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Maertens B, Blot S, Huis In 't Veld D, Blot K, Koch A, Mignolet K, Pannier E, Sarens T, Temmerman W, Swinnen W. Stepwise implementation of prevention strategies and their impact on ventilator-associated pneumonia incidence: A 13-Year observational surveillance study. Intensive Crit Care Nurs 2024:103769. [PMID: 39043503 DOI: 10.1016/j.iccn.2024.103769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 07/05/2024] [Accepted: 07/07/2024] [Indexed: 07/25/2024]
Abstract
OBJECTIVE To describe the practice of ventilator-associated pneumonia (VAP) prevention and control through the incremental introduction of prevention strategies and assess the effect on VAP incidence. DESIGN Historical observational surveillance study conducted over 13 years. SETTING A 12-bed adult intensive care unit (ICU) in a general hospital in Belgium. PARTICIPANTS Patients admitted between 2007 and 2019, with ICU stays of ≥48 h. INTERVENTIONS Incremental introduction of VAP preventive measures from 2008, including head-of-bed elevation, cuff pressure control, endotracheal tubes with tapered cuffs, subglottic secretion drainage, chlorhexidine oral care, and daily sedation assessment. MEASUREMENTS AND MAIN RESULTS A significant decline in VAP incidence density rates was observed, from 18.3 to 2.6 cases per 1000 ventilator days from the baseline to the final period. CONCLUSIONS Systematic implementation of VAP preventive measures significantly reduced VAP incidence. However, this reduction did not translate into decreased overall ICU mortality. IMPLICATIONS FOR PRACTICE The study underscores the importance of continuous VAP surveillance and preventive measures in reducing VAP incidence.
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Affiliation(s)
- Bert Maertens
- Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Stijn Blot
- Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium; UQ Centre for Clinical Research, The University of Queensland, Faculty of Medicine, Herston, Queensland, Australia.
| | - Diana Huis In 't Veld
- Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Koen Blot
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
| | - Annelies Koch
- General Hospital Sint Blasius, Department of Intensive Care, Dendermonde, Belgium
| | - Katrien Mignolet
- General Hospital Sint Blasius, Department of Intensive Care, Dendermonde, Belgium
| | - Elise Pannier
- General Hospital Sint Blasius, Department of Intensive Care, Dendermonde, Belgium
| | - Tom Sarens
- General Hospital Sint Blasius, Department of Intensive Care, Dendermonde, Belgium
| | - Werner Temmerman
- General Hospital Sint Blasius, Department of Intensive Care, Dendermonde, Belgium
| | - Walter Swinnen
- General Hospital Sint Blasius, Department of Intensive Care, Dendermonde, Belgium
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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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Bankanie V, Outwater AH, Wan L, Yinglan L. Assessment of knowledge and compliance to evidence-based guidelines for VAP prevention among ICU nurses in Tanzania. BMC Nurs 2021; 20:209. [PMID: 34696753 PMCID: PMC8543108 DOI: 10.1186/s12912-021-00735-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 09/29/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Implementation of evidence-based guidelines (EBGs) related to VAP is an effective measure for the prevention of ventilator-associated pneumonia (VAP). While low knowledge regarding the EBGs related to VAP prevention among ICU nurses is still a major concern among nurses in ICUs globally, the situation in Tanzania is scarcely known. This study aimed to assess the ICU nurses' knowledge, compliance, and barriers toward evidence-based guidelines for the prevention of VAP in Tanzania. METHODS A cross-sectional study, involving ICU nurses of major hospitals in Tanzania, was conducted. A structured questionnaire was administered among 116 ICU nurses. Data analysis included descriptive statistics and the independent sample t-test. RESULTS The mean knowledge score was 3.86(SD = 1.56), based on ten questions (equivalent to 38.6%). Nurses with a degree or higher level of nursing education performed significantly better than the nurses with a diploma or lower level of nursing education (p = 0.004). The mean self-reported compliance score for EBGs for the prevention of VAP was 15.20 (SD = 0.93) which is equivalent to 60.8% based on 25 questions. The main barriers to the implementation of EBGs for VAP prevention were lack of skills (96.6%), lack of adequate staff (95.5%), and lack of knowledge (79.3%). CONCLUSION Considering the severity and impact of VAP, and the higher risks of HAIs in resource-limited countries like Tanzania, the lower level of knowledge and compliance implies the need for ongoing educational interventions and evaluation of the implementation of the EBGs for VAP prevention by considering the local context.
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Affiliation(s)
- Vicent Bankanie
- XiangYa school of Nursing, Central South University, No.172Tongzi po Road, Changsha, Yuelu District, China
- Department of Clinical Nursing, University of Dodoma, Dodoma, Tanzania
| | - Anne H Outwater
- Department of Community Health Nursing, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Li Wan
- XiangYa school of Nursing, Central South University, No.172Tongzi po Road, Changsha, Yuelu District, China
| | - Li Yinglan
- XiangYa school of Nursing, Central South University, No.172Tongzi po Road, Changsha, Yuelu District, China.
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Three-Year Trends of Healthcare-Associated Infections and Antibiotic Use in Acute Care Hospitals: Findings from 2016-2018 Point Prevalence Surveys in Sicily, Italy. Antibiotics (Basel) 2020; 10:antibiotics10010001. [PMID: 33375105 PMCID: PMC7822200 DOI: 10.3390/antibiotics10010001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 12/14/2020] [Accepted: 12/19/2020] [Indexed: 01/11/2023] Open
Abstract
Repeated point prevalence surveys (PPSs) of healthcare-associated infections (HAIs) and antibiotic use are crucial to monitor trends over years at regional level, especially in countries with decentralized healthcare systems. Here, we reported the results of three PPSs conducted in Sicilian acute care hospitals (Italy) from 2016 to 2018, according to the European Centre for Disease Prevention and Control protocol. Overall, prevalence of patients with at least one HAI was 5.1% in 2016, 4.7% in 2017, and 5.1% in 2018, without a significant trend over years (p = 0.434). At the patient level, the most important factor associated with HAIs was antibiotic use, since patients receiving at least one antimicrobial were more likely to be infected than those who did not receive antimicrobials (OR = 18.87; 95%CI = 13.08–27.22). The analysis of the prevalence of antibiotic use indicated a significant trend across years of the PPSs: 50.5% of patients received at least one antimicrobial agent in 2016, 55.2% in 2017, and 53.7% in 2018 (p < 0.001). The most common indication for antimicrobial prescription was medical prophylaxis, while third-generation cephalosporins represented the most frequently used class of antimicrobial agents, followed by fluoroquinolones and combinations of penicillins. Our study confirms that HAIs still remain a major public health issue, which could be intensified by antibiotic abuse. This raises the need for infection prevention and control and antibiotic stewardship programs aimed to improve knowledge about appropriate antibiotic prescription and to reduce the use of broad-spectrum antimicrobials.
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Madhuvu A, Endacott R, Plummer V, Morphet J. Nurses' knowledge, experience and self-reported adherence to evidence-based guidelines for prevention of ventilator-associated events: A national online survey. Intensive Crit Care Nurs 2020; 59:102827. [PMID: 32151484 DOI: 10.1016/j.iccn.2020.102827] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 02/03/2020] [Accepted: 02/09/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To explore Australian intensive care nurses' knowledge of ventilator-associated pneumonia and self-reported adherence to evidence-based guidelines for the prevention of ventilator-associated events. DESIGN A quantitative cross-sectional online survey was used. SETTING The study was conducted in two Australia intensive care units, in large health services in Victoria and an Australia-wide nurses' professional association (Australian College of Critical Care Nurses). MAIN OUTCOME MEASURES Participants' knowledge and self-reported adherence to evidence-based guidelines. RESULTS The median knowledge score was 6/10 (IQR: 5-7). There was a significant positive association between completion of post graduate qualification and their overall knowledge score p = 0.014). However, there was no association (p = 0.674) between participants' years of experience in intensive care nursing and their overall score. The median self-reported adherence was 8/10 (IQR: 6-8). The most adhered to procedures were performing oral care on mechanically ventilated patients (n = 259, 90.9%) and semi-fowlers positioning of the patient (n = 241, 84.6%). There was no relationship between participants' knowledge and adherence to evidence-based guidelines (p = 0.144). CONCLUSION Participants lack knowledge of evidence-based guidelines for the prevention of ventilator-associated pneumonia. Specific education on ventilator-associated events may improve awareness and guideline adherence.
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Affiliation(s)
- Auxillia Madhuvu
- School of Nursing and Midwifery, Monash University, McMahons Road, Frankston, Victoria, Australia; Monash Health, Dandenong Hospital, 135 David Street, Dandenong, Victoria, Australia.
| | - Ruth Endacott
- School of Nursing and Midwifery, Monash University, McMahons Road, Frankston, Victoria, Australia; Plymouth University/Royal Devon and Exeter Hospital Clinical School, Drake Circus, Plymouth, Devon PL4 8AA, United Kingdom
| | - Virginia Plummer
- School of Nursing and Midwifery, Monash University, McMahons Road, Frankston, Victoria, Australia; Peninsula Health, Frankston Hospital, 2 Hastings Road, Frankston, Victoria, Australia
| | - Julia Morphet
- School of Nursing and Midwifery, Monash University, McMahons Road, Frankston, Victoria, Australia; Monash Health, Dandenong Hospital, 135 David Street, Dandenong, Victoria, Australia
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Lepape A, Jean A, De Waele J, Friggeri A, Savey A, Vanhems P, Gustin MP, Monnet DL, Garnacho-Montero J, Kohlenberg A. European intensive care physicians' experience of infections due to antibiotic-resistant bacteria. Antimicrob Resist Infect Control 2020; 9:1. [PMID: 31908772 PMCID: PMC6941296 DOI: 10.1186/s13756-019-0662-8] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 12/10/2019] [Indexed: 11/10/2022] Open
Abstract
Background Antimicrobial resistance (AMR) compromises the treatment of patients with serious infections in intensive care units (ICUs), and intensive care physicians are increasingly facing patients with bacterial infections with limited or no adequate therapeutic options. A survey was conducted to assess the intensive care physicians' perception of the AMR situation in the European Union/European Economic Area (EU/EEA). Methods Between May and July 2017, physicians working in European ICUs were invited to complete an online questionnaire hosted by the European Society of Intensive Care Medicine. The survey included 20 questions on hospital and ICU characteristics, frequency of infections with multidrug-resistant (MDR) bacteria and relevance of AMR in the respondent's ICU, management of antimicrobial treatment as well as the use of last-line antibiotics in the six months preceding the survey. For the analysis of regional differences, EU/EEA countries were grouped into the four sub-regions of Eastern, Northern, Southern and Western Europe. Results Overall, 1062 responses from four European sub-regions were analysed. Infections with MDR bacteria in their ICU were rated as a major problem by 257 (24.2%), moderate problem by 360 (33.9%) and minor problem by 391 (36.8%) respondents. Third-generation cephalosporin-resistant Enterobacteriaceae were the most frequently encountered MDR bacteria followed by, in order of decreasing frequency, meticillin-resistant Staphylococcus aureus, carbapenem-resistant Enterobacteriaceae, carbapenem-resistant Pseudomonas aeruginosa and vancomycin-resistant enterococci. Perception of the relevance of the AMR problem and the frequency of specific MDR bacteria varied by European sub-region. Bacteria resistant to all or almost all available antibiotics were encountered by 132 (12.4%) respondents. Many physicians reported not having access to specific last-line antibiotics. Conclusions The percentage of European ICU physicians perceiving AMR as a substantial problem in their ICU is high with variation by sub-region in line with epidemiological studies. The reports of bacteria resistant to almost all available antibiotics and the limited availability of last-line antibiotics in ICUs in the EU/EEA are of concern.
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Affiliation(s)
- Alain Lepape
- 1Clinical Research Unit, Critical care, Lyon-Sud University Hospital, Hospices Civils de Lyon, Lyon, France.,2Infection Section, European Society of Intensive Care Medicine, Brussels, Belgium.,3Epidémiologie et Santé Internationale, Centre International de Recherche en Infectiologie (CIRI). Inserm U1111, CNRS UMR5308, ENS de Lyon, Université Claude Bernard Lyon, Lyon, France
| | - Astrid Jean
- 1Clinical Research Unit, Critical care, Lyon-Sud University Hospital, Hospices Civils de Lyon, Lyon, France.,3Epidémiologie et Santé Internationale, Centre International de Recherche en Infectiologie (CIRI). Inserm U1111, CNRS UMR5308, ENS de Lyon, Université Claude Bernard Lyon, Lyon, France
| | - Jan De Waele
- 2Infection Section, European Society of Intensive Care Medicine, Brussels, Belgium.,4Department of Critical Care Medicine, Ghent University Hospital, Ghent, Belgium
| | - Arnaud Friggeri
- 1Clinical Research Unit, Critical care, Lyon-Sud University Hospital, Hospices Civils de Lyon, Lyon, France.,3Epidémiologie et Santé Internationale, Centre International de Recherche en Infectiologie (CIRI). Inserm U1111, CNRS UMR5308, ENS de Lyon, Université Claude Bernard Lyon, Lyon, France
| | - Anne Savey
- 3Epidémiologie et Santé Internationale, Centre International de Recherche en Infectiologie (CIRI). Inserm U1111, CNRS UMR5308, ENS de Lyon, Université Claude Bernard Lyon, Lyon, France
| | - Philippe Vanhems
- 3Epidémiologie et Santé Internationale, Centre International de Recherche en Infectiologie (CIRI). Inserm U1111, CNRS UMR5308, ENS de Lyon, Université Claude Bernard Lyon, Lyon, France
| | - Marie Paule Gustin
- 3Epidémiologie et Santé Internationale, Centre International de Recherche en Infectiologie (CIRI). Inserm U1111, CNRS UMR5308, ENS de Lyon, Université Claude Bernard Lyon, Lyon, France
| | - Dominique L Monnet
- 5European Centre for Disease Prevention and Control (ECDC), Solna, Sweden
| | - José Garnacho-Montero
- 2Infection Section, European Society of Intensive Care Medicine, Brussels, Belgium.,6Intensive Care Clinical Unit, Virgen Macarena University Hospital, Seville, Spain
| | - Anke Kohlenberg
- 5European Centre for Disease Prevention and Control (ECDC), Solna, Sweden
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Osman S, Al Talhi YM, AlDabbagh M, Baksh M, Osman M, Azzam M. The incidence of ventilator-associated pneumonia (VAP) in a tertiary-care center: Comparison between pre- and post-VAP prevention bundle. J Infect Public Health 2019; 13:552-557. [PMID: 31668986 DOI: 10.1016/j.jiph.2019.09.015] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 07/28/2019] [Accepted: 09/24/2019] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Ventilator-associated pneumonia (VAP) is a nosocomial infection that develops 48h after the initiation of mechanical ventilatory support. Current evidence-based guidelines demonstrate that VAP prevention is feasible through the implementation of certain VAP prevention bundle of interventions simultaneously. We aimed in this study to investigate the effect of VAP prevention pre- and post- implementation. METHODS This is a single-center, cohort study that took place at the Pediatric Intensive Care Unit (PICU) of King Abdulaziz Medical City (KAMC), Jeddah, Saudi Arabia from January 2015 to March 2018 and assessed the rate of VAP before and after implementation of the bundle. RESULTS The study included 141 children, 95 were included from the pre-bundle group and 36 from the bundle group. VAP developed in 35% of the pre-bundle group compared to 31% of the bundle group (p=0.651) with incidence rates equaled to 18 and 12 per 1000 ventilator days, respectively. CONCLUSION This study found that VAP bundle did not significantly reduce VAP rate in the PICU. Further large prospective multi-center studies with longer intervention duration are indicated to investigate the benefits of using VAP prevention bundle.
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Affiliation(s)
- Sara Osman
- Department of Pediatrics, King Abdulaziz Medical City, P.O. Box 65362, Jeddah 21556, Saudi Arabia; King Abdullah International Medical Research Centre, Jeddah, Saudi Arabia
| | - Yousef M Al Talhi
- King Abdullah International Medical Research Centre, Jeddah, Saudi Arabia; King Saud bin Abdulaziz University for Health Sciences, P.O. Box 65362, Jeddah 21556, Saudi Arabia.
| | - Mona AlDabbagh
- Department of Pediatrics, King Abdulaziz Medical City, P.O. Box 65362, Jeddah 21556, Saudi Arabia; King Abdullah International Medical Research Centre, Jeddah, Saudi Arabia; King Saud bin Abdulaziz University for Health Sciences, P.O. Box 65362, Jeddah 21556, Saudi Arabia
| | - Mohamed Baksh
- Department of Pediatrics, King Abdulaziz Medical City, P.O. Box 65362, Jeddah 21556, Saudi Arabia; King Abdullah International Medical Research Centre, Jeddah, Saudi Arabia; King Saud bin Abdulaziz University for Health Sciences, P.O. Box 65362, Jeddah 21556, Saudi Arabia
| | - Mohamed Osman
- Department of Pediatrics, King Abdulaziz Medical City, P.O. Box 65362, Jeddah 21556, Saudi Arabia; King Abdullah International Medical Research Centre, Jeddah, Saudi Arabia
| | - Maha Azzam
- Department of Pediatrics, King Abdulaziz Medical City, P.O. Box 65362, Jeddah 21556, Saudi Arabia; King Abdullah International Medical Research Centre, Jeddah, Saudi Arabia; King Saud bin Abdulaziz University for Health Sciences, P.O. Box 65362, Jeddah 21556, Saudi Arabia
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Buurs R, Vlaar A, Paulus F. Continuous cuff pressure control: More high-quality evidence is needed. Nurs Crit Care 2019; 26:13. [PMID: 31602734 DOI: 10.1111/nicc.12476] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 09/04/2019] [Indexed: 12/21/2022]
Affiliation(s)
- Rogier Buurs
- Bachelor of Nursing, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands.,Intensive Care Department, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Alexander Vlaar
- Intensive Care Department, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Frederique Paulus
- Bachelor of Nursing, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands.,Intensive Care Department, Amsterdam University Medical Center, Amsterdam, The Netherlands
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Álvarez-Lerma F, Sánchez García M. "The multimodal approach for ventilator-associated pneumonia prevention"-requirements for nationwide implementation. ANNALS OF TRANSLATIONAL MEDICINE 2018; 6:420. [PMID: 30581828 PMCID: PMC6275409 DOI: 10.21037/atm.2018.08.40] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 08/17/2018] [Indexed: 01/06/2023]
Abstract
The multimodal approach for ventilator-associated pneumonia (VAP) prevention has been shown to be a successful strategy in reducing VAP rates in many intensive care units (ICU) in some countries. The simultaneous application of several measures or "bundles" to reduce VAP rates has achieved a higher impact than the progressive implementation of the individual interventions. The ultimate objective of recommendation bundles is their integration in the culture of routine healthcare of the staff in charge of ventilated patients for accomplished rates to persist over time. The noteworthy elements of this new strategy include the selection of the individual recommendations of the bundle, education of care workers (HCW) in the culture of patient safety, audit of compliance with the recommendations, commitment of the hospital management to support implementation, nomination and empowerment of local leaders of the projects in ICUs, both physicians and nurses, and the continuous collection of VAP episodes. The implementation of this new strategy is not an easy task, as both its inherent strength and important barriers to its application have become evident, which need to be overcome for maximal reduction of VAP rates.
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Affiliation(s)
- Francisco Álvarez-Lerma
- Service of Intensive Care Medicine, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
| | - M. Sánchez García
- Department of Critical Care, Hospital Clínico San Carlos, Madrid, Spain
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Blum DFC, Munaretto J, Baeder FM, Gomez J, Castro CPP, Bona ÁD. Influence of dentistry professionals and oral health assistance protocols on intensive care unit nursing staff. A survey study. Rev Bras Ter Intensiva 2018; 29:391-393. [PMID: 29044309 PMCID: PMC5632984 DOI: 10.5935/0103-507x.20170049] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 04/27/2017] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | - Jussara Gomez
- Hospital São Vicente de Paulo - Passo Fundo (RS), Brasil
| | | | - Álvaro Della Bona
- Faculdade de Odontologia, Universidade de Passo Fundo - Passo Fundo (RS), Brasil
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12
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Blum DFC, Silva JASD, Baeder FM, Della Bona Á. The practice of dentistry in intensive care units in Brazil. Rev Bras Ter Intensiva 2018; 30:327-332. [PMID: 30183977 PMCID: PMC6180464 DOI: 10.5935/0103-507x.20180044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Accepted: 05/04/2018] [Indexed: 11/28/2022] Open
Abstract
Objective To evaluate the practice of dentistry in intensive care units. Methods An observational survey study was conducted in which questionnaires were sent
via the online platform for collaboration in intensive care research in
Brazil (AMIBnet). The study was carried out from June to October 2017. The
questionnaires, which contained 26 closed questions about hospitals and
dentistry practices in the intensive care units, were sent to 4,569
professionals from different specialties practicing in the units. Results In total, 203 questionnaires were returned, resulting in a response rate of
4.44%. Most of the responses were from intensive care units in the Southeast
region of the country (46.8%). Public hospitals (37.9%) and private
hospitals (36.4%) had similar participation rates. Of the respondents, 55%
indicated that a bedside dentistry service was present, and they were
provided in different ways. Conclusion The presence of dentistry services and oral health service delivery training
and protocols were correlated. The oral care methods varied greatly among
the intensive care units surveyed.
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Affiliation(s)
| | | | | | - Álvaro Della Bona
- Faculdade de Odontologia, Universidade de Passo Fundo - Passo Fundo (RS), Brasil
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Atashi V, Yousefi H, Mahjobipoor H, Yazdannik A. The barriers to the prevention of ventilator-associated pneumonia from the perspective of critical care nurses: A qualitative descriptive study. J Clin Nurs 2018; 27:e1161-e1170. [PMID: 29215801 DOI: 10.1111/jocn.14216] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2017] [Indexed: 12/29/2022]
Abstract
AIMS AND OBJECTIVES The aim of this study was to explore the perspectives of Iranian critical care nurses on the barriers to ventilator-associated pneumonia prevention in intensive care units. BACKGROUND Most patients hospitalized in intensive care units need mechanical ventilation. One of the most prevalent and serious complications of mechanical ventilation is ventilator-associated pneumonia. There are different barriers to the prevention of this kind of pneumonia. DESIGN Qualitative descriptive design was used. METHODS In this qualitative study, 23 critical care nurses were recruited via purposive sampling. Semi-structured interviews were done for data collection. The interviews were recorded digitally, transcribed word by word, and analyzed using the inductive content analysis approach. RESULTS The barriers to the prevention of ventilator-associated pneumonia fell into three main categories, namely nurses' limited professional competence, unfavorable environmental conditions, and passive human resource management. The 10 subcategories of these main categories were unfavorable professional attitude, limited professional knowledge, low job motivation, limited professional accountability, non-standard physical structure, inadequate or inappropriate equipment, heavy workload, staff shortage, inadequate staff training, and ineffective supervision. CONCLUSION The barriers to the prevention of ventilator-associated pneumonia in intensive care units are very diverse and complex and include a wide range of interrelated personal, environmental, and organizational barriers. RELEVANCE TO CLINICAL PRACTICE This study created a better understanding of the barriers to ventilator-associated pneumonia prevention. Moreover, highlighted the importance of sufficient resources, adequate staffing level, and contextually-appropriate evidence-based guidelines for effective ventilator-associated pneumonia prevention.
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Affiliation(s)
- Vajihe Atashi
- Student Research Committee, Faculty of Nursing and Midwifery School, Isfahan University of Medical Science, Isfahan, Iran
| | - Hojatollah Yousefi
- Ulcer Repair Research Center, School of Nursing and Midwifery, Isfahan University of Medical Science, Isfahan, Iran
| | - Hosein Mahjobipoor
- Department of Anesthesiology and Critical Care Medicine, Critical care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ahmadreza Yazdannik
- Critical Care Nursing Department, Nursing and Midwifery School, Nursing and Midwifery Care Research Center, Isfahan University of Medical Science, Isfahan, Iran
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Pivkina AI, Gusarov VG, Blot SI, Zhivotneva IV, Pasko NV, Zamyatin MN. Effect of an acrylic terpolymer barrier film beneath transparent catheter dressings on skin integrity, risk of dressing disruption, catheter colonisation and infection. Intensive Crit Care Nurs 2018; 46:17-23. [PMID: 29576395 DOI: 10.1016/j.iccn.2017.11.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 11/22/2017] [Accepted: 11/26/2017] [Indexed: 12/14/2022]
Abstract
OBJECTIVES We assessed the effect of a skin-protective terpolymer barrier film around the catheter insertion site on frequency of dressing disruptions and skin integrity issues (hyperaemia, skin irritation, residues of adhesives and moisture under the dressing). Secondary outcomes included colonisation of the central venous catheter (CVC) and rates of central line-associated bloodstream infection. RESEARCH METHODOLOGY A monocentric, open-label, randomised controlled trial was performed comparing a control group receiving standard transparent catheter dressings without the skin-protecting barrier film and an intervention group receiving a transparent chlorhexidine-impregnated dressing with use of the skin-protective acrylic terpolymer barrier film (3M™ Cavilon™ No - Sting Barrier Film, 3 M Health Care, St. Paul, MN, USA). RESULTS Sixty patients were enrolled and randomised in the study accounting for 60 central venous catheters and a total of 533 catheter days. Dressing disruptions occurred more frequently and at sooner time point in the control group. Skin integrity issues were significantly less observed in the intervention group. No differences in CVC colonisation or central line-associated bloodstream infection were observed. CONCLUSIONS The application of a barrier film creating a skin-protective polymer layer beneath transparent catheter dressings is associated with less dressing disruptions and skin integrity issues without altering the risk of infectious complications if used in combination with a chlorhexidine-impregnated catheter dressing.
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Affiliation(s)
- A I Pivkina
- N. I. Pirogov National Medical Surgical Center, Moscow, Russia
| | - V G Gusarov
- N. I. Pirogov National Medical Surgical Center, Moscow, Russia
| | - S I Blot
- Dept. of Internal Medicine, Ghent University, Ghent, Flanders, Belgium; Burns, Trauma and Critical Care Research Centre, The University of Queensland, Brisbane, Australia.
| | - I V Zhivotneva
- N. I. Pirogov National Medical Surgical Center, Moscow, Russia
| | - N V Pasko
- N. I. Pirogov National Medical Surgical Center, Moscow, Russia
| | - M N Zamyatin
- N. I. Pirogov National Medical Surgical Center, Moscow, Russia
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Afonso E, Lizy C, Blot S. Bridging the knowledge-practice gap: a key issue in the prevention of healthcare-associated infections. Contemp Nurse 2017; 53:713-715. [PMID: 29228884 DOI: 10.1080/10376178.2017.1416307] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Elsa Afonso
- a Rosie Neonatal Intensive Care Unit , Cambridge University Hospitals , Cambridge , UK.,b Department of Internal Medicine , Ghent University , Ghent , Flanders , Belgium
| | - Christelle Lizy
- c Department of Nephrology, Endocrinology, and Cardiology , Ghent University Hospital , Ghent , Belgium
| | - Stijn Blot
- b Department of Internal Medicine , Ghent University , Ghent , Flanders , Belgium.,d Burns, Trauma, and Critical Care Research Centre, The University of Queensland , Brisbane , QLD , Australia
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16
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Jam R, Hernández O, Mesquida J, Turégano C, Carrillo E, Pedragosa R, Gómez V, Martí L, Vallés J, Delgado-Hito P. Nursing workload and adherence to non-pharmacological measures in the prevention of ventilator-associated pneumonia. A pilot study. ENFERMERIA INTENSIVA 2017; 28:178-186. [PMID: 28890209 DOI: 10.1016/j.enfi.2017.03.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Revised: 03/24/2017] [Accepted: 03/27/2017] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To analyse whether adherence to non-pharmacological measures in the prevention of ventilator-associated pneumonia (VAP) is associated with nursing workload. METHODS A prospective observational study performed in a single medical-surgical ICU. Nurses in charge of patients under ventilator support were assessed. VARIABLES knowledge questionnaire, application of non-pharmacological VAP prevention measures, and workload (Nine Equivalents of Nursing Manpower Use Score). Phases: 1) the nurses carried out a educational programme, consisting of 60-minute lectures on non-pharmacological measures for VAP prevention, and at the end completed a questionnaire knowledge; 2) observation period; 3) knowledge questionnaire. RESULTS Among 67 ICU-staff nurses, 54 completed the educational programme and were observed. A total of 160 observations of 49 nurses were made. Adequate knowledge was confirmed in both the initial and final questionnaires. Application of preventive measures ranged from 11% for hand washing pre-aspiration to 97% for the use of a sterile aspiration probe. The Nine Equivalents of Nursing Manpower Use Score was 50±13. No significant differences were observed between the association of the nurses' knowledge and the application of preventive measures or between workload and the application of preventive measures. CONCLUSIONS Nurses' knowledge of VAP prevention measures is not necessarily applied in daily practice. Failure to follow these measures is not subject to lack of knowledge or to increased workload, but presumably to contextual factors.
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Affiliation(s)
- R Jam
- Área de Cuidados Críticos, Hospital de Sabadell, Corporació Sanitària Universitària Parc Taulí, Sabadell, Barcelona, España
| | - O Hernández
- Servicio de Atención Primaria, Vallés Occidental, Sabadell, Barcelona, España
| | - J Mesquida
- Área de Cuidados Críticos, Hospital de Sabadell, Corporació Sanitària Universitària Parc Taulí, Sabadell, Barcelona, España
| | - C Turégano
- Área de Cuidados Críticos, Hospital de Sabadell, Corporació Sanitària Universitària Parc Taulí, Sabadell, Barcelona, España
| | - E Carrillo
- Área de Cuidados Críticos, Hospital de Sabadell, Corporació Sanitària Universitària Parc Taulí, Sabadell, Barcelona, España
| | - R Pedragosa
- Área de Cuidados Críticos, Hospital de Sabadell, Corporació Sanitària Universitària Parc Taulí, Sabadell, Barcelona, España
| | - V Gómez
- Área de Cuidados Críticos, Hospital de Sabadell, Corporació Sanitària Universitària Parc Taulí, Sabadell, Barcelona, España
| | - L Martí
- Área de Cuidados Críticos, Hospital de Sabadell, Corporació Sanitària Universitària Parc Taulí, Sabadell, Barcelona, España
| | - J Vallés
- Área de Cuidados Críticos, Hospital de Sabadell, Corporació Sanitària Universitària Parc Taulí, Sabadell, Barcelona, España
| | - P Delgado-Hito
- Departamento de Enfermería Fundamental y Médico-Quirúrgica, Escuela de Enfermería, Universidad de Barcelona, Barcelona, España; Miembro del Grupo GRIN-IDIBELL.
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17
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Oral care with chlorhexidine gluconate: Time to focus on outcomes that matter. J Crit Care 2017; 40:308-309. [DOI: 10.1016/j.jcrc.2017.04.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 04/21/2017] [Indexed: 11/24/2022]
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Mogyoródi B, Dunai E, Gál J, Iványi Z. Ventilator-associated pneumonia and the importance of education of ICU nurses on prevention - Preliminary results. Interv Med Appl Sci 2017; 8:147-151. [PMID: 28180003 PMCID: PMC5283772 DOI: 10.1556/1646.8.2016.4.9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND AIMS Ventilator-associated pneumonia (VAP) increases intensive care unit (ICU) length of stay, ICU mortality, the number of ventilator days, and costs. We implemented a VAP bundle and investigated its efficacy on prevention. MATERIALS AND METHODS A prospective observational study was conducted between January 1, 2015 and December 31, 2015 in a 12-bed multidisciplinary ICU. The bundle was implemented on July 02, 2015. Comparative analysis was performed before and after the implementation of the bundle. The compliance of the nurses was also studied. RESULTS The incidence of VAP was 21.5/1,000 ventilator days (95% CI: 14.17-31.10) in the first phase and 12.0/1,000 ventilator days (95% CI: 7.2-19.49) in the second phase. Relative risk reduction was 44% (95% CI: -0.5 to 0.98). Most common bacteria identified during the first phase were Pseudomonas aeruginosa, Stenotrophomonas maltophilia, and Staphylococcus aureus; and in the second phase P. aeruginosa, Acinetobacter baumannii, and S. maltophilia were identified. Significant improvement was achieved in the head-of-bed elevation (p = 0.004), oral care (p = 0.01), hand hygiene (p < 0.001), endotracheal suctioning (p = 0.004), and removal of condensate (p = 0.043). DISCUSSION The incidence of VAP showed tendency for reduction. The prevalence of nursing-dependent bacteria decreased and compliance in following prevention methods increased. CONCLUSION These results underline the importance of education of prevention methods.
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Affiliation(s)
- Bence Mogyoródi
- Department of Anaesthesiology and Intensive Therapy, Semmelweis University , Budapest, Hungary
| | - Erzsébet Dunai
- Department of Anaesthesiology and Intensive Therapy, Semmelweis University , Budapest, Hungary
| | - János Gál
- Department of Anaesthesiology and Intensive Therapy, Semmelweis University , Budapest, Hungary
| | - Zsolt Iványi
- Department of Anaesthesiology and Intensive Therapy, Semmelweis University , Budapest, Hungary
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Optimizing educational initiatives to prevent ventilator-associated complications. Am J Infect Control 2017; 45:102-103. [PMID: 28065326 DOI: 10.1016/j.ajic.2016.05.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 05/19/2016] [Indexed: 11/20/2022]
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Valencia C, Hammami N, Agodi A, Lepape A, Herrejon EP, Blot S, Vincent JL, Lambert ML. Poor adherence to guidelines for preventing central line-associated bloodstream infections (CLABSI): results of a worldwide survey. Antimicrob Resist Infect Control 2016; 5:49. [PMID: 27895904 PMCID: PMC5120566 DOI: 10.1186/s13756-016-0139-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 10/07/2016] [Indexed: 01/03/2023] Open
Abstract
Background Central line-associated bloodstream infections (CLABSI) are a cause of increased morbidity and mortality, and are largely preventable. We documented attitudes and practices in intensive care units (ICUs) in 2015 in order to assess compliance with CLABSI prevention guidelines. Methods Between June and October 2015, an online questionnaire was made available to medical doctors and nurses working in ICUs worldwide. We investigated practices related to central line (CL) insertion, maintenance and measurement of CLABSI-related data following the SHEA guidelines as a standard. We computed weighted estimates for high, middle and low-income countries using country population as a weight. Only countries providing at least 10 complete responses were included in these estimates. Results Ninety five countries provided 3407 individual responses; no low income, 14 middle income (MIC) and 27 high income (HIC) countries provided 10 or more responses. Of the total respondents, 80% (MIC, SE = 1.5) and 81% (HIC, SE = 1.0) reported availability of written clinical guidelines for CLABSI prevention in their ICU; 23% (MIC,SE = 1.7) and 62% (HIC,SE = 1.4) reported compliance to the following (combined) recommendations for CL insertion: hand hygiene, full barrier precaution, chlorhexidine >0.5%, no topic or systemic antimicrobial prophylaxis; 60% (MIC,SE = 2.0) and 73% (HIC,SE = 1.2) reported daily assessment for the need of a central line. Most considered CLABSI measurement key to quality improvement, however few were able to report their CLABSI rate. Heterogeneity between countries was high and country specific results are made available. Conclusions This study has identified areas for improvement in CLABSI prevention practices linked to CL insertion and maintenance. Priorities for intervention differ between countries. Electronic supplementary material The online version of this article (doi:10.1186/s13756-016-0139-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Cristina Valencia
- Healthcare Associate Infections Unit, Scientific Institute of Public Health, Brussels, Belgium.,European Programme for Interventional Epidemiology Training (EPIET), ECDC, Stockholm, Sweden
| | - Naïma Hammami
- Healthcare Associate Infections Unit, Scientific Institute of Public Health, Brussels, Belgium
| | - Antonella Agodi
- Department GF Ingrassia, University of Catania, Catania, Italy
| | - Alain Lepape
- Department Anaesthesia, General Intensive Care, University hospital, Lyon, France
| | | | - Stijn Blot
- Department of Internal Medicine, Ghent University, Ghent, Belgium
| | | | - Marie-Laurence Lambert
- Healthcare Associate Infections Unit, Scientific Institute of Public Health, Brussels, Belgium
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Huang HP, Chen B, Wang HY, He M. The efficacy of daily chlorhexidine bathing for preventing healthcare-associated infections in adult intensive care units. Korean J Intern Med 2016; 31:1159-1170. [PMID: 27048258 PMCID: PMC5094930 DOI: 10.3904/kjim.2015.240] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 08/23/2015] [Accepted: 09/06/2015] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIMS Healthcare-associated infections (HAIs) in critically ill patients with prolonged length of hospital stay and increased medical costs. The aim of this study is to assess whether daily chlorhexidine gluconate (CHG) bathing will significantly reduce the rates of HAIs in adult intensive care units (ICUs). METHODS PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials were systematically searched until December 31, 2014 to identify relevant studies. Two authors independently reviewed and extracted data from included studies. All data was analyzed by Review Manager version 5.3. RESULTS Fifteen studies including three randomized controlled trials and 12 quasi-experimental studies were available in this study. The outcomes showed that daily CHG bathing were associated with significant reduction in the rates of primary outcomes: catheter-related bloodstream infection (risk ratio [RR], 0.44; 95% confidence interval [CI], 0.32 to 0.63; p < 0.00001), catheter-associated urinary tract infection (RR, 0.68; 95% CI, 0.52 to 0.88; p = 0.004), ventilator-associated pneumonia (RR, 0.73; 95% CI, 0.57 to 0.93; p = 0.01), acquisition of methicillin-resistant Staphylococcus aureus (RR, 0.78; 95% CI, 0.68 to 0.91; p = 0.001) and vancomycin-resistant Enterococcus (RR, 0.56; 95% CI, 0.31 to 0.99; p = 0.05). CONCLUSIONS Our study suggests that the use of daily CHG bathing can significantly prevent HAIs in ICUs. However, more well-designed studies are needed to confirm these findings.
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Affiliation(s)
- Hua-ping Huang
- Nursing Administration, Mianyang Central Hospital, Mianyang, China
- Correspondence to Hua-ping Huang, R.N. Nursing Administration, Mianyang Central Hospital, No. 12, Changjia Alley, Jingzhong Street, Fucheng District, Mianyang 621000, China Tel: +86-816-223-9671 Fax: +86-816-222-2566 E-mail:
| | - Bin Chen
- Intensive Care Unit, Mianyang Central Hospital, Mianyang, China
| | - Hai-Yan Wang
- Nursing Administration, Mianyang Central Hospital, Mianyang, China
| | - Me He
- Nursing Administration, Mianyang Central Hospital, Mianyang, China
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Blot SI, Rello J, Koulenti D. The value of polyurethane-cuffed endotracheal tubes to reduce microaspiration and intubation-related pneumonia: a systematic review of laboratory and clinical studies. Crit Care 2016; 20:203. [PMID: 27342802 PMCID: PMC4921025 DOI: 10.1186/s13054-016-1380-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Accepted: 06/07/2016] [Indexed: 11/10/2022] Open
Abstract
Background When conventional high-volume, low-pressure cuffs of endotracheal tubes (ETTs) are inflated, channel formation due to folds in the cuff wall can occur. These channels facilitate microaspiration of subglottic secretions, which is the main pathogenic mechanism leading to intubation-related pneumonia. Ultrathin polyurethane (PU)-cuffed ETTs are developed to minimize channel formation in the cuff wall and therefore the risk of microaspiration and respiratory infections. Methods We systematically reviewed the available literature for laboratory and clinical studies comparing fluid leakage or microaspiration and/or rates of respiratory infections between ETTs with polyvinyl chloride (PVC) cuffs and ETTs with PU cuffs. Results The literature search revealed nine in vitro experiments, one in vivo (animal) experiment, and five clinical studies. Among the 9 in vitro studies, 10 types of PU-cuffed ETTs were compared with 17 types of PVC-cuffed tubes, accounting for 67 vs. 108 experiments with 36 PU-cuffed tubes and 42 PVC-cuffed tubes, respectively. Among the clinical studies, three randomized controlled trials (RCTs) were identified that involved 708 patients. In this review, we provide evidence that PU cuffs protect more efficiently than PVC cuffs against fluid leakage or microaspiration. All studies with leakage and/or microaspiration as the primary outcome demonstrated significantly less leakage (eight in vitro and two clinical studies) or at least a tendency toward more efficient sealing (one in vivo animal experiment). In particular, high-risk patients intubated for shorter periods may benefit from the more effective sealing capacity afforded by PU cuffs. For example, cardiac surgery patients experienced a lower risk of early postoperative pneumonia in one RCT. The evidence that PU-cuffed tubes prevent ventilator-associated pneumonia (VAP) is less robust, probably because microaspiration is postponed rather than eliminated. One RCT demonstrated no difference in VAP risk between patients intubated with either PU-cuffed or PVC-cuffed tubes, and one before-after trial demonstrated a favorable reduction in VAP rates following the introduction of PU-cuffed tubes. Conclusions Current evidence can support the use of PU-cuffed ETTs in high-risk surgical patients, while there is only very limited evidence that PU cuffs prevent pneumonia in patients ventilated for prolonged periods. Electronic supplementary material The online version of this article (doi:10.1186/s13054-016-1380-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Stijn I Blot
- Department of Internal Medicine, Ghent University, Campus UZ Gent, De Pintelaan 185, 9000, Ghent, Belgium.
| | - Jordi Rello
- CIBERES, Universitat Autonòma de Barcelona, Barcelona, Spain
| | - Despoina Koulenti
- Burns Trauma and Critical Care Research Centre, The University of Queensland, Brisbane, Australia.,2nd Critical Care Department, Attikon University Hospital, Athens, Greece
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Trouillet JL, Luyt CE, Brechot N, Chastre J. Intérêt des soins de bouche et du brossage des dents dans la prévention des pneumonies acquises sous ventilation mécanique. MEDECINE INTENSIVE REANIMATION 2016. [DOI: 10.1007/s13546-015-1148-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Abstract
The intensive care unit is a work environment where superior dedication is crucial for optimizing patients' outcomes. As this demanding commitment is multidisciplinary in nature, it requires special qualities of health care workers and organizations. Thus research in the field covers a broad spectrum of activities necessary to deliver cutting-edge care. However, given the numerous research articles and education activities available, it is difficult for modern critical care clinicians to keep up with the latest progress and innovation in the field. This article broadly summarizes new developments in multidisciplinary intensive care. It provides elementary information about advanced insights in the field via brief descriptions of selected articles grouped by specific topics. Issues considered include care for heart patients, mechanical ventilation, delirium, nutrition, pressure ulcers, early mobility, infection prevention, transplantation and organ donation, care for caregivers, and family matters.
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Affiliation(s)
- Stijn Blot
- Stijn Blot is a professor in the Department of Internal Medicine, Faculty of Medicine and Health Science, Ghent University, Belgium and the Burns Trauma and Critical Care Research Centre, The University of Queensland, Brisbane, Australia. Elsa Afonso is a staff nurse in the neonatal intensive care unit, Chelsea and Westminster NHS Trust, London, United Kingdom. Sonia Labeau is a lecturer in the Faculty of Education, Health and Social Work, University College Ghent, Belgium
| | - Elsa Afonso
- Stijn Blot is a professor in the Department of Internal Medicine, Faculty of Medicine and Health Science, Ghent University, Belgium and the Burns Trauma and Critical Care Research Centre, The University of Queensland, Brisbane, Australia. Elsa Afonso is a staff nurse in the neonatal intensive care unit, Chelsea and Westminster NHS Trust, London, United Kingdom. Sonia Labeau is a lecturer in the Faculty of Education, Health and Social Work, University College Ghent, Belgium
| | - Sonia Labeau
- Stijn Blot is a professor in the Department of Internal Medicine, Faculty of Medicine and Health Science, Ghent University, Belgium and the Burns Trauma and Critical Care Research Centre, The University of Queensland, Brisbane, Australia. Elsa Afonso is a staff nurse in the neonatal intensive care unit, Chelsea and Westminster NHS Trust, London, United Kingdom. Sonia Labeau is a lecturer in the Faculty of Education, Health and Social Work, University College Ghent, Belgium
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Blot SI, Poelaert J, Kollef M. How to avoid microaspiration? A key element for the prevention of ventilator-associated pneumonia in intubated ICU patients. BMC Infect Dis 2014; 14:119. [PMID: 25430629 PMCID: PMC4289393 DOI: 10.1186/1471-2334-14-119] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Accepted: 02/28/2014] [Indexed: 12/02/2022] Open
Abstract
Microaspiration of subglottic secretions through channels formed by folds in high volume-low pressure poly-vinyl chloride cuffs of endotracheal tubes is considered a significant pathogenic mechanism of ventilator-associated pneumonia (VAP). Therefore a series of prevention measures target the avoidance of microaspiration. However, although some of these can minimize microaspiration, benefits in terms of VAP prevention are not always obvious. Polyurethane-cuffed endotracheal tubes successfully reduce microaspiration but high quality data demonstrating VAP rate reduction are lacking. An analogous conclusion can be made regarding taper-shaped cuffs compared with classic barrel-shaped cuffs. More clinical data regarding these endotracheal tube designs are needed to demonstrate clinical value in addition to in vitro-based evidence. The clinical usefulness of endotracheal tubes developed for subglottic secretions drainage is established in multiple studies and confirmed by meta-analysis. Any change in cuff design will fail to prevent microaspiration if the cuff is insufficiently inflated. At least one well-designed trial demonstrated that continuous cuff pressure monitoring and control decrease the risk of VAP. Gel lubrication of the cuff prior to intubation temporarily hampers microaspiration through sludging the channels formed by folds in high volume-low pressure cuffs. As the beneficial effect of gel lubrication is temporarily, its potential to reduce VAP risk is probably nonsignificant. A minimum positive end-expiratory pressure of at least 5 cmH2O can be recommended as it reduces the risk of microaspiration in vitro and in vivo. One randomized controlled study demonstrated a reduced risk of VAP in patients ventilated with PEEP (5–8 cmH2O). Regarding head-of-bed elevation, it can be recommended to avoid supine positioning. Whether a 45° head-of-bed elevation is to be preferred above 25-30° head-of-bed elevation remains unproven. Finally, the routine monitoring of gastric residual volumes in mechanically ventilated patients receiving enteral nutrition cannot be recommended.
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Affiliation(s)
- Stijn I Blot
- Dept, of Internal Medicine, Faculty of Medicine & Health Sciences, Ghent University, De Pintelaan 185, 9000 Ghent, Belgium.
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Continuous control of tracheal cuff pressure for the prevention of ventilator-associated pneumonia in critically ill patients: where is the evidence? Curr Opin Crit Care 2014; 19:440-7. [PMID: 23856895 DOI: 10.1097/mcc.0b013e3283636b71] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE OF REVIEW Ventilator-associated pneumonia (VAP) is a major cause of death, morbidity and costs in ICUs. Several evidence-based clinical interventions have been increasingly described for its prevention. However, continuous control of tracheal cuff pressure (Pcuff) is rarely mentioned in the latest clinical guidelines. This review focuses on the available data about the management of Pcuff in the ICU, including discontinuous and continuous control, and its impact on the prevention of VAP. RECENT FINDINGS Current discontinuous monitoring and adjustment of Pcuff, even well performed, is inaccurate in maintaining Pcuff in the target range. Underinflation (Pcuff<20 cmH2O) of tracheal cuff is an independent risk factor for VAP through microaspiration of contaminated subglottic secretions into the lower respiratory tract. Two main types of devices, electronic and pneumatic, have been developed for the continuous control of Pcuff. Both have shown effectiveness in maintaining Pcuff in recommended range in ICU patients, but only the pneumatic device has provided a reduction in microaspiration and VAP incidence. SUMMARY Continuous controllers of Pcuff represent effective, easy to use and timesaving devices in today's busy ICU environment. However, further studies are required to determine the impact of continuous control of Pcuff on VAP incidence, patient outcomes, antimicrobial consumption and to compare pneumatic and electronic devices, before generalizing their use in routine practice.
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Kaier K, Lambert ML, Frank UK, Vach W, Wolkewitz M, Tacconelli E, Rello J, Theuretzbacher U, Martin M. Impact of availability of guidelines and active surveillance in reducing the incidence of ventilator-associated pneumonia in Europe and worldwide. BMC Infect Dis 2014; 14:199. [PMID: 24725914 PMCID: PMC4021349 DOI: 10.1186/1471-2334-14-199] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Accepted: 04/08/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To analyse whether the availability of written standards for management of mechanically ventilated patients and/or the existence of a surveillance system for cases of ventilation-associated pneumonia (VAP) are positively associated with compliance with 6 well-established VAP prevention measures. METHODS Ecological study based on responses to an online-questionnaire completed by 1730 critical care physicians. Replies were received from 77 different countries, of which the majority, i.e. 1351, came from 36 European countries. RESULTS On a cross-country level, compliance with VAP prevention measures is higher in countries with a large number of prevention standards and/or VAP surveillance systems in place at ICU level., Likewise, implementation of standards and VAP surveillance systems has a significant impact on self-reported total compliance with VAP prevention measures (both p < 0.001). Moreover, predictions of overall prevention measure compliance show the effect size of the availability of written standards and existence of surveillance system. For instance, a female physician with 10 years of experience in critical care working in a 15-bed ICU in France has a predicted baseline level of VAP prevention measure compliance of 63 per cent. This baseline level increases by 9.5 percentage points (p < 0.001) if a written clinical VAP prevention standard is available in the ICU, and by another 4 percentage points (p < 0.001) if complemented by a VAP surveillance system. CONCLUSIONS The existence of written standards for management of mechanically ventilated patients in an ICU and the availability of VAP surveillance systems have shown to be positively associated with compliance with VAP prevention measures and should be fostered on a policy level.
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Affiliation(s)
- Klaus Kaier
- Institute of Medical Biometry and Medical Informatics, University Medical Center, Freiburg, Germany.
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Making Wise Choices When Incorporating Technology for Infection Control Prevention. CURRENT TREATMENT OPTIONS IN INFECTIOUS DISEASES 2014. [DOI: 10.1007/s40506-013-0004-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Infection prevention in the ICU: more than just picking one or another preventive measure. Aust Crit Care 2013; 26:151-2. [PMID: 23962741 DOI: 10.1016/j.aucc.2013.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Accepted: 07/07/2013] [Indexed: 11/22/2022] Open
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