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Jalal A, Iwamoto K, Gedik G, Ravaghi H, Kodama C. Health workforce capacity of intensive care units in the Eastern Mediterranean Region. PLoS One 2023; 18:e0286980. [PMID: 37327195 PMCID: PMC10275434 DOI: 10.1371/journal.pone.0286980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 05/27/2023] [Indexed: 06/18/2023] Open
Abstract
OBJECTIVE The onset of COVID-19 pandemic increased the need for functioning and equipped intensive care units (ICUs) with staff trained in operating them. In the Eastern Mediterranean Region, this also triggered the need for assessing the available capacities of ICUs and health workforce so that appropriate strategies can be developed to address emerging challenges of staff shortages in the wake of COVID-19. To address this need, a scoping review on the health workforce capacity of intensive care units in the Eastern Mediterranean Region was conducted. METHODS A scoping review methodology as outlined by Cochrane was followed. Available literature and different data sources were reviewed. Database includes Pubmed (medline,Plos included), IMEMR, Google Scholar for peer-reviewed literature, and Google for grey literature such as relevant website of ministries, national and international organization. The search was performed for publications on intensive care unit health workers for each of the EMR countries in the past 10 years (2011-2021). Data from included studies was charted, analysed and reported in a narrative format. A brief country survey was also conducted to supplement the findings of the review. It included quantitative and qualitative questions about number of ICU beds, physicians and nurses, training programs as well as challenges faced by ICU health workforce. RESULTS Despite limited data availability, this scoping review was able to capture information important for the Eastern Mediterranean Region. Following major themes appeared in findings and results were synthesized for each category: facility and staffing, training and qualification, working conditions/environment and performance appraisal. Shortage of intensive care specialist physicians and nurses were in majority of countries. Some countries offer training programmes, mostly for physicians, at post-graduate level and through short courses. High level of workload, emotional and physical burnout and stress were a consistent finding across all countries. Gaps in knowledge were found regarding procedures common for managing critically ill patients as well as lack of compliance with guidelines and recommendations. CONCLUSION The literature on ICU capacities in EMR is limited, however, our study identified valuable information on health workforce capacity of ICUs in the region. While well-structured, up-to-date, comprehensive and national representative data is still lacking in literature and in countries, there is a clearly emerging need for scaling up the health workforce capacities of ICUs in EMR. Further research is necessary to understand the situation of ICU capacity in EMR. Plans and efforts should be made to build current and future health workforce.
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Affiliation(s)
- Arooj Jalal
- Health Workforce Development, World Health Organization Regional Office for Eastern Mediterranean, Cairo, Egypt
| | - Kazuyo Iwamoto
- Health Emergencies Programme, World Health Organization Regional Office for Eastern Mediterranean, Cairo, Egypt
| | - Gulin Gedik
- Health Workforce Development, World Health Organization Regional Office for Eastern Mediterranean, Cairo, Egypt
| | - Hamid Ravaghi
- Hospital Care Management, World Health Organization Regional Office for Eastern Mediterranean, Cairo, Egypt
| | - Chiori Kodama
- Health Emergencies Programme, World Health Organization Regional Office for Eastern Mediterranean, Cairo, Egypt
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Al-Tamimi M, Refaat F, Bani Issa W. Barriers to compliance with evidence-based guidelines for ventilator-associated pneumonia among critical care nurses: A scoping review. F1000Res 2023; 11:1551. [PMID: 37035463 PMCID: PMC10076907 DOI: 10.12688/f1000research.128144.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/17/2023] [Indexed: 04/03/2023] Open
Abstract
Background: Healthcare organizations provide evidence-based guidelines designed to support nurses in preventing ventilator-associated pneumonia (VAP) in intensive care units (ICUs), but there are barriers to compliance with such guidelines. This review explicitly explored evidence of compliance barriers among critical care nurses. Methods: A systematic search was conducted in PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and EBSCO databases for relevant English-language studies published between January 2003 and June 2022, focused on barriers to nursing compliance with VAP prevention guidelines. Data was reported according to the Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMAScR) guidelines. Results: 230 publications were screened, resulting in 53 full-text articles being retrieved after removing duplicates, of which 13 relevant to the aims of the review and meeting the inclusion criteria were included for data extraction. One was a qualitative study, while the remainder were quantitative. Simple descriptive content analysis identified the barriers to critical care nurses’ compliance with VAP prevention guidelines, and categorized them as: (1) work environment barriers (e.g., lack of equipment and supplies; lack of staff and time; lack of educational support; and ineffective supportive system); (2) nurse-related barriers (limited personal competencies); and (3) situation-related barriers (patient health, discomfort, and adverse events). Conclusions: This review revealed important evidence on barriers to VAP prevention guidelines compliance. Nurses are challenged mainly by work-environmental barriers along, with the presence of nurse and situational barriers. It is evident from the findings that further qualitative and mixed-methodology follow-up studies are recommended to further explore the issues in depth. Healthcare leaders must be aware of these barriers and integrate work policies that assist in overcoming them, to increase compliance.
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Affiliation(s)
- Muna Al-Tamimi
- Department of Nursing, College of Health Sciences, University of Sharjah, Sharjah, Sharjah, 27272, United Arab Emirates
| | - Fatma Refaat
- Department of Nursing, College of Health Sciences, University of Sharjah, Sharjah, Sharjah, 27272, United Arab Emirates
| | - Wegdan Bani Issa
- Department of Nursing, College of Health Sciences, University of Sharjah, Sharjah, Sharjah, 27272, United Arab Emirates
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3
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Al-Tamimi M, Refaat F, Bani Issa W. Barriers to compliance with evidence-based guidelines for ventilator-associated pneumonia among critical care nurses: A scoping review. F1000Res 2022; 11:1551. [PMID: 37035463 PMCID: PMC10076907 DOI: 10.12688/f1000research.128144.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/18/2022] [Indexed: 12/24/2022] Open
Abstract
Background: Healthcare organizations provide evidence-based guidelines designed to support nurses in preventing ventilator-associated pneumonia (VAP) in intensive care units (ICUs), but there are barriers to compliance with such guidelines. This review explicitly explored evidence of compliance barriers among critical care nurses. Methods: A systematic search was conducted in PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and EBSCO databases for relevant English-language studies published between January 2003 and June 2022, focused on barriers to nursing compliance with VAP prevention guidelines. Data was reported according to the Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMAScR) guidelines. Results: 230 publications were screened, resulting in 53 full-text articles being retrieved after removing duplicates, of which 13 relevant to the aims of the review and meeting the inclusion criteria were included for data extraction. One was a qualitative study, while the remainder were quantitative. Simple descriptive content analysis identified the barriers to critical care nurses’ compliance with VAP prevention guidelines, and categorized them as: (1) work environment barriers (e.g., lack of equipment and supplies; lack of staff and time; lack of educational support; and ineffective supportive system); (2) nurse-related barriers (limited personal competencies); and (3) situation-related barriers (patient health, discomfort, and adverse events). Conclusions: This review revealed important evidence on barriers to VAP prevention guidelines compliance. Nurses are challenged mainly by work-environmental barriers along, with the presence of nurse and situational barriers. It is evident from the findings that further qualitative and mixed-methodology follow-up studies are recommended to further explore the issues in depth. Healthcare leaders must be aware of these barriers and integrate work policies that assist in overcoming them, to increase compliance.
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Affiliation(s)
- Muna Al-Tamimi
- Department of Nursing, College of Health Sciences, University of Sharjah, Sharjah, Sharjah, 27272, United Arab Emirates
| | - Fatma Refaat
- Department of Nursing, College of Health Sciences, University of Sharjah, Sharjah, Sharjah, 27272, United Arab Emirates
| | - Wegdan Bani Issa
- Department of Nursing, College of Health Sciences, University of Sharjah, Sharjah, Sharjah, 27272, United Arab Emirates
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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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Jalal SM, Alrajeh AM, Al-Abdulwahed JAA. Performance Assessment of Medical Professionals in Prevention of Ventilator Associated Pneumonia in Intensive Care Units. Int J Gen Med 2022; 15:3829-3838. [PMID: 35418777 PMCID: PMC9000598 DOI: 10.2147/ijgm.s363449] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 03/29/2022] [Indexed: 12/14/2022] Open
Abstract
Purpose Ventilator-associated pneumonia (VAP) is one of the most common infections in intensive care units (ICU) with a 6–52% incidence. The VAP mortality rate is 50% to 70%. Medical professionals (MPs) working in the ICU are expected to follow the guidelines to prevent VAP. The study aimed to assess the performance of MPs in preventing VAP and to associate the performance with the baseline information. Methods An observational cross-sectional study was conducted in the ICUs of selected hospitals in eastern Saudi Arabia. A total of 152 MPs were selected by random sampling. A structured questionnaire including baseline information, knowledge and performance-related questions was used to collect the data. Frequency, mean, and chi-square tests were used for analysis. Results Out of 152 MPs, 40.8% had adequate and 7.9% had inadequate knowledge. A high mean score of 12.9 ± 2.2 was obtained by physicians, followed by 11.3 ± 1.6 by nurses, 9.8 ± 2.2 by RTs, and 8.6 ± 2.1 by interns. Overall, 52.6% had satisfactory performance. Approximately 57.9% and 67.8% of MPs cleaned their hands before touching the patient and the ventilator, respectively. Many (79.6%) MPs used personal protective equipment in the ICU. Some (47.4%) of the MPs changed the patient’s position regularly. About 77.6% of MPs followed the sterile technique when suctioning the airway. There was a significant association found between the performance of MPs on the prevention of VAP with age (p < 0.001), designation (p < 0.05), professional experience (p < 0.05), managing chronic obstructive pulmonary disease conditions (p < 0.05) and training attended (p < 0.001). Conclusion Although some of the MPs had satisfactory performance regarding VAP prevention in the ICU, more attention should be paid to training them on clinical guidelines to improve health care quality and reduce the rate of VAP.
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Affiliation(s)
- Sahbanathul Missiriya Jalal
- Department of Nursing, College of Applied Medical Sciences, King Faisal University, Al-Ahsa, 31982, Saudi Arabia
- Correspondence: Sahbanathul Missiriya Jalal, Department of Nursing, College of Applied Medical Sciences, King Faisal University, Al-Ahsa, 31982, Saudi Arabia, Tel +966564070973, Email
| | - Ahmed Mansour Alrajeh
- Department of Respiratory Therapy, College of Applied Medical Sciences, King Faisal University, Al-Ahsa, 31982, Saudi Arabia
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Alkubati SA, Saghir SAM, Al-Sayaghi KM, Alhariri A, Al-Areefi M. Healthcare workers' knowledge of evidence-based guidelines for prevention of ventilator-associated pneumonia in Hodeida, Yemen. J Basic Clin Physiol Pharmacol 2021; 34:321-327. [PMID: 34714992 DOI: 10.1515/jbcpp-2020-0388] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 09/30/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Ventilator-associated pneumonia (VAP) is the most common nosocomial infection in patients requiring mechanical ventilation in intensive care units (ICUs). VAP is associated with delayed extubation, prolonged hospital stays, increased healthcare costs and mortality rates. The aims of this study to evaluate the level of knowledge for the prevention of VAP among healthcare workers (HCWs) in ICUs and to assess their knowledge in relation to their socio-demographic characteristics. METHODS A descriptive, cross-sectional design was conducted to assess HCWs' knowledge of the guidelines for prevention of VAP in the ICUs of public and private hospitals in Hodeida city, Yemen. Around 140 self-administered multiple-choice questionnaires were distributed between April and July 2017. RESULTS A total of 120 (85.6%) HCWs completed questionnaire were obtained (20 physicians, 20 anesthesia technicians and 80 nurses) in this study. The total mean score of the HCWs' knowledge was low (41 ± 18). A statistically significant difference was found in the HCWs' knowledge scores according to their specialties and gender. Anesthesia technicians had the highest knowledge score followed by physicians and nurses (52.2 ± 16.2, 45.6 ± 21.2 and 37.1 ± 16.9, respectively, p=0.002). Males had higher scores than females (Median [IQR] 4 [3-5] vs. 3 [2-4], p<0.001). Participants who received information about the prevention of VAP had better knowledge than those who did not (46.2 ± 17.7 vs. 36.8 ± 17.3, p=0.006). CONCLUSIONS HCWs had a low knowledge level of the guidelines for the prevention of VAP, which may affect their practice. HCWs' knowledge was affected by their previous received information that increases the necessity to provide them with regular in-service education and training programs.
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Affiliation(s)
- Sameer A Alkubati
- Department of Nursing, Faculty of Medicine and Health Sciences, Hodeida University, Hodeida, Yemen.,Faculty of Nursing, University of Ha'il, Hail, Saudi Arabia
| | - Sultan A M Saghir
- Department of Medical Analysis, Princess Aisha Bint Al-Hussein College of Nursing and Medical Sciences, Al-Hussein Bin Talal University, Ma`an, Jordan
| | - Khaled M Al-Sayaghi
- Department of Medical Surgical Nursing, College of Nursing, Taibah University, Madina, Saudi Arabia.,Department of Critical Care and Emergency Nursing, Faculty of Medicine and Health Sciences, Sana'a University, Sana'a, Yemen
| | - Abdullah Alhariri
- Preventive Medicine Unit-General Military Hospital (GMH), Hodeida, Yemen
| | - Mahmoud Al-Areefi
- Faculty of Public Health & Health Informatics, Umm Al-Qura University, Makkah, Saudi Arabia
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Branco A, Lourençone EMS, Monteiro AB, Fonseca JP, Blatt CR, Caregnato RCA. Education to prevent ventilator-associated pneumonia in intensive care unit. Rev Bras Enferm 2020; 73:e20190477. [PMID: 32813804 DOI: 10.1590/0034-7167-2019-0477] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 03/03/2020] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE to evaluate nursing adherence to the Ventilator-Associated Pneumonia Prevention Bundle and the incidence rate, before and after Continuing education. METHODS a quasi-experimental, retrospective study with a total of 302 patients on mechanical ventilator admitted to the Intensive Care Unit. Data obtained from the application of the bundle, from June 2017 to June 2018. In December 2017, a training on the infection was carried out with 48 professionals. RESULTS the mean age of patients was 62.39±17.06 years old. Appropriate measures before and after training, respectively: position of the ventilator filter 94.8% and 96.2%, p=0.074; elevated headboard 88.4% and 94.5%, p<0.001; oral hygiene with chlorhexidine 89.5% and 98.2%, p<0.001; teeth brushing 80.8% and 96.4%, p<0.001; and cuff pressure 92.7% and 95.6%, p=0.002. Incidence density was 7.99 for 4.28 infections/1000 ventilators per day. CONCLUSION the bundle application and education made it possible to increase adherence and decrease infection.
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Affiliation(s)
- Aline Branco
- Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | | | | | | | - Carine Raquel Blatt
- Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
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Liu W, Jiao Y, Xing H, Hai Y, Li H, Zhang K, Zhao Y, Yang Y, Xu B, Bai H, Bao H, Zhang S, Guo T. Active surveillance of ventilator-associated pneumonia in the intensive care unit and establishment of the risk grading system and effect evaluation. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:617. [PMID: 31930018 PMCID: PMC6944584 DOI: 10.21037/atm.2019.11.25] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 10/22/2019] [Indexed: 11/06/2022]
Abstract
BACKGROUND To discuss ventilator-associated pneumonia (VAP) patient's clinical characteristic and related factors in the intensive care unit (ICU), and to establish a risk grading system for VAP patients in the ICU in order to provide a reference for VAP prevention. METHODS A total of 1,513 patients in eight ICUs who received mechanical ventilation between June 2015 and June 2018 were randomized and into two groups, with 908 patients in the model group and 605 patients in the verification group. The model group was used to analyze the influencing factors of VAP and establish a risk grading system, while the verification group was used to verify the risk grading system. A receiver operating characteristic (ROC) curve was used to evaluate the predictive effect of the grading system. RESULTS During the 3-year study period, of the 1,513 total patients, 188 patients were infected with VAP, leading to an incidence rate of 12.43% (188/1,513) and an infection rate of 15.23‰ (188/12,347). ICU length of stay, mechanical ventilation days, frequency of oral care, unused subglottic secretion drainage, tracheotomy, APACHE II score, and combined antibiotics use were risk factors of VAP infection for patients who received mechanical ventilation in the modeling group (P<0.05). In a VAP risk-grading system established based on risk factors, the high, medium and low-grade patients had a statistically significantly different VAP infection rate in the model group, and patients with a high grade had a higher risk of VAP infection. Patients' data in the model and verification groups were used to draw a ROC curve which showed a good predictive effect. CONCLUSIONS This study establishes and verifies the VAP risk grading system for patients who receive mechanical ventilation. It is helpful in high-risk patient surveillance and in reducing and preventing VAP infection.
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Affiliation(s)
- Weiping Liu
- Department of Nosocomial Infection Control, Inner Mongolia People's Hospital, Hohhot 010017, China
| | - Yueying Jiao
- Department of Nosocomial Infection Control, Inner Mongolia People's Hospital, Hohhot 010017, China
| | - Huimin Xing
- Department of Nosocomial Infection Control, Inner Mongolia People's Hospital, Hohhot 010017, China
| | - Yunting Hai
- Department of Nosocomial Infection Control, Inner Mongolia People's Hospital, Hohhot 010017, China
| | - Haoxue Li
- Department of Nosocomial Infection Control, Inner Mongolia People's Hospital, Hohhot 010017, China
| | - Kai Zhang
- Department of Nosocomial Infection Control, Inner Mongolia People's Hospital, Hohhot 010017, China
| | - Yuping Zhao
- Department of Nosocomial Infection Control, Inner Mongolia People's Hospital, Hohhot 010017, China
| | - Yongfang Yang
- Department of Nosocomial Infection Control, Inner Mongolia People's Hospital, Hohhot 010017, China
| | - Binbin Xu
- Department of Nosocomial Infection Control, Inner Mongolia People's Hospital, Hohhot 010017, China
| | - Haibo Bai
- Department of Nosocomial Infection Control, Inner Mongolia People's Hospital, Hohhot 010017, China
| | - Huan Bao
- Department of Nosocomial Infection Control, Inner Mongolia People's Hospital, Hohhot 010017, China
| | - Shuai Zhang
- Department of Nosocomial Infection Control, Inner Mongolia People's Hospital, Hohhot 010017, China
| | - Tianhui Guo
- Department of Nosocomial Infection Control, Inner Mongolia People's Hospital, Hohhot 010017, China
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Comparative Study of CDST & Multiplex PCR to Detect MBL Producing Gram-Negative Bacilli among VAP Patients Admitted in a Public Medical College Hospital of Bangladesh. Pathogens 2019; 8:pathogens8030151. [PMID: 31547453 PMCID: PMC6789483 DOI: 10.3390/pathogens8030151] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 09/04/2019] [Accepted: 09/09/2019] [Indexed: 11/30/2022] Open
Abstract
Background: Ventilator-associated pneumonia (VAP) is the most common nosocomial infection in intensive care units (ICU), which accounts for 25% of all ICU infection. Documenting carbapenem-resistant gram-negative bacilli is very important as these strains may often cause outbreaks in the ICU setting and are responsible for the increased mortality and morbidity or limiting therapeutic options. The classical phenotypic method cannot provide an efficient means of diagnosis of the metallo-β-lactamases (MBLs) producer. Polymerase chain reaction (PCR) assays have lessened the importance of the phenotypic approach by detecting metallo-β-lactamase resistance genes such as New Delhi metallo-β-lactamase (NDM), Imipenemase (IMP), Verona integron-encoded metallo-β-lactamase (VIM), Sao Paulo metallo-β-lactamase (SPM), Germany Imipenemase (GIM). Objective: To compare the results of the Combined Disc Synergy Test (CDST) with that of the multiplex PCR to detect MBL-producing gram-negative bacilli. Materials and Method: A total of 105 endotracheal aspirates (ETA) samples were collected from the ICU of a public school in Bangladesh. This cross-sectional study was carried out in the Department of Microbiology, Chittagong for quantitative culture, CDST test, and multiplex PCR for blaIMP, blaVIM, blaNDM genes of MBL producers. Results: Among the 105 clinically suspected VAP cases, the quantitative culture was positive in 95 (90%) and among 95 g-negative bacilli isolated from VAP patients, 46 (48.42%) were imipenem resistant, 30 (65.22%) were MBL producers by CDST, 21 (45.65%) were identified as MBL producers by multiplex PCR. Conclusion: PCR was highly sensitive and specific for the detection of MBL producers.
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Jam R, Mesquida J, Hernández Ó, Sandalinas I, Turégano C, Carrillo E, Pedragosa R, Valls J, Parera A, Ateca B, Salamero M, Jane R, Oliva JC, Delgado-Hito P. Nursing workload and compliance with non-pharmacological measures to prevent ventilator-associated pneumonia: a multicentre study. Nurs Crit Care 2018; 23:291-298. [DOI: 10.1111/nicc.12380] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 07/09/2018] [Indexed: 12/26/2022]
Affiliation(s)
- Rosa Jam
- Critical Care Department; Parc Taulí. Hospital Universitari; Sabadell Spain
| | - Jaume Mesquida
- Critical Care Department; Parc Taulí. Hospital Universitari; Sabadell Spain
| | | | | | | | - Esther Carrillo
- Critical Care Department; Parc Taulí. Hospital Universitari; Sabadell Spain
| | - Rosario Pedragosa
- Critical Care Department; Parc Taulí. Hospital Universitari; Sabadell Spain
| | - Josefa Valls
- Critical Care Department; Hospital Universitari Mútua de Terrassa; Terrassa Spain
| | - Ana Parera
- Critical Care Department; Hospital Universitari Mútua de Terrassa; Terrassa Spain
| | - Begoña Ateca
- Critical Care Department; Hospital Universitari Mútua de Terrassa; Terrassa Spain
| | - Maria Salamero
- Critical Care Department; Hospital Universitari Mútua de Terrassa; Terrassa Spain
| | - Roser Jane
- Critical Care Department; Hospital Universitari Mútua de Terrassa; Terrassa Spain
| | - Joan Carles Oliva
- Department of Results Centers; Fundació Parc Taulí, Unit of Clinical Trials; Sabadell Spain
| | - Pilar Delgado-Hito
- Fundamental and Medical-Surgical Nursing Department, School of Nursing; University of Barcelona; Barcelona Spain
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12
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Compliance of Nurses and Hospitals With Ventilator-Associated Pneumonia Prevention Guidelines: A Middle Eastern Survey. J Nurs Care Qual 2018; 33:E8-E14. [PMID: 28858912 DOI: 10.1097/ncq.0000000000000286] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study was a self-reported cross-sectional survey that investigated nurses' and hospitals' compliance with ventilator-associated pneumonia prevention guidelines and the barriers and factors that affect their level of compliance. A questionnaire was completed by 471 intensive care unit nurses from 16 medical centers in 3 Middle Eastern countries: Jordan, Egypt, and Saudi Arabia. The results show that both nurses and hospitals have insufficient compliance. Previous education, experience, and academic degree were all found to affect nurses' compliance.
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13
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Alja'afreh MA, Mosleh SM, Habashneh SS. Nurses' perception and attitudes towards oral care practices for mechanically ventilated patients. Saudi Med J 2018; 39:379-385. [PMID: 29619490 PMCID: PMC5938652 DOI: 10.15537/smj.2018.4.21749] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 02/28/2018] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES To explore the perception and attitudes of intensive care unit (ICU) nurses towards oral care practice for mechanically ventilated (MV) patients. METHOD A descriptive cross-sectional design was used in this study. A convenience sample of 96 ICU nurses completed a questionnaire on their perception and attitudes towards oral care. The study setting was 3 representative Jordanian hospitals in Al-Karak and the capital, Amman, over a 6-month period between February and September 2016. RESULTS Ninety-six nurses participated in the study. The response rate was 76.8%. The results revealed that 65% only follow a specific oral care protocol. Nurses did not adhere to minimal standards. Although nurses' attitude towards oral care was strongly positive, 68% of them perceived it as an unpleasant task and 29% agreed that they had insufficient training; 78% agreed to learn more about the best way to perform oral care. Standard descriptive statistics were calculated for all baseline information (sociodemographic characteristics). Binary variables were expressed as proportions, and normally distributed continuous variables as means and standard deviations. CONCLUSION The poor perception and attitudes of ICU nurses regarding oral care for MV patients require the urgent attention of clinical administrators. In-hospital training regarding oral care protocol could improve nurses' perception and attitudes.
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Affiliation(s)
- Mahmoud A Alja'afreh
- Department of Adult Health Nursing, Faculty of Nursing, Mutah University, Alkarak, Jordan. E-mail.
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14
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Li L, Wang Q, Wang J, Liu K, Wang P, Li X, Yang J, Lu J, Li D, Wang L, Wang Z, Peng F. Development, validation and application of a ventilator-associated pneumonia prevention checklist in a single cardiac surgery centre. Intensive Crit Care Nurs 2018; 49:58-64. [PMID: 29605237 DOI: 10.1016/j.iccn.2017.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 09/29/2017] [Accepted: 10/19/2017] [Indexed: 10/17/2022]
Abstract
OBJECTIVES The purpose of this study was to develop, validate and apply a ventilator-associated pneumonia prevention checklist in a single cardiac surgery centre. METHODS An initial checklist was designed based on the published care bundles for prevention of ventilator-associated pneumonia; the Delphi method used for validation. A total of 20 experts were invited to score the items and give suggestions for the checklist. The final checklist was then applied to patients receiving cardiac surgery. Non-compliance with the protocol and outcome indicators were observed. RESULTS Two rounds of Delphi were conducted. The final one-page checklist consisted of three main parts: (1) demographic data of the patient receiving cardiac surgery; (2) general assessment of the patient (3) checklist of prevention measures. The average time to complete the checklist was between two and four minutes. After the application of the checklist, the incidence of ventilator-associated pneumonia decreased from 14.48 to 5.47 episodes per thousand ventilator hours. In patients requiring >48 hours mechanical ventilation, the ventilator-associated pneumonia rate and duration of ventilation was significantly decreased. CONCLUSION A checklist was developed for ventilator associated pneumonia based on care bundles and validated using the Delphi method. The checklist appeared to be a useful tool in preventing ventilator associated pneumonia and shortening the ventilation time.
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Affiliation(s)
- Luolan Li
- Department of Nursing, Changzheng Hospital, Second Military Medical University, Shanghai, China; Department of Cardiothoracic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Qing Wang
- Department of Cardiothoracic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Jingjing Wang
- Department of Nursing, Changzheng Hospital, Second Military Medical University, Shanghai, China; Department of Cardiothoracic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Kai Liu
- Department of Cardiothoracic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Pei Wang
- Department of Cardiothoracic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Xian Li
- Department of Nursing, Changzheng Hospital, Second Military Medical University, Shanghai, China; Department of Cardiothoracic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Jing Yang
- Department of Nursing, Changzheng Hospital, Second Military Medical University, Shanghai, China; Department of Cardiothoracic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Jing Lu
- Department of Nursing, Changzheng Hospital, Second Military Medical University, Shanghai, China; Department of Cardiothoracic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Dian Li
- Department of Nursing, Changzheng Hospital, Second Military Medical University, Shanghai, China; Department of Cardiothoracic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Li Wang
- Department of Nursing, Changzheng Hospital, Second Military Medical University, Shanghai, China; Department of Cardiothoracic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Zhinong Wang
- Department of Cardiothoracic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China.
| | - Fei Peng
- Department of Nursing, Changzheng Hospital, Second Military Medical University, Shanghai, China.
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15
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Aloush SM. Nurses' implementation of ventilator-associated pneumonia prevention guidelines: an observational study in Jordan. Nurs Crit Care 2017; 23:147-151. [PMID: 29143487 DOI: 10.1111/nicc.12323] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 09/21/2017] [Accepted: 10/05/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Ventilator-associated pneumonia prevention guidelines from the Center for Disease Control and Prevention, the American Thoracic Society, and the Institute for Health Care and Improvement have been published to reduce the rate of ventilator-associated pneumonia in the clinical settings; however, nurses' compliance with these guidelines is still questionable. AIMS The purpose of this study was to assess nurses' compliance with ventilator-associated pneumonia prevention guidelines and the factors that influence their compliance. DESIGN A structured observational design with a non-participant approach. METHOD One hundred nurses were observed during their care for patients on mechanical ventilator. The observers documented nurses' implementation of ventilator-associated pneumonia prevention guidelines using a structured observational sheet. RESULTS Compliance of nurses was found to be unsatisfactory. Of the participants, 63% showed 'insufficient compliance'. Nurses working in units with a 1:1 nurse:patient ratio and lower beds' capacity demonstrated higher compliance and their intensive care units had a lower rate of ventilator-associated pneumonia and shorter intensive care unit stay in comparison with their counterparts working with a 1:2 nurse:patient ratio and higher beds' capacity. CONCLUSION Nurses' compliance with ventilator-associated pneumonia prevention guidelines was insufficient. Low nurse-patient ratio and large intensive care unit beds capacity were found to affect nurses' compliance and patients' outcomes. This study expanded knowledge about important aspects of nursing care; nurses' compliance with ventilator-associated pneumonia prevention guidelines and the factors that affect their compliance. This knowledge can be used by health professional to guide the clinical practice and to improve the quality of care.
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Affiliation(s)
- Sami M Aloush
- School of Nursing, Al Al-Bayt University, Mafraq, Jordan
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16
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Walker W, Albarran J. What's in this issue. Nurs Crit Care 2017; 22:121-122. [PMID: 28444719 DOI: 10.1111/nicc.12295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Wendy Walker
- Reader in Acute and Critical Care Nursing, Intern in Nursing in Critical Care
| | - John Albarran
- Associate Professor in Critical and Cardiovascular Nursing and Associate Editor of Nursing in Critical Care
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