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Bulut M, Yüksel Ç. Developing evidence-based medication therapy management tools for psychiatric nurses: An evaluative qualitative case study. J Eval Clin Pract 2024. [PMID: 38959384 DOI: 10.1111/jep.14050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 05/16/2024] [Accepted: 06/02/2024] [Indexed: 07/05/2024]
Abstract
RATIONALE, AIMS AND OBJECTIVES Clinical use of psychotropic medications involves diverse risks, addressable by nursing interventions. The research had a dual purpose: developing an "Evidence-Based Medication Therapy Management Guideline" and a "Medication Administration-Tracking Chart" and evaluating their use through an evaluative case study. METHODS Evidence-based guideline and chart development and evaluative case study. Initially, Evidence-Based Medication Therapy Management Guideline and Medication Administration Tracking Chart for managing medication in a psychiatric unit were developed. Subsequently, their efficacy was evaluated in a case study involving 10 participating nurses used in the psychiatric unit with 123-bed of a training and research hospital in Turkey. Data was collected through personal forms, interviews, medication charts, and researcher observations, and the analysis employed Merriam's case study method. RESULTS Three themes (inception, implementation, termination, and sustainers) and 12 sub-themes emerged. Nurses stated that the research tools filled their information gaps, enhancing the medication therapy management process's effectiveness and safety, improving nursing care quality and continuity, and benefiting patient outcomes. Nurses expressed a desire to consistently use the tools in the unit and provided suggestions. CONCLUSION Nurses highlighted the tools' potential to enhance medication safety, psychiatric care, and patient outcomes. However, their stance on using evidence-based tools revealed an approach/avoidance conflict, balancing benefits and barriers. Experience emerged as a hindrance in embracing evidence-based clinical tools. This study is among the first to comprehensively develop evidence-based medication management guideline and administration-tracking chart for psychiatric nurses globally and in our country. Routine use of the tools is expected to enhance nurses' expertise in psychotropic medication management, leading to improved patient outcomes in medication-related aspects.
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Affiliation(s)
- Melisa Bulut
- Department of Mental Health and Psychiatric Nursing, Faculty of Health Sciences, Bolu Abant Izzet Baysal University Turkey, Bolu, Turkey
| | - Çiğdem Yüksel
- Department of Mental Health and Psychiatric Nursing, Gulhane Faculty of Nursing, University of Health Sciences Turkey, Ankara, Turkey
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Guillamet CV, Kollef MH. Is Zero Ventilator-Associated Pneumonia Achievable? Updated Practical Approaches to Ventilator-Associated Pneumonia Prevention. Infect Dis Clin North Am 2024; 38:65-86. [PMID: 38040518 DOI: 10.1016/j.idc.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2023]
Abstract
Ventilator-associated pneumonia (VAP) remains a significant clinical entity with reported incidence rates of 7% to 15%. Given the considerable adverse consequences associated with this infection, VAP prevention became a core measure required in most US hospitals. Many institutions took pride in implementing effective VAP prevention bundles that combined at least head of bed elevation, hand hygiene, chlorhexidine oral care, and subglottic drainage. Spontaneous breathing and awakening trials have also consistently been shown to shorten the duration of mechanical ventilation and secondarily reduce the occurrence of VAP.
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Affiliation(s)
| | - Marin H Kollef
- Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, St. Louis, MO, USA.
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Ashkenazy S, Ganz FD, Kuniavsky M, Jakobson L, Levy H, Avital IL, Kolpak O, Golan D, Rebecca ML, Itzhakov S, Suliman M, Lavy A, Biton C, Broyer C, Benbenishty J. Patient mobilization in the intensive care unit: Assessing practice behavior - A multi-center point prevalence study. Intensive Crit Care Nurs 2024; 80:103510. [PMID: 37599127 DOI: 10.1016/j.iccn.2023.103510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 07/22/2023] [Accepted: 07/24/2023] [Indexed: 08/22/2023]
Abstract
OBJECTIVES To describe intensive care unit mobility clinical practice behaviors and the factors associated with these behaviors that could explain the theory-practice gap. METHODOLOGY A multi-center, descriptive, retrospective, one-day point prevalence study. SETTING intensive care patients hospitalized for a minimum of 24 hours, in 20 Israeli Adult Intensive Care Units, from six medical centers. MAIN OUTCOME MEASURES Maximum patient mobility level during the 24 hours prior to the prevalence study collection day and 48 hours from patient admission; mobility clinical practice behaviors and their inhibiting factors. RESULTS The study included 210 patients from a relatively even distribution of admission diagnoses. About half (46%) were intubated and 31% were hemodynamically unstable. Position change was most frequently reported as the maximum mobility level. The use of intubation, ventilation, tracheostomy, and inotropes was positively correlated with the level of mobility. Charlson Comorbidity Index and body mass index were not related to the level of mobility. A multiple regression model including these variables found that only intubation was a significant predictor of mobility level (R2 = 0.52, p < 0.001). CONCLUSION There is a gap between clinical practice guidelines and actual intensive care mobility practice behaviors. The association between mobility level and common therapies suggests subjective norms or common practices that could serve as a barrier to guideline implementation and partially explain the gap between clinical practice guidelines and clinical practice behavior. IMPLICATIONS FOR CLINICAL PRACTICE Behaviors and their subjective norms can be barriers to the implementation of clinical practice guidelines. Promoting increased provider awareness and policies of proactive mobilization could potentially improve patient outcomes.
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Affiliation(s)
- Shelly Ashkenazy
- Hadassah-Hebrew University Medical Center, Jerusalem, Israel, Kiryat Hadassah, POB 12000, Jerusalem 91120, Israel.
| | - Freda DeKeyser Ganz
- Jerusalem College of Technology, Hadassah Hebrew University School of Nursing, Jerusalem College of Technology, 11 Beit Hadfus, Jerusalem 9548311, Israel.
| | - Michael Kuniavsky
- Quality and Safety Division, Israel Ministry of Health - 39 Yirmeyahu Street, Jerusalem 9101002, Israel; Shamir (Assaf HaRofeh) Medical Center, Beer-Jaacov 7030000, Israel; Tel Aviv-Jaffa Academic College, Rabenu Yeruham St., P.O.B 840, Yaffo 6818211, Israel.
| | - Levana Jakobson
- Nahariya Galilee Medical Center, Nahariya cabri-89, Nahariya 22100001 Israel.
| | - Hadassa Levy
- Rambam Health Care Campus, P.O.B. 9602, Haifa 3109601, Haifa, Israel.
| | - Iris Levdov Avital
- Israel Poison Information Center, Rambam Health Care Campus, Ministry of Health, Haaliya Hashniya 8 Bat Galim, POB 9602, Haifa 3109601, Israel.
| | - Orly Kolpak
- Nahariya Galilee Medical Center, Nahariya cabri-89, Nahariya 22100001 Israel.
| | - Dorit Golan
- Rambam Health Care Campus, Bat Galim POB 9602, Haifa 3109601, Israel.
| | - Mor Levy Rebecca
- Sheba Medical Center, Derech Sheba 2, Tel Hashomer, Ramat Gan, Israel.
| | - Shiran Itzhakov
- Sheba Medical Center, Derech Sheba 2, Tel Hashomer, Ramat Gan, Israel.
| | - Moriya Suliman
- Sheba Medical Center, Derech Sheba 2, Tel Hashomer, Ramat Gan, Israel.
| | - Alinoy Lavy
- Shamir (Assaf HaRofeh) Medical Center, Tel Aviv University, Zerifin 70300, Israel.
| | - Chen Biton
- Shamir (Assaf HaRofeh) Medical Center, Tel Aviv University, Zerifin 70300, Israel.
| | - Chaya Broyer
- Shaare Zedek Medical Center, 12 Bait St., Jerusalem, Israel.
| | - Julie Benbenishty
- Hadassah Hebrew University Faculty of Medicine School of Nursing, Jerusalem, Israel; Kiryat Hadassah, POB 12000, Jerusalem 91120, Israel.
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Hoang HM, Dao CX, Huy Ngo H, Okamoto T, Matsubara C, Do SN, Bui GTH, Bui HQ, Duong NT, Nguyen NT, Vuong TX, Van Vu K, Phạm TT, Van Bui C. Efficacy of compliance with ventilator-associated pneumonia care bundle: A 24-month longitudinal study at Bach Mai Hospital, Vietnam. SAGE Open Med 2024; 12:20503121231223467. [PMID: 38249955 PMCID: PMC10798102 DOI: 10.1177/20503121231223467] [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: 09/20/2023] [Accepted: 12/11/2023] [Indexed: 01/23/2024] Open
Abstract
Introduction To decrease the risk of complications from ventilator-associated pneumonia, it is essential to implement preventative measures in all ICU patients. Since 2018, with the help of Japanese experts, we have applied a ventilator-associated pneumonia care bundle with 10 basic standards in patient care and monitoring. Therefore, we conducted a study to evaluate the results of applying 10 solutions to prevent ventilator-associated pneumonia over 24 months. Methods A cross-sectional descriptive study with longitudinal follow-up for 24 months on 170 mechanically ventilated patients at the Center for Critical Care Medicine, Bach Mai Hospital. According to the Centers for Disease Control (CDC, 2021), the diagnosis of ventilator-associated pneumonia is when pneumonia appears 48 h after intubation by confirmation by at least two doctors. Evaluate compliance with each solution in the care bundle through camera monitoring, medical records, and directly on patients daily. Results The rate of ventilator-associated pneumonia is 12.9%, the frequency of occurrence is 16.54 of 1000 days. The compliance rate for complete compliance with a 10-item ventilator-associated pneumonia was only 1.8%, while the average value was 84.1%. Average values of compliance with each solution for hand hygiene, head elevation 30-45 degrees, oral hygiene, stopping sedation, breathing circuit management, cuff pressure management, hypoplastic suction, Spontaneous breathing trial (SBT) daily and assessed extubation, mobilization and early leaving bed, ulcer and thrombosis prevention were 96.9%, 97.3%, 99.4%, 81.5%, 99.9%, 99.9%, 86.3%, 83.5%, 49.3%, and 46.4%, respectively. The time to appear ventilator-associated pneumonia in the high compliance group was 46.7 ± 5.0 days, higher than in the low compliance group, 10.3 ± 0.7 days, p < 0.001. Conclusions A 10-item ventilator-associated pneumonia care bundle has helped reduce the incidence of ventilator-associated pneumonia. To reduce the risk of ventilator-associated pneumonia and shorten ICU and hospital stays, it is essential to fully adhere to subglottic secretion suction, daily SBT, and early mobilization and leaving the bed.
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Affiliation(s)
- Hoan Minh Hoang
- Bach Mai Hospital, Hanoi, Vietnam
- Nam Dinh University of Nursing, Nam Dinh, Vietnam
| | - Co Xuan Dao
- Bach Mai Hospital, Hanoi, Vietnam
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, University of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam
| | | | - Tatsuya Okamoto
- National Center for Global Health and Medicine Research Institute, Tokyo, Japan
| | | | - Son Ngoc Do
- Bach Mai Hospital, Hanoi, Vietnam
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, University of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam
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Buterakos R, Jenkins PM, Cranford J, Haake RS, Maxson M, Moon J, Rice B, Sachwani-Daswani GR. An in-depth look at ventilator-associated pneumonia in trauma patients and efforts to increase bundle compliance, education and documentation in a surgical trauma critical care unit. Am J Infect Control 2022; 50:1333-1338. [PMID: 35131347 DOI: 10.1016/j.ajic.2022.01.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 01/21/2022] [Accepted: 01/22/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Ventilator-associated pneumonia (VAP) is considered the most common hospital acquired infection seen in critical care settings and leading cause of death in Intensive Care Units (ICU). The objective of this study was to assess whether specimen collection impacted diagnosis and if implementation of a VAP bundle would decrease rates at our center. METHODS This single center study design is a retrospective chart review from 2017 to 2020 utilizing the electronic medical record. A pre-/postintervention comparison was performed following implementation of a unit wide VAP bundle and nursing education. Descriptive statistics and continuous variables were analyzed with independent group t -tests, and categorical variables were analyzed with chi-squared tests. RESULTS Ventilator-associated pneumonia rates decreased in the postimplementation time (20.8%, n = 74 vs 12.2%, n = 15; P = .03). There were no significant differences in the patient profile of those who acquired VAP (ie, males 79.7% vs 86.7%, blunt injuries 63.5% vs 86.7% and severity scores 24.8 vs 25.1, pre vs postimplementation, respectively, all P-values greater than .05). DISCUSSION/CONCLUSIONS Reduction in VAP rates were achieved by implementing a standardized, evidence based, prevention protocol. Further research is warranted as studies have noted that patients requiring mechanical ventilation are at greater risk for VAP than other ICU patients due to the nature of their injuries and increased risk of prolonged mechanical ventilation ≥ 21 days.
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Affiliation(s)
- Roxanne Buterakos
- Department of Trauma and Acute Care Surgery, Hurley Medical Center, Flint, MI; School of Nursing, University of Michigan Flint, Flint, MI
| | - Phillip M Jenkins
- Department of Trauma and Acute Care Surgery, Hurley Medical Center, Flint, MI.
| | - James Cranford
- Department of Trauma and Acute Care Surgery, Hurley Medical Center, Flint, MI; Department of Emergency Medicine, University of Michigan Ann Arbor, Ann Arbor, MI
| | | | - Michelle Maxson
- Department of Trauma and Acute Care Surgery, Hurley Medical Center, Flint, MI
| | - Jihye Moon
- School of Nursing, University of Michigan Flint, Flint, MI
| | - Brittney Rice
- School of Nursing, University of Michigan Flint, Flint, MI
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AL-Mugheed K, Bani-Issa W, Rababa M, Hayajneh AA, Syouf AA, Al-Bsheish M, Jarrar M. Knowledge, Practice, Compliance, and Barriers toward Ventilator-Associated Pneumonia among Critical Care Nurses in Eastern Mediterranean Region: A Systematic Review. Healthcare (Basel) 2022; 10:1852. [PMID: 36292297 PMCID: PMC9602381 DOI: 10.3390/healthcare10101852] [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: 08/22/2022] [Revised: 09/16/2022] [Accepted: 09/19/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Ventilator-associated pneumonia (VAP) has been identified as a serious complication among hospitalized patients and is associated with prolonged hospitalizations and increased costs. The purpose of this study was to examine the knowledge, practices, compliance, and barriers related to ventilator-associated pneumonia among critical care nurses in the eastern Mediterranean region. METHODS The PRISMA guidelines guided this systematic review. Four electronic databases (EMBASE, MEDLINE (via PubMed), SCOPUS, and Web of Science) were used to find studies that were published from 2000 to October 2021. RESULTS Knowledge of ventilator-associated pneumonia was the highest outcome measure used in 14 of the 23 studies. The review results confirmed that nurses demonstrated low levels of knowledge of ventilator-associated pneumonia, with 11 studies assessing critical care nurses' compliance with and practice with respect to ventilator-associated pneumonia. Overall, the results showed that most sampled nurses had insufficient levels of compliance with and practices related to ventilator-associated pneumonia. The main barriers reported across the reviewed studies were a lack of education (N = 6), shortage of nursing staff (N = 5), lack of policies and protocols (N = 4), and lack of time (N = 4). CONCLUSIONS The review confirmed the need for comprehensive interventions to improve critical care nurses' knowledge, compliance, and practice toward ventilator-associated pneumonia. Nurse managers must address barriers that impact nurses' levels of knowledge, compliance with, and practices related to ventilator-associated pneumonia.
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Affiliation(s)
- Khaild AL-Mugheed
- Faculty of Nursing, Surgical Nursing Department, Near East University, Nicosia 99138, Cyprus
| | - Wegdan Bani-Issa
- College of Health Science\Nursing Department, University of Sharjah, Sharjah 26666, United Arab Emirates
| | - Mohammad Rababa
- Department of Adult Health-Nursing, Faculty of Nursing, Jordan University of Science and Technology, Irbid 22110, Jordan
| | - Audai A. Hayajneh
- Department of Adult Health-Nursing, Faculty of Nursing, Jordan University of Science and Technology, Irbid 22110, Jordan
| | - Adi Al Syouf
- Department of Managing Health Services and Hospitals, Faculty of Business Rabigh, College of Business (COB), King Abdulaziz University, Jeddah 21991, Saudi Arabia
| | - Mohammad Al-Bsheish
- Health Management Department, Batterjee Medical College, Jeddah 21442, Saudi Arabia
- Al-Nadeem Governmental Hospital, Ministry of Health, Amman 11118, Jordan
| | - Mu’taman Jarrar
- Medical Education Department, King Fahd Hospital of the University, Al-Khobar 34445, Saudi Arabia
- Vice Deanship for Quality and Development, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia
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Yin Y, Sun M, Li Z, Bu J, Chen Y, Zhang K, Hu Z. Exploring the Nursing Factors Related to Ventilator-Associated Pneumonia in the Intensive Care Unit. Front Public Health 2022; 10:715566. [PMID: 35462831 PMCID: PMC9019058 DOI: 10.3389/fpubh.2022.715566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 02/18/2022] [Indexed: 11/24/2022] Open
Abstract
Objective The purpose of this study was to investigate the key nursing factors associated with ventilator-associated pneumonia (VAP) in critical care patients. Methods Through the quality control platform of Hebei Province, questionnaires were sent to intensive care nurses in 32 tertiary hospitals in Hebei Province, China to collect data concerning the incidence of VAP and the status of the nursing staff. All the data were analyzed using an independent t-test and a one-way analysis of variance (ANOVA). The Pearson correlation coefficient was used to analyse the correlation between the nursing factors and the incidence of VAP. Multivariate logistic regression analysis was used to determine the risk factors affecting VAP. Results In terms of nursing, the incidence of VAP was affected by the differential nursing strategies. Multivariate logistic regression analysis showed that the incidence of VAP was significantly associated with the following six variables: the ratio of nurses to beds (p = 0.000), the ratio of nurses with a bachelor's degree or higher (p = 0.000), the ratio of specialist nurses (p = 0.000), the proportion of nurses with work experience of 5–10 years (p = 0.04), the number of patients nurses were responsible for at night (p = 0.01) and the frequency of oral care (p = 0.000). Conclusion The incidence of VAP is closely related to nursing factors. In terms of nursing human resources, even junior nurses (less experienced nurses) can play an essential role in reducing VAP. In addition, to reduce VAP, the number of patients that nurses are responsible for at night should be reduced as much as possible, and improving nursing qualifications.
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Affiliation(s)
- Yanling Yin
- Department of ICU, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Meirong Sun
- Department of ICU, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Zhe Li
- Department of ICU, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Jingjing Bu
- Department of ICU, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yuhong Chen
- Department of ICU, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Kun Zhang
- Department of ICU, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Zhenjie Hu
- Department of ICU, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
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Risk Factors of Endotracheal Intubation-Related Pressure Injury among Patients Admitted to the ICU. Adv Skin Wound Care 2021; 34:144-148. [PMID: 33587475 DOI: 10.1097/01.asw.0000732896.29121.06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate the characteristics and risk factors of endotracheal intubation-related pressure injury (EIRPI) in patients admitted to the ICU and provide a basis for EIRPI prevention and treatment. METHODS A total of 156 patients with endotracheal intubation who were admitted to ICU at a first-class hospital from January to December 2018 were enrolled in this study. Investigators collected and analyzed data and outcomes such as patient characteristics (demographic and clinical), endotracheal catheter-related factors, and the assessment and features of pressure injuries. RESULTS The incidence of EIRPI was 23.7%. The most commonly affected site was the lip (76.7%). The incidence was affected by endotracheal intubation types, endotracheal catheter indwelling time, subglottic suction, catheter fixation, and fixator types (P < .05). In addition, the moisture, mobility, and friction/shear Braden subscale scores were also correlated with the incidence of pressure injury (P < .05). Long endotracheal catheter indwelling time, the use of catheters with subglottic suction, high Braden moisture subscale score, low Braden mobility subscale score, and low Braden friction and shear subscale scores were predictive factors for EIRPI (P < .05). CONCLUSIONS Patients in the ICU are at higher risk of developing EIRPI. Early identification of risk factors and timely intervention are the keys to preventing EIRPI.
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Vazquez Guillamet C, Kollef MH. Is Zero Ventilator-Associated Pneumonia Achievable?: Practical Approaches to Ventilator-Associated Pneumonia Prevention. Clin Chest Med 2019; 39:809-822. [PMID: 30390751 DOI: 10.1016/j.ccm.2018.08.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Ventilator-associated pneumonia (VAP) remains a significant clinical entity with reported incidence rates of 7% to 15%. Given the considerable adverse consequences associated with this infection, VAP prevention became a core measure required in most US hospitals. Many institutions implemented effective VAP prevention bundles that combined head of bed elevation, hand hygiene, chlorhexidine oral care, and subglottic drainage. More recently, spontaneous breathing and awakening trials have consistently been shown to shorten the duration of mechanical ventilation and secondarily reduce the occurrence of VAP. More recent data question the overall positive impact of prevention bundles, including some of their core component interventions.
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Affiliation(s)
- Cristina Vazquez Guillamet
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of New Mexico School of Medicine, 2425 Camino de Salud, Albuquerque, NM 87106, USA; Division of Infectious Diseases, University of New Mexico School of Medicine, 2425 Camino de Salud, Albuquerque, NM 87106, USA
| | - Marin H Kollef
- Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, 4523 Clayton Avenue, Campus Box 8052, St Louis, MO 63110, USA.
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