Critical Care Research Centre, The University of Queensland, Brisbane, Australia
| | - S Blot
- Burns Trauma and Critical Care Research Centre, The University of Queensland, Brisbane, Australia. .,Department of Internal Medicine, Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185, 9000, Ghent, Belgium.
| | - J M Dulhunty
- Burns Trauma and Critical Care Research Centre, The University of Queensland, Brisbane, Australia.,Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - L Papazian
- Department of Intensive Care Medicine, Réanimation des Détresses Respiratoires et Infections Sévères Hôpital Nord-Assistance Publique-Hôpitaux de Marseille Aix-Marseille Université, Μarseille, France
| | - I Martin-Loeches
- Department of Intensive Care Medicine, Corporació Sanitària Parc Taulí, Sabadell, Spain.,Department of Intensive Care Medicine, Mater Misericordiae University Hospital, Dublin, Ireland.,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - G Dimopoulos
- 2nd Critical Care Department, Attikon University Hospital, Athens, Greece
| | - C Brun-Buisson
- Department of Intensive Care Medicine, Henri-Mondor University Hospital, Paris, France
| | - M Nauwynck
- Department of Intensive Care Medicine, St. Jan Hospital, Bruges, Belgium
| | - C Putensen
- Department of Intensive Care Medicine, Bonn University Hospital, Bonn, Germany
| | - J Sole-Violan
- Department of Intensive Care Medicine, Dr. Negrin University Hospital, Las Palmas, Gran Canaria, Spain
| | - A Armaganidis
- 2nd Critical Care Department, Attikon University Hospital, Athens, Greece
| | - J Rello
- Critical Care Department, Vall d'Hebron University Hospital, Barcelona, Spain.,Vall d'Hebron Institute of Research, Universitat Autonoma de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
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Herepath A, Kitchener M, Waring J. A realist analysis of hospital patient safety in Wales: applied learning for alternative contexts from a multisite case study. HEALTH SERVICES AND DELIVERY RESEARCH 2015. [DOI: 10.3310/hsdr03400] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BackgroundHospital patient safety is a major social problem. In the UK, policy responses focus on the introduction of improvement programmes that seek to implement evidence-based clinical practices using the Model for Improvement, Plan-Do-Study-Act cycle. Empirical evidence that the outcomes of such programmes vary across hospitals demonstrates that the context of their implementation matters. However, the relationships between features of context and the implementation of safety programmes are both undertheorised and poorly understood in empirical terms.ObjectivesThis study is designed to address gaps in conceptual, methodological and empirical knowledge about the influence of context on the local implementation of patient safety programmes.DesignWe used concepts from critical realism and institutional analysis to conduct a qualitative comparative-intensive case study involving 21 hospitals across all seven Welsh health boards. We focused on the local implementation of three focal interventions from the 1000 Lives+patient safety programme: Improving Leadership for Quality Improvement, Reducing Surgical Complications and Reducing Health-care Associated Infection. Our main sources of data were 160 semistructured interviews, observation and 1700 health policy and organisational documents. These data were analysed using the realist approaches of abstraction, abduction and retroduction.SettingWelsh Government and NHS Wales.ParticipantsInterviews were conducted with 160 participants including government policy leads, health managers and professionals, partner agencies with strategic oversight of patient safety, advocacy groups and academics with expertise in patient safety.Main outcome measuresIdentification of the contextual factors pertinent to the local implementation of the 1000 Lives+patient safety programme in Welsh NHS hospitals.ResultsAn innovative conceptual framework harnessing realist social theory and institutional theory was produced to address challenges identified within previous applications of realist inquiry in patient safety research. This involved the development and use of an explanatory intervention–context–mechanism–agency–outcome (I-CMAO) configuration to illustrate the processes behind implementation of a change programme. Our findings, illustrated by multiple nested I-CMAO configurations, show how local implementation of patient safety interventions are impacted and modified by particular aspects of context: specifically, isomorphism, by which an intervention becomes adapted to the environment in which it is implemented; institutional logics, the beliefs and values underpinning the intervention and its source, and their perceived legitimacy among different groups of health-care professionals; and the relational structure and power dynamics of the functional group, that is, those tasked with implementing the initiative. This dynamic interplay shapes and guides actions leading to the normalisation or the rejection of the patient safety programme.ConclusionsHeightened awareness of the influence of context on the local implementation of patient safety programmes is required to inform the design of such interventions and to ensure their effective implementation and operationalisation in the day-to-day practice of health-care teams. Future work is required to elaborate our conceptual model and findings in similar settings where different interventions are introduced, and in different settings where similar innovations are implemented.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Andrea Herepath
- Sir Roland Smith Centre for Strategic Management, Department of Entrepreneurship, Strategy and Innovation, Lancaster University Management School, Lancaster University, Lancaster, UK
- Cardiff Business School, Cardiff University, Cardiff, UK
| | | | - Justin Waring
- Nottingham University Business School, University of Nottingham, Nottingham, UK
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Park SA, Cho SS, Kwak GJ. Factors influencing ventilator-associated pneumonia in cancer patients. Asian Pac J Cancer Prev 2015; 15:5787-91. [PMID: 25081653 DOI: 10.7314/apjcp.2014.15.14.5787] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND With increasing survival periods and diversification of treatment methods, treatment of critically ill cancer patients has become an important factor influencing patient prognosis. Patients with cancer are at high risk of infections and subsequent complications. This study investigated the incidence and factors contributing to the development of ventilator-associated pneumonia (VAP). MATERIALS AND METHODS This retrospective study investigated the incidence of VAP and factors leading to infection in patients admitted to the intensive care unit (ICU) of a cancer center from January 1, 2012 to December 31, 2013. RESULTS The incidence of VAP was 2.13 cases per 1,000 days of intubation, and 13 of 288 patients (4.5%) developed VAP. Lung cancer was the most common cancer associated with VAP (N=7, 53.9%), and longer hospital stays and intubation were associated with increased VAP incidence. In the group using a "ventilator bundle," the incidence was 1.14 cases per 1,000 days compared to 2.89 cases per 1,000 days without its use; however, this difference was not statistically significant (p=0.158). Age (≥ 65, OR=5.56, 95% confidence interval [CI]=1.29-23.95), surgery (OR=3.78, 95%CI=1.05- 13.78), and tracheotomy (OR=4.46, 95%CI=1.00-19.85) were significant VAP risk factors. The most common causative organisms were methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa (N=4, 30.8% each), followed by Acinetobacter baumannii and Candida albicans (N=2, 15.4% each). CONCLUSIONS The incidence of pneumonia among critically ill cancer patients is highest in those with lung cancer, but lower than among non-cancer patients. The length of hospital stay and time on mechanical ventilation are important risk factors for development of VAP. Although not statistically significant, "ventilator bundle" care is an effective intervention that delays or reduces incidence of VAP. Major risk factors for VAP include age (≥ 65 years), surgery, and tracheostomy, while fungi, gram-negative bacteria, and multidrug-resistant organisms were identified as the major causative pathogens of VAP in this study.
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Affiliation(s)
- Sun-A Park
- Office of Infection Control, National Cancer Center in Korea E-mail :
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Rouze A, Nseir S. Pneumonie acquise sous ventilation mécanique chez le patient BPCO : épidémiologie, physiopathologie, prévention. MEDECINE INTENSIVE REANIMATION 2015. [DOI: 10.1007/s13546-015-1061-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Desai SV, Fang CH, Raikundalia MD, Baredes S, Liu JK, Eloy JA. Impact of postoperative pneumonia following pituitary surgery. Laryngoscope 2015; 125:1792-7. [PMID: 25892492 DOI: 10.1002/lary.25307] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Revised: 02/11/2015] [Accepted: 03/12/2015] [Indexed: 11/06/2022]
Abstract
OBJECTIVES/HYPOTHESIS Postoperative pneumonia (PNA) has been identified as a preventable never event by the Centers for Medicare and Medicaid Services (CMS). The CMS has discussed possibly discontinuing reimbursement for this postoperative complication. In this study, risk factors, patient outcomes, and hospital charges of care associated with postoperative PNA in patients undergoing pituitary surgery were evaluated. METHODS Discharge data of patients who underwent pituitary surgery between 2002 and 2010 were obtained from the National Inpatient Sample database. Demographics, preexisting comorbidities, postoperative complications, morbidity, length of hospital stay, and hospital charges were analyzed. RESULTS A total of 15,317 patients were included in this analysis. Ninety-eight patients (0.6%) were diagnosed with PNA postoperatively. There was a significant association between postoperative PNA and older age (P < 0.001), male gender (P = 0.044), and transfrontal surgical approach (P < 0.001). Patients with anemia, congestive heart failure, chronic pulmonary disease, diabetes mellitus, fluid and electrolyte disorders, paralysis, and weight loss had a significantly higher rate of PNA. Patients with PNA had a significantly higher mortality (P < 0.001). They also incurred on average over four times the hospital charges and nearly five times longer hospitalizations compared to patients without PNA. CONCLUSIONS Variables associated with an increased risk of postoperative PNA in patients undergoing pituitary surgery include older age, male gender, and transfrontal surgical approach. Patients with postoperative PNA had a longer length of hospital stay, higher hospital charges, and increased mortality. LEVEL OF EVIDENCE 2C.
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Affiliation(s)
| | | | | | - Soly Baredes
- Department of Otolaryngology-Head and Neck Surgery.,Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey
| | - James K Liu
- Department of Otolaryngology-Head and Neck Surgery.,Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey.,Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
| | - Jean Anderson Eloy
- Department of Otolaryngology-Head and Neck Surgery.,Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey.,Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
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Al-Thaqafy MS, El-Saed A, Arabi YM, Balkhy HH. Association of compliance of ventilator bundle with incidence of ventilator-associated pneumonia and ventilator utilization among critical patients over 4 years. Ann Thorac Med 2014; 9:221-6. [PMID: 25276241 PMCID: PMC4166069 DOI: 10.4103/1817-1737.140132] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Accepted: 04/27/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND: Several studies showed that the implementation of the Institute for Healthcare Improvement (IHI) ventilator bundle alone or with other preventive measures are associated with reducing Ventilator-Associated Pneumonia (VAP) rates. However, the association with ventilator utilization was rarely examined and the findings were conflicting. The objectives were to validate the bundle association with VAP rate in a traditionally high VAP environment and to examine its association with ventilator utilization. MATERIALS AND METHODS: The study was conducted at the adult medical-surgical intensive care unit (ICU) at King Abdulaziz Medical City, Saudi Arabia, between 2010 and 2013. VAP data were collected by a prospective targeted surveillance as per Centers for Disease Control and Prevention (CDC)/National Healthcare Safety Network (NHSN) methodology while bundle data were collected by a cross-sectional design as per IHI methodology. RESULTS: Ventilator bundle compliance significantly increased from 90% in 2010 to 97% in 2013 (P for trend < 0.001). On the other hand, VAP rate decreased from 3.6 (per 1000 ventilator days) in 2010 to 1.0 in 2013 (P for trend = 0.054) and ventilator utilization ratio decreased from 0.73 in 2010 to 0.59 in 2013 (P for trend < 0.001). There were negative significant correlations between the trends of ventilator bundle compliance and VAP rate (cross-correlation coefficients −0.63 to 0.07) and ventilator utilization (cross-correlation coefficients −0.18 to −0.63). CONCLUSION: More than 70% improvement of VAP rates and approximately 20% improvement of ventilator utilization were observed during IHI ventilator bundle implementation among adult critical patients in a tertiary care center in Saudi Arabia. Replicating the current finding in multicenter randomized trials is required before establishing any causal link.
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Affiliation(s)
- Majid S Al-Thaqafy
- Infection Prevention and Control Department, King Abdulaziz Medical City, Jeddah and Riyadh, Saudi Arabia
| | - Aiman El-Saed
- Infection Prevention and Control Department, King Abdulaziz Medical City, Jeddah and Riyadh, Saudi Arabia ; Community Medicine Department, Faculty of Medicine, Mansoura University, Egypt
| | - Yaseen M Arabi
- Intensive Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Hanan H Balkhy
- Infection Prevention and Control Department, King Abdulaziz Medical City, Jeddah and Riyadh, Saudi Arabia
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Chronic obstructive pulmonary disease and the risk for ventilator-associated pneumonia. Curr Opin Crit Care 2014; 20:525-31. [DOI: 10.1097/mcc.0000000000000123] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Lascarrou JB, Le Gouge A, Dimet J, Lacherade JC, Martin-Lefèvre L, Fiancette M, Vinatier I, Lebert C, Bachoumas K, Yehia A, Lagarrigue MH, Colin G, Reignier J. Neuromuscular blockade during therapeutic hypothermia after cardiac arrest: Observational study of neurological and infectious outcomes. Resuscitation 2014; 85:1257-62. [DOI: 10.1016/j.resuscitation.2014.05.017] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Revised: 05/21/2014] [Accepted: 05/22/2014] [Indexed: 01/15/2023]
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Balkhy HH, El-Saed A, Maghraby R, Al-Dorzi HM, Khan R, Rishu AH, Arabi YM. Drug-resistant ventilator associated pneumonia in a tertiary care hospital in Saudi Arabia. Ann Thorac Med 2014; 9:104-11. [PMID: 24791174 PMCID: PMC4005156 DOI: 10.4103/1817-1737.128858] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Accepted: 01/05/2014] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND: There is a wide geographic and temporal variability of bacterial resistance among microbial causes of ventilator-associated pneumonia (VAP). The contribution of multi-drug resistant (MDR) pathogens to the VAP etiology in Saudi Arabia was never studied. We sought to examine the extent of multiple-drug resistance among common microbial causes of VAP. MATERIALS AND METHODS: We conducted a retrospective susceptibility study in the adult intensive care unit (ICU) of King Abdulaziz Medical City, Riyadh, Saudi Arabia. Susceptibility results of isolates from patients diagnosed with VAP between October 2004 and June 2009 were examined. The US National Healthcare Safety Network definition of MDR was adopted. RESULTS: A total of 248 isolates including 9 different pathogens were included. Acinetobacter spp. was highly (60-89%) resistant to all tested antimicrobials, including carbapenems (three- and four-class MDR prevalence were 86% and 69%, respectively). Pseudomonas aeruginosa was moderately (13-31%) resistant to all tested antimicrobials, including antipseudomonal penicillins (three- and four-class MDR prevalence were 13% and 10%, respectively). With an exception of ampicillin (fully resistant), Klebsiella spp. had low (0-13%) resistance to other tested antimicrobials with no detected MDR. Staphylococcus aureus was fully susceptible to vancomycin with 42% resistance to oxacillin. There were significant increasing trends of MDR Acinetobacter spp. however not P. aeruginosa during the study. Resistant pathogens were associated with worse profile of ICU patients but not patients’ outcomes. CONCLUSION: Acinetobacter in the current study was an increasingly resistant VAP-associated pathogen more than seen in many parts of the world. The current finding may impact local choice of initial empiric antibiotics.
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Affiliation(s)
- Hanan H Balkhy
- Department of Infection Prevention and Control, King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia ; Gulf Cooperation Council States and WHO Collaborating Center for Infection Prevention and Control, Riyadh, Kingdom of Saudi Arabia ; King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia ; Department of Pediatrics, King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Aiman El-Saed
- Department of Infection Prevention and Control, King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia ; Gulf Cooperation Council States and WHO Collaborating Center for Infection Prevention and Control, Riyadh, Kingdom of Saudi Arabia ; King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia ; Department of Community Medicine, Faculty of Medicine, Mansoura University, Egypt
| | - Rana Maghraby
- Department of Pediatrics, King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Hasan M Al-Dorzi
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia ; Department of Intensive Care, King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Raymond Khan
- Department of Intensive Care, King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Asgar H Rishu
- Department of Intensive Care, King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Yaseen M Arabi
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia ; Department of Intensive Care, King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia
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El-Saed A, Balkhy HH, Al-Dorzi HM, Khan R, Rishu AH, Arabi YM. Acinetobacter is the most common pathogen associated with late-onset and recurrent ventilator-associated pneumonia in an adult intensive care unit in Saudi Arabia. Int J Infect Dis 2013; 17:e696-701. [DOI: 10.1016/j.ijid.2013.02.004] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2012] [Revised: 01/30/2013] [Accepted: 02/02/2013] [Indexed: 01/12/2023] Open
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Al-Tawfiq JA, Amalraj A, Memish ZA. Reduction and surveillance of device-associated infections in adult intensive care units at a Saudi Arabian hospital, 2004-2011. Int J Infect Dis 2013; 17:e1207-11. [PMID: 23932872 DOI: 10.1016/j.ijid.2013.06.015] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Revised: 06/21/2013] [Accepted: 06/26/2013] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Device-associated infections (DAI) are recognized as a marker of patient safety. Data regarding DAI rates in Saudi Arabia are sparse. METHODS This was a prospective surveillance study of DAI rates conducted in the adult intensive care units of the Saudi Aramco Medical Services Organization, carried out using the DAI definition provided by the Centers for Disease Control and Prevention's National Healthcare Safety Network. DAI prevention bundles were introduced in 2006 for ventilator-associated pneumonia (VAP), in mid-2010 for catheter-associated urinary tract infections (CAUTI), and in 2008 for central line-associated blood stream infections (CLABSI). RESULTS DAI rates for VAP, CLABSI, and CAUTI are reported for the study period from 2004 to 2011. CAUTI was the most common DAI (42.2%), followed by CLABSI (38.5%) and VAP (19.3%). The overall rate of each infection type per 1000 device-days was 8.18 for CAUTI, 10 for CLABSI, and 4.52 for VAP. Annual DAI rates showed a significant reduction over time from the beginning of the study to the end of the study for CLABSI (16.3 vs. 6.06), CAUTI (6.75 vs. 3.41), and VAP (9.8 vs. 1.3) (p<0.05). CONCLUSIONS CAUTI was the most common infection, and the use of DAI prevention bundles was associated with a significant decrease in DAI rates over time.
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Affiliation(s)
- Jaffar A Al-Tawfiq
- Specialty Internal Medicine Unit, Room A-428-2, Building 61, Dhahran Health Center, Saudi Aramco Medical Services Organization, Saudi Aramco, PO Box 76, Dhahran 31311, Saudi Arabia.
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The author replies. Crit Care Med 2013; 41:e97. [DOI: 10.1097/ccm.0b013e318291b89e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Hübner NO, Fleßa S, Jakisch R, Assadian O, Kramer A. Review of indicators for cross-sectoral optimization of nosocomial infection prophylaxis - a perspective from structurally- and process-oriented hygiene. GMS KRANKENHAUSHYGIENE INTERDISZIPLINAR 2012; 7:Doc15. [PMID: 22558049 PMCID: PMC3334955 DOI: 10.3205/dgkh000199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
In the care of patients, the prevention of nosocomial infections is crucial. For it to be successful, cross-sectoral, interface-oriented hygiene quality management is necessary. The goal is to apply the HACCP (Hazard Assessment and Critical Control Points) concept to hospital hygiene, in order to create a multi-dimensional hygiene control system based on hygiene indicators that will overcome the limitations of a procedurally non-integrated and non-cross-sectoral view of hygiene. Three critical risk dimensions can be identified for the implementation of three-dimensional quality control of hygiene in clinical routine: the constitution of the person concerned, the surrounding physical structures and technical equipment, and the medical procedures. In these dimensions, the establishment of indicators and threshold values enables a comprehensive assessment of hygiene quality. Thus, the cross-sectoral evaluation of the quality of structure, processes and results is decisive for the success of integrated infection prophylaxis. This study lays the foundation for hygiene indicator requirements and develops initial concepts for evaluating quality management in hygiene.
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