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Rosenthal VD, Jin Z, Yin R, Sahu S, Rajhans P, Kharbanda M, Nair PK, Mishra SB, Chawla R, Arjun R, Sandhu K, Rodrigues C, Dongol R, Myatra SN, Mohd-Basri MN, Chian-Wern T, Bhakta A, Bat-Erdene I, Acharya SP, Alvarez GA, Moreno LAA, Gomez K, da Jimenez-Alvarez LF, Henao-Rodas CM, Valderrama-Beltran SL, Zuniga-Chavarria MA, Aguirre-Avalos G, Hernandez-Chena BE, Sassoe-Gonzalez A, Aleman-Bocanegra MC, Villegas-Mota MI, De Moros DA, Castaneda-Sabogal A, Carreazo NY, Alkhawaja S, Agha HM, El-Kholy A, Abdellatif-Daboor M, Dursun O, Okulu E, Havan M, Yildizdas D, Deniz SSO, Guclu E, Hlinkova S, Ikram A, Tao L, Omar AA, Elahi N, Memish ZA, Petrov MM, Raka L, Janc J, Horhat-Florin G, Medeiros EA, Salgado E, Dueñas L, Coloma M, Perez V, Brown EC. Assessing the impact of a multidimensional approach and an 8-component bundle in reducing incidences of ventilator-associated pneumonia across 35 countries in Latin America, Asia, the Middle East, and Eastern Europe. J Crit Care 2024; 80:154500. [PMID: 38128216 DOI: 10.1016/j.jcrc.2023.154500] [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: 10/12/2023] [Revised: 12/01/2023] [Accepted: 12/03/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Ventilator associated pneumonia (VAP) occurring in the intensive care unit (ICU) are common, costly, and potentially lethal. METHODS We implemented a multidimensional approach and an 8-component bundle in 374 ICUs across 35 low and middle-income countries (LMICs) from Latin-America, Asia, Eastern-Europe, and the Middle-East, to reduce VAP rates in ICUs. The VAP rate per 1000 mechanical ventilator (MV)-days was measured at baseline and during intervention at the 2nd month, 3rd month, 4-15 month, 16-27 month, and 28-39 month periods. RESULTS 174,987 patients, during 1,201,592 patient-days, used 463,592 MV-days. VAP per 1000 MV-days rates decreased from 28.46 at baseline to 17.58 at the 2nd month (RR = 0.61; 95% CI = 0.58-0.65; P < 0.001); 13.97 at the 3rd month (RR = 0.49; 95% CI = 0.46-0.52; P < 0.001); 14.44 at the 4-15 month (RR = 0.51; 95% CI = 0.48-0.53; P < 0.001); 11.40 at the 16-27 month (RR = 0.41; 95% CI = 0.38-0.42; P < 0.001), and to 9.68 at the 28-39 month (RR = 0.34; 95% CI = 0.32-0.36; P < 0.001). The multilevel Poisson regression model showed a continuous significant decrease in incidence rate ratios, reaching 0.39 (p < 0.0001) during the 28th to 39th months after implementation of the intervention. CONCLUSIONS This intervention resulted in a significant VAP rate reduction by 66% that was maintained throughout the 39-month period.
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Affiliation(s)
- Victor Daniel Rosenthal
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA; INICC Foundation, International Nosocomial Infection Control Consortium, Miami, USA.
| | - Zhilin Jin
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Ruijie Yin
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | | | - Prasad Rajhans
- Deenanath Mangeshkar Hospital and Research Center Erandwane Pune, Pune, India
| | | | | | | | - Rajesh Chawla
- Indraprastha Apollo Hospital Delhi, New Delhi, India
| | | | - Kavita Sandhu
- Max Super Speciality Hospital Saket Delhi, New Delhi, India
| | - Camilla Rodrigues
- Pd Hinduja National Hospital and Medical Research Centre, Mumbai, India
| | | | | | - Mat Nor Mohd-Basri
- International Islamic University Malaysia, Department of Anesthesia and Critical Care, Kuantan, Malaysia
| | - Tai Chian-Wern
- Universiti Kebangsaan Malaysia Specialist Children's Hospital, Kuala Lumpur, Malaysia
| | - Arpita Bhakta
- University Malaya Medical Centre, Department of Pediatric Intensive Care, Kuala Lumpur, Malaysia
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Nilton Yhuri Carreazo
- Universidad Peruana de Ciencias Aplicadas, Hospital de Emergencias Pediatricas, Lima, Peru
| | | | - Hala Mounir Agha
- Cairo University Specialized Pediatric Hospital Cardio Thoracic Icu, Cairo, Egypt
| | | | | | - Oguz Dursun
- Akdeniz University Medical School, Antalya, Turkey
| | - Emel Okulu
- Ankara University Faculty of Medicine Childrens Hospital NICU, Ankara, Turkey
| | - Merve Havan
- Ankara University Faculty of Medicine, Ankara, Turkey
| | | | | | - Ertugrul Guclu
- Sakarya University Training and Research Hospital, Sakarya, Turkey
| | - Sona Hlinkova
- Catholic University in Ruzomberok Faculty of Health Central Military Hospital Snp Ruzomberok, Ruzomberok, Slovakia
| | - Aamer Ikram
- Armed Forces Institute of Urology, Rawalpindi, Pakistan
| | - Lili Tao
- Zhongshan Hospital, Fudan University, Shanghai, China
| | - Abeer Aly Omar
- Infection Control Directorate, Ministry of Health, Kuwait City, Kuwait
| | | | - Ziad A Memish
- King Saud Medical City, Ministry of Health, Riyadh, Saudi Arabia
| | - Michael M Petrov
- Department of Microbiology, Faculty of Pharmacy, Medical University of Plovdiv, Bulgaria
| | - Lul Raka
- National Institute for Public Health, Prishtina, Kosovo
| | - Jarosław Janc
- Department of Anesthesiology and Intensive Therapy, 4th Clinical Military Hospital with Polyclinic, Wroclaw, Poland
| | - George Horhat-Florin
- University of Medicine and Pharmacy Victor Babes Timisoara Emergency Clinical County Hospital Romania, Timisoara, Romania
| | | | | | - Lourdes Dueñas
- Hospital Nacional de Niños Benjamin Bloom, San Salvador, El Salvador
| | - Monica Coloma
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Valentina Perez
- Department of Biological Sciences, Florida International University, Miami, Fl, USA
| | - Eric Christopher Brown
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
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Saavedra Bravo MA, Santos GCSD, Petenate AJ, Westphal PJ, Souza LGDA, Marques RG, Morosov EDM, Gushken AKF, Franco FF, Silva WG, de Moura RM, de Lima AL, Dos Santos RG, Andrade KDC, Hamada APS, Cristalda CMR, Ue LY, de Barros CG, Vernal S. Adapting lean management to prevent healthcare-associated infections: a low-cost strategy involving Kamishibai cards to sustain bundles' compliance. Int J Qual Health Care 2023; 35:mzad100. [PMID: 38157269 DOI: 10.1093/intqhc/mzad100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 10/31/2023] [Accepted: 12/07/2023] [Indexed: 01/03/2024] Open
Abstract
Lean healthcare visual management has been successfully integrated into infection control programs, leading to lower healthcare-associated infection (HAI) rates and greater provider compliance with evidence-based prevention practices; however, its implementation during quality improvement (QI) initiatives in limited-resource settings has not yet been well exploited. We aimed to describe a low-cost strategy involving Kamishibai cards to sustain bundles' adherence to prevent HAIs in a middle-income country. This descriptive case study evaluated the implementation of a lean healthcare visual management tool-Kamishibai board (K-board)-during a nationwide QI collaborative preventing three critical HAIs in 189 adult and pediatric/neonatal intensive care units (ICUs) from September 2021 to January 2023. Considering a limited-resource setting, our team adapted a K-board using simple, cheap, and easy-to-handle materials for routine monitoring of QI procedures, including safety bundles' compliance. After test prototypes, the final K-board version was implemented. The chart materials and assembly cost BRL 80.00 (USD 15.48). Before launching, expert working group meetings were held to shape the contents, refine technical issues, and prepare the ICU teams for implementation. After starting, plan-do-study-act cycles were conducted according to the Breakthrough Series model. Participating ICU teams, including leaders and front-line health workers, performed bedside audits following a weekly chronogram. Two indicators were calculated: the percentage of ICUs in which K-boards were being implemented and whether bundles' compliance was addressed in the K-board. Audit data were recorded in 'SimpleQI'. After 17 months of this initiative, 177 (93.7%) participating ICUs had included this visual management tool in their daily care routines. When more than 94 (>50%) ICUs posted K-board data, the mean compliance for the bundles for each HAI was sustained above 85%. A lean healthcare visual management tool can be adapted to local settings, including healthcare facilities with limited resources. K-board seems to be a feasible method for auditing evidence-based practices in medical care, including safety bundles to simultaneously prevent three types of HAIs.
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Affiliation(s)
| | | | - Ademir Jose Petenate
- Universidade Estadual de Campinas - UNICAMP, Cidade Universitária Zeferino Vaz - Barão Geraldo, Campinas, SP, 13083-970, Brazil
| | - Patrick Jacobsen Westphal
- Hospital Moinhos de Vento, Rua Ramiro Barcelos, 910 - Moinhos de Vento, Porto Alegre, RS 90035-000, Brazil
| | | | - Roberta Gonçalves Marques
- Hospital Israelita Albert Einstein, Avenida Paulista, 2300 - Bela Vista, Sao Paulo, SP 01310-300, Brazil
| | | | | | - Flavia Fernanda Franco
- Hospital Israelita Albert Einstein, Avenida Paulista, 2300 - Bela Vista, Sao Paulo, SP 01310-300, Brazil
| | - Wladimir Garcia Silva
- Hospital Alemão Oswaldo Cruz, Rua Treze de Maio, 1815 - Bela Vista, Sao Paulo, SP 01323-020, Brazil
| | - Rafaela Moraes de Moura
- Hospital Moinhos de Vento, Rua Ramiro Barcelos, 910 - Moinhos de Vento, Porto Alegre, RS 90035-000, Brazil
| | - Andreia Lopes de Lima
- BP - A Beneficência Portuguesa de São Paulo, Rua Maestro Cardim, 769 - Bela Vista, Sao Paulo, SP 01323-001, Brazil
| | | | | | - Andreza Pivato Susin Hamada
- Hospital Sírio-Libanês, Rua Dona Adma Jafet, 91 - Bela Vista, Sao Paulo, SP 01308-050, Brazil
- BP - A Beneficência Portuguesa de São Paulo, Rua Maestro Cardim, 769 - Bela Vista, Sao Paulo, SP 01323-001, Brazil
- Hospital Moinhos de Vento, Rua Ramiro Barcelos, 910 - Moinhos de Vento, Porto Alegre, RS 90035-000, Brazil
- Hospital Alemão Oswaldo Cruz, Rua Treze de Maio, 1815 - Bela Vista, Sao Paulo, SP 01323-020, Brazil
- Hospital Israelita Albert Einstein, Avenida Paulista, 2300 - Bela Vista, Sao Paulo, SP 01310-300, Brazil
- Hcor, Rua Desembargador Eliseu Guilherme, 147 - Paraíso, Sao Paulo, SP 04004-030, Brazil
| | | | - Luciana Yumi Ue
- Ministério da Saúde, Esplanada dos Ministérios - Bloco G, Brasília, DF 70058-900, Brazil
| | - Claudia Garcia de Barros
- Hospital Israelita Albert Einstein, Avenida Paulista, 2300 - Bela Vista, Sao Paulo, SP 01310-300, Brazil
| | - Sebastian Vernal
- Hospital Sírio-Libanês, Rua Dona Adma Jafet, 91 - Bela Vista, Sao Paulo, SP 01308-050, Brazil
- BP - A Beneficência Portuguesa de São Paulo, Rua Maestro Cardim, 769 - Bela Vista, Sao Paulo, SP 01323-001, Brazil
- Hospital Moinhos de Vento, Rua Ramiro Barcelos, 910 - Moinhos de Vento, Porto Alegre, RS 90035-000, Brazil
- Hospital Alemão Oswaldo Cruz, Rua Treze de Maio, 1815 - Bela Vista, Sao Paulo, SP 01323-020, Brazil
- Hospital Israelita Albert Einstein, Avenida Paulista, 2300 - Bela Vista, Sao Paulo, SP 01310-300, Brazil
- Hcor, Rua Desembargador Eliseu Guilherme, 147 - Paraíso, Sao Paulo, SP 04004-030, Brazil
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Ismaeil R, Nahas ARF, Kamarudin NB, Abubakar U, Mat-Nor MB, Mohamed MHN. Evaluation of the impact of COVID-19 pandemic on hospital-acquired infections in a tertiary hospital in Malaysia. BMC Infect Dis 2023; 23:779. [PMID: 37946158 PMCID: PMC10636815 DOI: 10.1186/s12879-023-08770-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 10/30/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Infection prevention measures are the gold standard for preventing the spread of hospital-acquired infections (HAIs). COVID-19 pandemic caused major disruptions in infection prevention measures, and this has implications on the rate of HAIs. This study assessed the impact of COVID-19 pandemic on the rate and the types of HAIs at Sultan Ahmed Shah Hospital. METHOD This is a retrospective cohort study that compared the rate of HAIs from April to October 2019 (pre COVID period) and April to October 2020 (during COVID period). Data was collected through the review of patients' electronic medical records. RESULTS There were a total of 578 patients included in the selected wards during the pre- and during the pandemic. Thirty-nine episodes (12.1%) of HAIs were report in the pre COVID period and 29 (11.3%) during COVID-19. In both periods, hospital-acquired pneumonia (HAP) was the most frequent HAI among the patients. There was a rise in catheter-associated bloodstream infections (CLABSI) (0.8%) and ventilator associated pneumonia (VAP) (1.1%) during the COVID-19 period. The most common bacteria were methicillin-resistant Staphylococcus aureus (MRSA) (28.2%) and Enterococcus faecalis (17.9%) in the Pre COVID-19 period, and Pseudomonas aeruginosa (27.6%) and Stenotrophomonas maltophilia (6.9%) during COVID-19. CONCLUSION Our research concluded that the rates of HAIs during the COVID-19 pandemic were not significantly impacted by the improved in-hospital infection prevention efforts to control the pandemic. There is need for further efforts to promote adherence to preventive practices.
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Affiliation(s)
- Rehab Ismaeil
- Department of Pharmacy Practice, Kulliyah of Pharmacy, International Islamic University Malaysia (IIUM), Jalan Sultan Ahmad Shah, 25200, Kuantan, Pahang, Malaysia
| | - Abdul Rahman Fata Nahas
- Department of Pharmacy Practice, Kulliyah of Pharmacy, International Islamic University Malaysia (IIUM), Jalan Sultan Ahmad Shah, 25200, Kuantan, Pahang, Malaysia
| | - Norhidayah Binti Kamarudin
- Department of Medical Microbiology, Kulliyyah of Medicine, International Islamic University Malaysia, 25200, Kuantan, Malaysia
| | - Usman Abubakar
- Department of Clinical Pharmacy and Practice, College of Pharmacy, QU Health, Qatar University, 2713, Doha, Qatar.
| | - Mohamad Basri Mat-Nor
- Department of Intensive Care, Kulliyyah of Medicine, International Islamic University Malaysia, 25200, Kuantan, Malaysia
| | - Mohamad Haniki Nik Mohamed
- Department of Pharmacy Practice, Kulliyah of Pharmacy, International Islamic University Malaysia (IIUM), Jalan Sultan Ahmad Shah, 25200, Kuantan, Pahang, Malaysia.
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Mastrogianni M, Katsoulas T, Galanis P, Korompeli A, Myrianthefs P. The Impact of Care Bundles on Ventilator-Associated Pneumonia (VAP) Prevention in Adult ICUs: A Systematic Review. Antibiotics (Basel) 2023; 12:antibiotics12020227. [PMID: 36830138 PMCID: PMC9952750 DOI: 10.3390/antibiotics12020227] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 01/13/2023] [Accepted: 01/17/2023] [Indexed: 01/26/2023] Open
Abstract
Ventilator-associated pneumonia (VAP) remains a common risk in mechanically ventilated patients. Different care bundles have been proposed to succeed VAP reduction. We aimed to identify the combined interventions that have been used to by ICUs worldwide from the implementation of "Institute for Healthcare Improvement Ventilator Bundle", i.e., from December 2004. A search was performed on the PubMed, Scopus and Science Direct databases. Finally, 38 studies met our inclusion criteria. The most common interventions monitored in the care bundles were sedation and weaning protocols, semi-recumbent positioning, oral and hand hygiene, peptic ulcer disease and deep venus thrombosis prophylaxis, subglottic suctioning, and cuff pressure control. Head-of-bed elevation was implemented by almost all studies, followed by oral hygiene, which was the second extensively used intervention. Four studies indicated a low VAP reduction, while 22 studies found an over 36% VAP decline, and in ten of them, the decrease was over 65%. Four of these studies indicated zero or nearly zero after intervention VAP rates. The studies with the highest VAP reduction adopted the "IHI Ventilator Bundle" combined with adequate endotracheal tube cuff pressure and subglottic suctioning. Multifaced techniques can lead to VAP reduction at a great extent. Multidisciplinary measures combined with long-lasting education programs and measurement of bundle's compliance should be the gold standard combination.
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Affiliation(s)
- Maria Mastrogianni
- Department of Nursing, National and Kapodistrian University of Athens, 123 Papadiamantopoulou Str, Goudi, 11527 Athens, Greece
- Department of Health Policy, Ministry of National Defense, Mesogeion Avenue 227–231, Holargos, 15561 Athens, Greece
| | - Theodoros Katsoulas
- Department of Nursing, National and Kapodistrian University of Athens, 123 Papadiamantopoulou Str, Goudi, 11527 Athens, Greece
- Intensive Care Unit, General and Oncologic Hospital of Kifissia “AgioiAnargiri”, Kaliftaki 41 Str, Kifissia, 14564 Athens, Greece
| | - Petros Galanis
- Department of Nursing, National and Kapodistrian University of Athens, 123 Papadiamantopoulou Str, Goudi, 11527 Athens, Greece
| | - Anna Korompeli
- Department of Nursing, National and Kapodistrian University of Athens, 123 Papadiamantopoulou Str, Goudi, 11527 Athens, Greece
- Intensive Care Unit, General and Oncologic Hospital of Kifissia “AgioiAnargiri”, Kaliftaki 41 Str, Kifissia, 14564 Athens, Greece
| | - Pavlos Myrianthefs
- Department of Nursing, National and Kapodistrian University of Athens, 123 Papadiamantopoulou Str, Goudi, 11527 Athens, Greece
- Intensive Care Unit, General and Oncologic Hospital of Kifissia “AgioiAnargiri”, Kaliftaki 41 Str, Kifissia, 14564 Athens, Greece
- Correspondence:
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BALASAR B, UĞUR Ö, EROĞLU E. Evaluation of healthcare-associated infections in general intensive care unit in Meram State Hospital. EGE TIP DERGISI 2022. [DOI: 10.19161/etd.1209450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Aim: Healthcare-associated infections are a major source of concern in all areas of hospitals, particularly in intensive care units. The goal of our study was to look at the current situation and evaluate the measures that can be taken based on the data obtained by examining the rates and factors of healthcare-associated infections in the general intensive care units of our hospital over a one-year period.
Materials and Methods: Between January 2020 and December 2020, 665 patients who were followed up and treated in the general intensive care unit of Meram State Hospital were followed up in terms of healthcare-associated infections, and their outcomes were evaluated.
Results: 5354 hospitalization days of 665 patients who were followed up in the general intensive care units for a year were evaluated, and it was determined that 53 of the patients developed healthcare-associated infections. Twenty-two (41.5%) of patients with healthcare-associated infections were female, while 31 (58.5%) were male. It was discovered that the patients' mean age was 71,7±14 (19-94). The infection rate was calculated to be 5.86 and the density to be 7.28. Furthermore, the rates of invasive device-associated nosocomial infection are as follows: 1.02 for central line-associated bloodstream infections, 0.56 for catheter-associated urinary tract infections, and 0 for ventilator-associated pneumonia.
Conclusion: Healthcare-associated infections are a significant cause of mortality and morbidity in intensive care units. Due to the improvement in medical care and the increase in life expectancy in parallel with this, effective surveillance practices are of critical importance.
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Affiliation(s)
- Barış BALASAR
- Konya Meram State Hospital, Department of Infectious Diseases and Clinical Microbiology, Konya, Türkiye
| | - Ömer UĞUR
- Konya Meram State Hospital, Department of Anesthesiology and Reanimation, Konya, Türkiye
| | - Esma EROĞLU
- Konya Meram State Hospital, Department of Infectious Diseases and Clinical Microbiology, Konya, Türkiye
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Papanikolopoulou A, Maltezou HC, Stoupis A, Pangalis A, Kouroumpetsis C, Chronopoulou G, Kalofissoudis Y, Kostares E, Boufidou F, Karalexi M, Koumaki V, Pantazis N, Tsakris A, Kantzanou M. Ventilator-Associated Pneumonia, Multidrug-Resistant Bacteremia and Infection Control Interventions in an Intensive Care Unit: Analysis of Six-Year Time-Series Data. Antibiotics (Basel) 2022; 11:antibiotics11081128. [PMID: 36009998 PMCID: PMC9405435 DOI: 10.3390/antibiotics11081128] [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: 07/21/2022] [Revised: 08/10/2022] [Accepted: 08/16/2022] [Indexed: 12/28/2022] Open
Abstract
Ventilator-associated pneumonia (VAP) occurs more than 48h after mechanical ventilation and is associated with a high mortality rate. The current hospital-based study aims to investigate the association between VAP rate, incidence of bacteremia from multidrug-resistant (MDR) pathogens, and infection control interventions in a single case mix ICU from 2013 to 2018. Methods: The following monthly indices were analyzed: (1) VAP rate; (2) use of hand hygiene disinfectants; (3) isolation rate of patients with MDR bacteria; and (4) incidence of bacteremia/1000 patient-days (total cases, total carbapenem-resistant cases, and carbapenem-resistant Acinetobacter baumannii, Pseudomonas aeruginosa, and Klebsiella pneumoniae cases separately). Results: Time trends of infection control interventions showed increased rates in isolation of patients with MDR pathogens (p <0.001) and consumption of hand disinfectant solutions (p =0.001). The last four years of the study an annual decrease of VAP rate by 35.12% (95% CI: −53.52 to −9.41; p =0.01) was recorded, which significantly correlated not only with reduced trauma and cardiothoracic surgery patients (IRR:2.49; 95% CI: 2.09−2.96; p <0.001), but also with increased isolation rate of patients with MDR pathogens (IRR: 0.52; 95% CI: 0.27−0.99; p = 0.048), and hand disinfectants use (IRR: 0.40; 95% CI: 0.18−0.89; p =0.024). Conclusions: Infection control interventions significantly contributed to the decrease of VAP rate. Constant infection control stewardship has a stable time-effect and guides evidence-based decisions.
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Affiliation(s)
| | - Helena C. Maltezou
- Directorate of Research, Studies and Documentation, National Public Health Organization, 15123 Athens, Greece
| | - Athina Stoupis
- Clinical Infectious Diseases Department, Athens Medical Center, 15125 Athens, Greece
| | - Anastasia Pangalis
- Biopathology Department Athens Medical Center, Marousi, 15125 Athens, Greece
| | | | | | - Yannis Kalofissoudis
- Quality Assurance Department, Athens Medical Center, Marousi, 15125 Athens, Greece
| | - Evangelos Kostares
- Department of Microbiology, School of Medicine, National and Kapodistrian University of Athens, 75 Mikras Asias Street, 11527 Athens, Greece
| | - Fotini Boufidou
- Neurochemistry and Biological Markers Unit, 1st Department of Neurology, School of Medicine, Eginition Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - Maria Karalexi
- Department of Microbiology, School of Medicine, National and Kapodistrian University of Athens, 75 Mikras Asias Street, 11527 Athens, Greece
| | - Vasiliki Koumaki
- Department of Microbiology, School of Medicine, National and Kapodistrian University of Athens, 75 Mikras Asias Street, 11527 Athens, Greece
| | - Nikos Pantazis
- Department of Hygiene, Epidemiology and Medical Statistics, Faculty of Medicine, School of Health Sciences, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Athanasios Tsakris
- Department of Microbiology, School of Medicine, National and Kapodistrian University of Athens, 75 Mikras Asias Street, 11527 Athens, Greece
- Correspondence: ; Tel.: +30-210-7462011
| | - Maria Kantzanou
- Department of Microbiology, School of Medicine, National and Kapodistrian University of Athens, 75 Mikras Asias Street, 11527 Athens, Greece
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7
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Triamvisit S, Wongprasert W, Puttima C, Chiangmai MN, Thienjindakul N, Rodkul L, Jetjumnong C. Effect of modified care bundle for prevention of ventilator-associated pneumonia in critically-ill neurosurgical patients. Acute Crit Care 2022; 36:294-299. [PMID: 35263824 PMCID: PMC8907469 DOI: 10.4266/acc.2021.00983] [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: 07/20/2021] [Accepted: 09/23/2021] [Indexed: 11/30/2022] Open
Abstract
Background: Care bundles for ventilator-associated pneumonia (VAP) have been shown to minimize the rate of VAP in critically ill patients. Standard care bundles may need to be modified in resource-constrained situations. The goal of this study was to see if our modified VAP-care bundles lowered the risk of VAP in neurosurgical patients. Methods: A prospective cohort study was conducted in mechanically ventilated neurosurgical patients. The VAP bundle was adjusted in the cohort group by increasing the frequency of intermittent endotracheal tube cuff pressure monitoring to six times a day while reducing oral care with 0.12% chlorhexidine to three times a day. The rate of VAP was compared to the historical control group. Results: A total of 146 and 145 patients were enrolled in control and cohort groups, respectively. The mean age of patients was 52±16 years in both groups (P=0.803). The admission Glasgow coma scores were 7.79±2.67 and 7.80±2.77 in control and cohort group, respectively (P=0.969). VAP was found in nine patients in control group but only one patient in cohort group. The occurrence rate of VAP was significantly reduced in cohort group compared to control group (0.88/1,000 vs. 6.84/1,000 ventilator days, P=0.036). Conclusions: The modified VAP bundle is effective in lowering the VAP rate in critically ill neurosurgical patients. It requires low budget and manpower and can be employed in resource-constrained settings.
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Affiliation(s)
| | | | | | | | | | - Laksika Rodkul
- Division of Nursing, Chiang Mai University Hospital, Chiang Mai, Thailand
| | - Chumpon Jetjumnong
- Neurosurgery Unit, Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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8
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Qu SN, Wang HJ, Huang CL, Zhang H, Wang H, Yuan ZN, Xing XZ. Incidence and outcomes of secondary infections in septic patients with cancer. World J Emerg Med 2022; 13:400-402. [PMID: 36119764 PMCID: PMC9420672 DOI: 10.5847/wjem.j.1920-8642.2022.076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 05/20/2022] [Indexed: 09/08/2024] Open
Affiliation(s)
- Shi-ning Qu
- Department of Intensive Care Unit, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Hai-jun Wang
- Department of Intensive Care Unit, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Chu-lin Huang
- Department of Intensive Care Unit, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Hao Zhang
- Department of Intensive Care Unit, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Hao Wang
- Department of Intensive Care Unit, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Zhen-nan Yuan
- Department of Intensive Care Unit, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Xue-zhong Xing
- Department of Intensive Care Unit, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
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Campos CGP, Pacheco A, Gaspar MDDR, Arcaro G, Reche PM, Nadal JM, Farago PV. Analysis of diagnostic criteria for ventilator-associated pneumonia: a cohort study. Rev Bras Enferm 2021; 74:e20190653. [PMID: 34406231 DOI: 10.1590/0034-7167-2019-0653] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 05/09/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES to analyze the diagnostic criteria for ventilator-associated pneumonia recommended by the Brazilian Health Regulatory Agency and the National Healthcare Safety Network/Centers for Disease Control and Prevention, as well as its risk factors. METHODS retrospective cohort study carried out in an intensive care unit throughout 12 months, in 2017. Analyses included chi-square, simple linear regression, and Kappa statistical tests and were conducted using Stata 12 software. RESULTS the sample was 543 patients who were in the intensive care unit and under mechanical ventilation, of whom 330 (60.9%) were men and 213 (39.1%) were women. Variables such as gender, age, time under mechanical ventilation, and oral hygiene proved to be significant risk factors for the development of ventilator-associated pneumonia. CONCLUSIONS patients submitted to mechanical ventilation need to be constantly evaluated so the used diagnostic methods can be accurate and applied in an objective and standardized way in Brazilian hospitals.
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Affiliation(s)
| | - Aline Pacheco
- Universidade Estadual de Ponta Grossa. Ponta Grossa, Paraná, Brazil
| | | | - Guilherme Arcaro
- Universidade Estadual de Ponta Grossa. Ponta Grossa, Paraná, Brazil
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