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Almeida DF, Pinto MDR, Durao MC, Henriques HR, Teixeira JF. Specialized nursing intervention on critically ill patient in the prevention of intubation-associated pneumonia: an integrative literature review. Acute Crit Care 2024; 39:341-349. [PMID: 39266269 PMCID: PMC11392692 DOI: 10.4266/acc.2024.00528] [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: 11/17/2023] [Accepted: 06/28/2024] [Indexed: 09/14/2024] Open
Abstract
Healthcare-associated infections are adverse events that affect people in critical condition, especially when hospitalized in an intensive care unit. The most prevalent is intubation-associated pneumonia (IAP), a nursing-care-sensitive area. This review aims to identify and analyze nursing interventions for preventing IAP. An integrative literature review was done using the Medline, CINAHL, Scopus and PubMed databases. After checking the eligibility of the studies and using Rayyan software, ten final documents were obtained for extraction and analysis. The results obtained suggest that the nursing interventions identified for the prevention of IAP are elevating the headboard to 30º; washing the teeth, mouth and mucous membranes with a toothbrush and then instilling chlorohexidine 0.12%-0.2% every 8/8 hr; monitoring the cuff pressure of the endotracheal tube (ETT) between 20-30 mm Hg; daily assessment of the need for sedation and ventilatory weaning and the use of ETT with drainage of subglottic secretions. The multimodal nursing interventions identified enable health gains to be made in preventing or reducing IAP. This area is sensitive to nursing care, positively impacting the patient, family, and organizations. Future research is suggested into the effectiveness of chlorohexidine compared to other oral hygiene products, as well as studies into the mortality rate associated with IAP, with and without ETT for subglottic aspiration.
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Affiliation(s)
- Daniela Fradinho Almeida
- Critical Care Department of Unidade Local de Saúde do Hospital de São José and Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR) - Project InfPrev4frica, Lisbon, Portugal
| | - Maria do Rosário Pinto
- Nursing School of Lisbon (ESEL) and Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR) - Project InfPrev4frica, Lisbon, Portugal
- The Health Sciences Research Unit UICISA: E, Coimbra, Portugal
| | - Maria Candida Durao
- Nursing School of Lisbon (ESEL) and Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR) - Project InfPrev4frica, Lisbon, Portugal
| | - Helga Rafael Henriques
- Nursing School of Lisbon (ESEL) and Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), Lisbon, Portugal
| | - Joana Ferreira Teixeira
- Nursing School of Lisbon (ESEL) and Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR) - Project InfPrev4frica, Lisbon, Portugal
- School of Medicine and Biomedical Sciences (ICBAS) - University of Porto and Research Unit CINTESIS@RISE, Porto, Portugal
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Cezar FS, Jacober FC, Gonçalves HAG, Cantarini KV, de Oliveira CF. Profile of patients in private home care who developed ventilator-associated pneumonia. Rev Bras Enferm 2024; 77:e20230146. [PMID: 39082534 PMCID: PMC11290723 DOI: 10.1590/0034-7167-2023-0146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 02/20/2024] [Indexed: 08/02/2024] Open
Abstract
OBJECTIVES to analyze the profile and clinical outcomes of patients who developed Ventilator-Associated Pneumonia (VAP) in private home care and to compare the incidence with national data. METHODS this was a retrospective study with data collected from July 2021 to June 2022 from patient records at a private clinic. Patients using intermittent ventilation or without ventilatory support were excluded. RESULTS the utilization rate of mechanical ventilation was 15.9%. The incidence density of pneumonia in pediatrics was 2.2 cases per 1000 ventilation-days and in adults was 1.7 cases per 1000 ventilation-days, figures lower than those reported by the National Health Surveillance Agency. There were 101 episodes of pneumonia in 73 patients, predominantly male (65.8%), adults (53.4%), and those with neurological diseases (57.5%). The treatment regimen predominantly took place at home (80.2%), and there was one death. CONCLUSIONS patients in home care showed a low incidence and mortality rate from ventilator-associated pneumonia.
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Senges C, Herzer C, Norkus E, Krewing M, Mattner C, Rose L, Gebhardt T, Mattner F, Niesalla H. Workflows and locations matter - insights from electronic hand hygiene monitoring into the use of hand rub dispensers across diverse hospital wards. Infect Prev Pract 2024; 6:100364. [PMID: 38601127 PMCID: PMC11004075 DOI: 10.1016/j.infpip.2024.100364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 02/28/2024] [Indexed: 04/12/2024] Open
Abstract
Background While healthcare-associated infections (HAIs) affect approximately 3.2-6.5% of hospitalised patients in the US and Europe, improving hand hygiene (HH) could reduce HAI rates. Investigating HH is time-consuming and not always objective, and comprehensive, unbiased data is needed to develop effective strategies. Using electronic tools can provide new and detailed insights on the determinants of HH. Aim To evaluate location-dependent usage of wall-mounted dispensers (WMDs) and point-of-care dispensers (POCs) using an electronic HH recording system. Methods In this retrospective study, hand rub volumes were anonymously recorded for 931,446 disinfections from 17 wards in nine German hospitals using the electronic monitoring system NosoEx®. Number of disinfections and rub volumes of WMDs/POCs by ward and room type were analysed. Findings Generally, WMDs were most prevalent. With >3 dispensers per bed and >20 disinfections per patient day, availability and use were highest in intensive care (ICU) and intermediate care (IMC), but here rub volumes from WMDs were lowest (∼2.0 mL). Although most dispensers are located in patient rooms (∼42%), they are more frequently used in hallways. In surgical ICUs, dispensers are often used in patient rooms, where contact with open wounds is common. About 3.6 mL of hand rub is used per disinfection in treatment rooms, the highest volume of all room types. Conclusion Dispenser use was dependent on location, room type, ward specialisation and workflow. Optimising the location of hand rub dispensers (HRDs)s is not the only solution to improve HH, but can help reduce inconvenience, achieve more ergonomic workflows and better meet user needs.
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Affiliation(s)
- Christoph Senges
- HARTMANN SCIENCE CENTER, BODE Chemie GmbH a company of the HARTMANN GROUP, Hamburg, Germany
| | | | | | - Marco Krewing
- HARTMANN SCIENCE CENTER, BODE Chemie GmbH a company of the HARTMANN GROUP, Hamburg, Germany
| | - Clara Mattner
- Chair for Hygiene and Environmental Medicine, University Witten-Herdecke, Cologne Clinics, Cologne, Germany
- Institute of Rural Studies, Johann Heinrich von Thünen Institute, Braunschweig, Germany
| | - Leonard Rose
- Chair for Hygiene and Environmental Medicine, University Witten-Herdecke, Cologne Clinics, Cologne, Germany
| | | | - Frauke Mattner
- Chair for Hygiene and Environmental Medicine, University Witten-Herdecke, Cologne Clinics, Cologne, Germany
| | - Heide Niesalla
- HARTMANN SCIENCE CENTER, BODE Chemie GmbH a company of the HARTMANN GROUP, Hamburg, Germany
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Thapa D, Liu T, Yang C, Acharya SP, Tam HL, Chair SY. Identifying the barriers and facilitators to implementation of ventilator bundle in the nepalese intensive care unit: A descriptive qualitative study. Aust Crit Care 2024; 37:212-221. [PMID: 37455212 DOI: 10.1016/j.aucc.2023.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 05/29/2023] [Accepted: 06/14/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND A ventilator bundle is an effective preventive strategy against the development of ventilator-associated pneumonia (VAP). However, in clinical practice ventilator bundle implementation is poor. Understanding the barriers to ventilator bundle implementation in low- and middle-income countries can inform the development of effective implementation strategies to reduce the burden of VAP. OBJECTIVES The primary objective of this study was to explore the barriers and facilitators of ventilator bundle implementation perceived by healthcare professionals (HCPs) working in intensive care units (ICU) in Nepal. The secondary objective was to prioritise the barriers when developing implementation strategies. METHODS This study used a pragmatic approach comprising a series of methods to identify the implementation strategies: (i) Barriers and facilitators were explored using a qualitative study design. Twenty-one HCPs selected using the maximum variation sampling technique from a large tertiary hospital, completed semistructured interviews. All the interviews were recorded, transcribed word-by-word, and uploaded into NVivo for analysis using the thematic analysis approach. (ii) After analysis, nine participants were selecteded to determine the priority order of the barriers using a barrier identification and mitigation tool. RESULTS The data analysis revealed five main themes and 19 subthemes that affected ventilator bundle implementation. The main themes were provider-related factors, organisational and practice-related factors, performances of work, environmental conditions, and patient-related factors. The common barriers were job insecurity, poor knowledge, negative attitude, insufficient equipment, and severity of patient disease. Common facilitators were educational training, equipment functioning, adequate staff, strong leadership, and organisational support. Finally, eight main barriers were prioritised to target the change. CONCLUSION The barriers to implementing ventilator bundles in ICUs were identified. Focussing on addressing the prioritised barriers may aid in improving patient care and safety in ICUs. Results may guide HCPs in the development of implementation strategies to reduce the burden of VAP.
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Affiliation(s)
- Dejina Thapa
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR, PR China.
| | - Ting Liu
- School of Nursing, Sun Yat-sen University, Guangzhou, Guangdong, PR China.
| | - Chen Yang
- School of Nursing, Sun Yat-sen University, Guangzhou, Guangdong, PR China.
| | - Subhash Prasad Acharya
- Department of Critical Care Medicine, Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal.
| | - Hon Lon Tam
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR, PR China.
| | - Sek Ying Chair
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR, PR China.
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Martinez-Reviejo R, Tejada S, Jansson M, Ruiz-Spinelli A, Ramirez-Estrada S, Ege D, Vieceli T, Maertens B, Blot S, Rello J. Prevention of ventilator-associated pneumonia through care bundles: A systematic review and meta-analysis. JOURNAL OF INTENSIVE MEDICINE 2023; 3:352-364. [PMID: 38028633 PMCID: PMC10658042 DOI: 10.1016/j.jointm.2023.04.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 03/31/2023] [Accepted: 04/13/2023] [Indexed: 12/01/2023]
Abstract
Background Ventilator-associated pneumonia (VAP) represents a common hospital-acquired infection among mechanically ventilated patients. We summarized evidence concerning ventilator care bundles to prevent VAP. Methods A systematic review and meta-analysis were performed. Randomized controlled trials and controlled observational studies of adults undergoing mechanical ventilation (MV) for at least 48 h were considered for inclusion. Outcomes of interest were the number of VAP episodes, duration of MV, hospital and intensive care unit (ICU) length of stay, and mortality. A systematic search was conducted in the MEDLINE, the Cochrane Library, and the Web of Science between 1985 and 2022. Results are reported as odds ratio (OR) or mean difference (MD) with 95% confidence intervals (CI). The PROSPERO registration number is CRD42022341780. Results Thirty-six studies including 116,873 MV participants met the inclusion criteria. A total of 84,031 participants underwent care bundles for VAP prevention. The most reported component of the ventilator bundle was head-of-bed elevation (n=83,146), followed by oral care (n=80,787). A reduction in the number of VAP episodes was observed among those receiving ventilator care bundles, compared with the non-care bundle group (OR=0.42, 95% CI: 0.33, 0.54). Additionally, the implementation of care bundles decreased the duration of MV (MD=-0.59, 95% CI: -1.03, -0.15) and hospital length of stay (MD=-1.24, 95% CI: -2.30, -0.18) in studies where educational activities were part of the bundle. Data regarding mortality were inconclusive. Conclusions The implementation of ventilator care bundles reduced the number of VAP episodes and the duration of MV in adult ICUs. Their application in combination with educational activities seemed to improve clinical outcomes.
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Affiliation(s)
- Raquel Martinez-Reviejo
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid 28029, Spain
| | - Sofia Tejada
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid 28029, Spain
- Clinical Research Epidemiology in Pneumonia & Sepsis (CRIPS), Vall d'Hebron Institute of Research (VHIR), Barcelona 08035, Spain
| | - Miia Jansson
- Research Unit of Health Sciences and Technology, University of Oulu, Oulu, 90570, Finland
- RMIT University, Melbourne, 3010, Australia
| | - Alfonsina Ruiz-Spinelli
- Critical Care Department, Hospital de Clínicas Dr. Manuel Quintela, Montevideo, 11600, Uruguay
- Medicine Department, Universitat Internacional de Catalunya (UIC), Barcelona, 08017, Spain
| | | | - Duygu Ege
- Emergency Medicine Department, Adnan Menderes University, Aydin, 09010, Turkey
| | - Tarsila Vieceli
- Infectious Diseases Department, Hospital de Clínicas de Porto Alegre, Porto Alegre, 90035-903, Brazil
| | - Bert Maertens
- Department of Internal Medicine and Pediatrics, Ghent University, Ghent, 9000, Belgium
| | - Stijn Blot
- Department of Internal Medicine and Pediatrics, Ghent University, Ghent, 9000, Belgium
| | - Jordi Rello
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid 28029, Spain
- Clinical Research Epidemiology in Pneumonia & Sepsis (CRIPS), Vall d'Hebron Institute of Research (VHIR), Barcelona 08035, Spain
- FOREVA Clinical Research, CHU Nimes, Université de Nîmes-Montpellier, Nîmes, 30012, France
- Medicine Department, Universitat Internacional de Catalunya (UIC), Barcelona, 08017, Spain
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Feifei Y, Junhai Z, Xiaoxiao G. Nursing Care of Patient With Tracheostomy Tube Cuff Rupture Caused by Tracheal Polyp: A Case Report. Crit Care Nurse 2023; 43:52-58. [PMID: 37257874 DOI: 10.4037/ccn2023649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
INTRODUCTION Tracheostomy is common in patients with critical illness. Mechanical ventilation requires the airway to be closed by an inflated tracheostomy tube cuff. Tracheostomy tube cuff rupture is a serious complication of airway management. This case study summarizes the nursing care of a patient who received prolonged mechanical ventilation and had recurrent tracheostomy tube cuff ruptures caused by a tracheal polyp. CLINICAL FINDINGS AND DIAGNOSIS An 81-year-old woman was admitted because of acute exacerbation of chronic obstructive pulmonary disease. The patient had undergone percutaneous tracheostomy 3 years earlier because of difficulty in weaning from the ventilator and had recurrent lung infections that led to respiratory failure. A tracheal polyp was identified as the cause of multiple tracheostomy tube cuff ruptures. OUTCOMES After the tracheal polyp was removed with bronchofiberscope guidance, the patient remained hospitalized because of difficulty in ventilator weaning but had no further tracheostomy tube cuff ruptures. CONCLUSION Tracheal polyps that cause tracheostomy tube cuff ruptures are rare, but nurses should be alert to their occurrence. If a tube cuff ruptures in a patient receiving long-term mechanical ventilation, bronchoscopy should be performed as soon as possible to allow for early identification of the cause and ensure patient safety.
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Affiliation(s)
- Ye Feifei
- Ye Feifei is a nurse, Department of Critical Care Medicine, Zhejiang Hospital, Hangzhou, Zhejiang, China
| | - Zhen Junhai
- Zhen Junhai is a physician, Department of Critical Care Medicine, Zhejiang Hospital
| | - Guan Xiaoxiao
- Guan Xiaoxiao is a nurse, Department of Critical Care Medicine, Zhejiang Hospital
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7
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Response to Society for Healthcare Epidemiology (SHEA) recommendations for ventilator-associated pneumonia (VAP). Infect Control Hosp Epidemiol 2023; 44:522-523. [PMID: 36688341 DOI: 10.1017/ice.2022.278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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8
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Zwicker P, Meng M, Friesecke S, Stein T, Herzog A, Herzer C, Kammerlander M, Gebhardt T, Kugler C, Kramer A. An interactive feedback system for increasing hand antisepsis adherence in stationary intensive care. J Hosp Infect 2023; 133:73-80. [PMID: 36646137 DOI: 10.1016/j.jhin.2022.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 12/05/2022] [Accepted: 12/13/2022] [Indexed: 01/15/2023]
Abstract
BACKGROUND Pathogens causing infections are in many cases transmitted via the hands of personnel. Thus, hand antisepsis has strong epidemiological evidence of infection prevention. Depending on various factors, hand antisepsis adherence ranges between 9.1% and 85.2%. AIM To evaluate a new transponder system that reminded medical staff to use an alcohol-based hand rub based on indication by giving real-time feedback, to detect hand antisepsis adherence. METHODS The monitoring system consisted of three components: a portable transponder detecting alcohol-based hand rub and able to give feedback; a beacon recognizing entries to and exits from the patient's surroundings; and a sensor placed at the hand-rub dispensers to count the number of hand rubs. With these components, the system provided feedback when hand antisepsis was not conducted although it was necessary according to moments 1, 4, and 5 of hand antisepsis. Adherence was measured in two use-cases with five phases, starting with the baseline measurement followed by intervention periods and phases without intervention to test the sustainability of the feedback. FINDINGS Using the monitoring system, hand antisepsis adherence was increased by up to 104.5% in comparison to the baseline measurement. When the intervention ceased, however, hand antisepsis adherence decreased to less than or equal to the baseline measurement. CONCLUSION A short-term intervention alone is not sufficient to lead to a long-term change in hand antisepsis adherence. Rather, permanent feedback and/or the integration in a multi-modal intervention strategy are necessary.
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Affiliation(s)
- P Zwicker
- Institute of Hygiene and Environmental Medicine, University Medicine, Greifswald, Germany; Section Antiseptic Stewardship of the German Society of Hospital Hygiene, Berlin, Germany.
| | - M Meng
- Institute of Nursing Science, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Federal Institute for Vocational Education and Training (VET), Bonn, Germany
| | - S Friesecke
- Department of Internal Medicine B, Medical Intensive Care Unit, University Medicine, Greifswald, Germany
| | - T Stein
- Neurological Rehabilitation Center gGmbH, Greifswald, Germany
| | - A Herzog
- HyHelp AG, Frankfurt am Main, Germany; United-Ventures GmbH, Frankfurt am Main, Germany
| | - C Herzer
- GWA Hygiene GmbH, Stralsund, Germany
| | - M Kammerlander
- Institute of Nursing Science, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Institute of Medical Biometry and Statistics, University of Freiburg, Freiburg, Germany
| | | | - C Kugler
- Institute of Nursing Science, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - A Kramer
- Institute of Hygiene and Environmental Medicine, University Medicine, Greifswald, Germany; Section Antiseptic Stewardship of the German Society of Hospital Hygiene, Berlin, Germany
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Chen T, Zhang L, Huang W, Zong H, Li Q, Zheng Y, Lv Q, Kong D, Ren Y, Jiang Y, Li Y, Liu P. Detection of Pathogens and Antimicrobial Resistance Genes in Ventilator-Associated Pneumonia by Metagenomic Next-Generation Sequencing Approach. Infect Drug Resist 2023; 16:923-936. [PMID: 36814827 PMCID: PMC9939671 DOI: 10.2147/idr.s397755] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 01/26/2023] [Indexed: 02/16/2023] Open
Abstract
Background The early identification of pathogens and their antibiotic resistance are essential for the management and treatment of patients affected by ventilator-associated pneumonia (VAP). However, microbiological culture may be time-consuming and has a limited culturability of many potential pathogens. In this study, we developed a rapid nanopore-based metagenomic next-generation sequencing (mNGS) diagnostic assay for detection of VAP pathogens and antimicrobial resistance genes (ARGs). Patients and Methods Endotracheal aspirate (ETA) samples from 63 patients with suspected VAP were collected between November 2021 and July 2022. Receiver operating characteristic (ROC) curves were established to compare the pathogen identification performance of the target pathogen reads, reads percent of microbes (RPM) and relative abundance (RA). The evaluation of the accuracy of mNGS was performed comparing with the gold standard and the composite standard, respectively. Then, the ARGs were analyzed by mNGS. Results ROC curves showed that RA has the highest diagnostic value and the corresponding threshold was 9.93%. The sensitivity and specificity of mNGS test were 91.3% and 78.3%, respectively, based on the gold standard, while the sensitivity and specificity of mNGS test were 97.4% and 100%, respectively, based on the composite standard. A total of 13 patients were virus-positive based on mNGS results, while the coinfection rate increased from 27% to 46% compared to the rate obtained based on clinical findings. The mNGS test also performed well at predicting antimicrobial resistance phenotypes. Patients with a late-onset VAP had a significantly greater proportion of ARGs in their respiratory microbiome compared to those with early-onset VAP (P = 0.041). Moreover, the median turnaround time of mNGS was 4.43 h, while routine culture was 72.00 h. Conclusion In this study, we developed a workflow that can accurately detect VAP pathogens and enable prediction of antimicrobial resistance phenotypes within 5 h of sample receipt by mNGS.
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Affiliation(s)
- Ting Chen
- The PLA 307 Clinical College of Anhui Medical University, The Fifth Clinical Medical College of Anhui Medical University, Hefei, People’s Republic of China,Department of Critical Care Medicine, The Fifth Medical Center, Chinese PLA General Hospital, Beijing, 100071, People’s Republic of China
| | - Lei Zhang
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Academy of Military Medical Sciences, Beijing, People’s Republic of China
| | - Wenhua Huang
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Academy of Military Medical Sciences, Beijing, People’s Republic of China
| | - Huijun Zong
- The PLA 307 Clinical College of Anhui Medical University, The Fifth Clinical Medical College of Anhui Medical University, Hefei, People’s Republic of China,Department of Critical Care Medicine, The Fifth Medical Center, Chinese PLA General Hospital, Beijing, 100071, People’s Republic of China
| | - Qian Li
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Academy of Military Medical Sciences, Beijing, People’s Republic of China
| | - Yuling Zheng
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Academy of Military Medical Sciences, Beijing, People’s Republic of China
| | - Qingyu Lv
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Academy of Military Medical Sciences, Beijing, People’s Republic of China
| | - Decong Kong
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Academy of Military Medical Sciences, Beijing, People’s Republic of China
| | - Yuhao Ren
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Academy of Military Medical Sciences, Beijing, People’s Republic of China
| | - Yongqiang Jiang
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Academy of Military Medical Sciences, Beijing, People’s Republic of China
| | - Yan Li
- The PLA 307 Clinical College of Anhui Medical University, The Fifth Clinical Medical College of Anhui Medical University, Hefei, People’s Republic of China,Department of Critical Care Medicine, The Fifth Medical Center, Chinese PLA General Hospital, Beijing, 100071, People’s Republic of China,Correspondence: Yan Li, The PLA 307 Clinical College of Anhui Medical University, The Fifth Clinical Medical College of Anhui Medical University, Hefei, 230032, People’s Republic of China, Email
| | - Peng Liu
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Academy of Military Medical Sciences, Beijing, People’s Republic of China,Peng Liu, Beijing Institute of Microbiology and Epidemiology, Dongdajie Road 20, Beijing, 100071, People’s Republic of China, Tel +86-010-66948487, Email
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10
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Thapa D, Liu T, Chair SY. Multifaceted interventions are likely to be more effective to increase adherence to the ventilator care bundle: A systematic review of strategies to improve care bundle compliance. Intensive Crit Care Nurs 2023; 74:103310. [PMID: 36154789 DOI: 10.1016/j.iccn.2022.103310] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 08/07/2022] [Accepted: 08/08/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND The implementation of ventilator care bundles has remained suboptimal. However, it is unclear whether improving adherence has a positive relationship with patient outcomes. OBJECTIVES To identify the most effective implementation strategies to improve adherence to ventilator bundles and to investigate the relationship between adherence to ventilator bundles and patient outcomes. METHODS A systematic review followed the PRISMA guidelines. A systematic literature search from the inception of ventilator care bundles 2001 to January 2021 of relevant databases, screening and data extraction according to Cochrane methodology. RESULTS In total, 6035 records were screened, and 24 studies met the eligibility criteria. The implementation strategies were provider-level interventions (n = 15), included educational activities, checklist, and audit/feedback. Organizational-level interventions include (n = 8) included change of medical record system and multidisciplinary team. System-level intervention (n = 1) had motivation and reward. The most common strategies were education, checklists, audit feedback, which are probably effective in improving adherence. We could not perform a meta-analysis due to heterogeneity of the strategies and types of adherence measurement. Most studies (n = 7) had a high risk of bias. There were some conflicting results in determining the associations between adherence and patient outcomes because of the poor quality of the studies. CONCLUSION Multifaceted interventions are likely to be effective for consistent improvement in adherence. It remains uncertain whether improvements in adherence have positive outcomes on patients due to limited evidence of low to moderate uncertainty. We recommend the need for robust research methodology to assess the effectiveness of implementation strategies on improving adherence and patient outcomes.
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Affiliation(s)
- Dejina Thapa
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong Special Administrative Region.
| | - Ting Liu
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong Special Administrative Region.
| | - Sek Ying Chair
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong Special Administrative Region.
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11
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Mastrogianni M, Katsoulas T, Galanis P, Korompeli A, Myrianthefs P. The Impact of Care Bundles on Ventilator-Associated Pneumonia (VAP) Prevention in Adult ICUs: A Systematic Review. Antibiotics (Basel) 2023; 12:227. [PMID: 36830138 PMCID: PMC9952750 DOI: 10.3390/antibiotics12020227] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 01/13/2023] [Accepted: 01/17/2023] [Indexed: 01/26/2023] Open
Abstract
Ventilator-associated pneumonia (VAP) remains a common risk in mechanically ventilated patients. Different care bundles have been proposed to succeed VAP reduction. We aimed to identify the combined interventions that have been used to by ICUs worldwide from the implementation of "Institute for Healthcare Improvement Ventilator Bundle", i.e., from December 2004. A search was performed on the PubMed, Scopus and Science Direct databases. Finally, 38 studies met our inclusion criteria. The most common interventions monitored in the care bundles were sedation and weaning protocols, semi-recumbent positioning, oral and hand hygiene, peptic ulcer disease and deep venus thrombosis prophylaxis, subglottic suctioning, and cuff pressure control. Head-of-bed elevation was implemented by almost all studies, followed by oral hygiene, which was the second extensively used intervention. Four studies indicated a low VAP reduction, while 22 studies found an over 36% VAP decline, and in ten of them, the decrease was over 65%. Four of these studies indicated zero or nearly zero after intervention VAP rates. The studies with the highest VAP reduction adopted the "IHI Ventilator Bundle" combined with adequate endotracheal tube cuff pressure and subglottic suctioning. Multifaced techniques can lead to VAP reduction at a great extent. Multidisciplinary measures combined with long-lasting education programs and measurement of bundle's compliance should be the gold standard combination.
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Affiliation(s)
- Maria Mastrogianni
- Department of Nursing, National and Kapodistrian University of Athens, 123 Papadiamantopoulou Str, Goudi, 11527 Athens, Greece
- Department of Health Policy, Ministry of National Defense, Mesogeion Avenue 227–231, Holargos, 15561 Athens, Greece
| | - Theodoros Katsoulas
- Department of Nursing, National and Kapodistrian University of Athens, 123 Papadiamantopoulou Str, Goudi, 11527 Athens, Greece
- Intensive Care Unit, General and Oncologic Hospital of Kifissia “AgioiAnargiri”, Kaliftaki 41 Str, Kifissia, 14564 Athens, Greece
| | - Petros Galanis
- Department of Nursing, National and Kapodistrian University of Athens, 123 Papadiamantopoulou Str, Goudi, 11527 Athens, Greece
| | - Anna Korompeli
- Department of Nursing, National and Kapodistrian University of Athens, 123 Papadiamantopoulou Str, Goudi, 11527 Athens, Greece
- Intensive Care Unit, General and Oncologic Hospital of Kifissia “AgioiAnargiri”, Kaliftaki 41 Str, Kifissia, 14564 Athens, Greece
| | - Pavlos Myrianthefs
- Department of Nursing, National and Kapodistrian University of Athens, 123 Papadiamantopoulou Str, Goudi, 11527 Athens, Greece
- Intensive Care Unit, General and Oncologic Hospital of Kifissia “AgioiAnargiri”, Kaliftaki 41 Str, Kifissia, 14564 Athens, Greece
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Effect of ICU quality control indicators on VAP incidence rate and mortality: a retrospective study of 1267 hospitals in China. Crit Care 2022; 26:405. [PMID: 36581952 PMCID: PMC9798551 DOI: 10.1186/s13054-022-04285-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 12/17/2022] [Indexed: 12/30/2022] Open
Abstract
PURPOSE To investigate the effects of ICU quality control indicators on the VAP incidence rate and mortality in China throughout 2019. METHODS This was a retrospective study. A total of 1267 ICUs from 30 provinces in mainland China were included. Data were collected using the National Clinical Improvement System Data that report ICU information. Ten related quality control indicators were analyzed, including 5 structural factors (patient-to-bed ratio, physician-to-bed ratio, nurse-to-bed ratio, patient-to-physician ratio, and patient-to-nurse ratio), 3 process factors (unplanned endotracheal extubation rate, reintubation rate within 48 h, and microbiology detection rate before antibiotic use), and 2 outcome factors (VAP incidence rate and mortality). The information on the most common infectious pathogens and the most commonly used antibiotics in ICU was also collected. The Poisson regression model was used to identify the impact of factors on the incidence rate and mortality of VAP. RESULTS The incidence rate of VAP in these hospitals in 2019 was 5.03 (2.38, 10.25) per 1000 ventilator days, and the mortality of VAP was 11.11 (0.32, 26.00) %. The most common causative pathogen was Acinetobacter baumannii (in 39.98% of hospitals), followed by Klebsiella pneumoniae (38.26%), Pseudomonas aeruginosa, and Escherichia coli. In 26.90% of hospitals, third-generation cephalosporin was the most used antibiotic, followed by carbapenem (24.22%), penicillin and beta-lactamase inhibitor combination (20.09%), cephalosporin with beta-lactamase inhibitor (17.93%). All the structural factors were significantly associated with VAP incidence rate, but not with the mortality, although the trend was inconsistent. Process factors including unplanned endotracheal extubation rate, reintubation rate in 48 h, and microbiology detection rate before antibiotic use were associated with higher VAP mortality, while unplanned endotracheal extubation rate and reintubation rate in 48 h were associated with higher VAP mortality. Furthermore, K. pneumoniae as the most common pathogen was associated with higher VAP mortality, and carbapenems as the most used antibiotics were associated with lower VAP mortality. CONCLUSION This study highlights the association between the ICU quality control (QC) factors and VAP incidence rate and mortality. The process factors rather than the structural factors need to be further improved for the QC of VAP in the ICU.
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Arias-Rivera S, Jam-Gatell R, Nuvials-Casals X, Vázquez-Calatayud M. [Update of the recommendations of the Pneumonia Zero project]. ENFERMERIA INTENSIVA 2022; 33:S17-S30. [PMID: 35911624 PMCID: PMC9326456 DOI: 10.1016/j.enfi.2022.05.005] [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] [Indexed: 12/04/2022]
Abstract
La pandemia por el SARS-Cov-2 ha impactado negativamente en la aplicación de las recomendaciones de Neumonía Zero y se ha acompañado de un incremento de las tasas de Neumonía asociada a ventilación mecánica (NAVM) en las unidades de cuidados intensivos de España. Con el objetivo de disminuir las tasas actuales a 7 episodios por 1000 días de VM, se han actualizado las recomendaciones del proyecto inicial. Se identificaron, 27 medidas que se clasificaron en 12 medidas funcionales (posición semisentada, higiene estricta de manos, entrenamiento para manipular la vía aérea, valoración diaria de posible extubación, protocolización del destete, traqueostomía precoz, ventilación no invasiva, vigilancia microbiológica, cambio de tubuladuras, humidificación, fisioterapia respiratoria, nutrición enteral postpilórica), 7 mecánicas (control de la presión del neumotaponamiento, tubos con aspiración subglótica, nutrición con sondas de bajo calibre/en intestino delgado, aspiración de secreciones con circuitos cerrados/abiertos, filtros respiratorios, cepillado de dientes, técnicas de presión negativa en la aspiración de secreciones) y 8 farmacológicas (descontaminación selectiva digestiva, descontaminación orofaríngea, ciclo corto de antibióticos, higiene de boca con clorhexidina, antibióticos inhalados, rotación de antibióticos, probióticos, anticuerpos monoclonales). Cada medida se analizó de forma independiente, por al menos dos miembros del grupo de trabajo, mediante una revisión sistemática de la literatura y una revisión iterativa de las recomendaciones de las sociedades científicas y/o grupos de expertos. Para la clasificación de la calidad de la evidencia y fuerza de las recomendaciones se siguió la propuesta del grupo GRADE. Para determinar el grado de recomendación, cada medida fue puntuada por todos los miembros del grupo de trabajo en relación con su efectividad, tolerabilidad y aplicabilidad en las UCI españolas a corto plazo de tiempo. Se solicitó el apoyo de expertos externos en alguna de las medidas que se revisaron. Se seleccionaron aquellas medidas que alcanzaron la máxima puntuación.
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Affiliation(s)
- S Arias-Rivera
- Investigación de enfermería. Hospital Universitario de Getafe, Getafe. CIBER Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, España
| | - R Jam-Gatell
- Área de críticos. Hospital Universitari Parc Taulí, Sabadell, Barcelona, España
| | - X Nuvials-Casals
- Área de Desarrollo Profesional e investigación de Enfermería, Clínica Universidad de Navarra. Universidad de Navarra. IdisNA, Instituto de Investigación Sanitaria de Navarra, Navarra, España
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Risk Factors and Nursing Countermeasures of Ventilator-Associated Pneumonia in Children in the Intensive Care Unit. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:9055587. [PMID: 35222896 PMCID: PMC8872678 DOI: 10.1155/2022/9055587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 01/12/2022] [Accepted: 01/17/2022] [Indexed: 12/02/2022]
Abstract
Objective This study discussed and analyzed the risk factors and nursing countermeasures of ventilator-associated pneumonia (VAP) in the children intensive care unit (ICU). Methods In this study, 155 children with mechanical ventilation in the pediatric intensive care unit from Oct. 2018 to Oct. 2020 were chosen as research objects. We retrospectively analyzed the clinical data of children and divided them into VAP groups and non-VAP groups according to the occurrence of VAP. Subsequently, we adopted a univariate and multivariate logistic regression model to analyze and clarify the risk factors of VAP and formulated the corresponding nursing countermeasures. Results 49 cases of total research objects had occurred VAP, with an infection rate of 31.62%. The primary pathogenic bacteria were Gram-negative bacteria (43/70, 61.43%). According to multivariate logistic regression analysis, the duration of mechanical ventilation, invasive procedures, and application of hormones and antacids are all independent risk factors for VAP in pediatric ICU. The VPA group had longer hospital stay than the non-VAP group, and the difference was statistically significant ((20.92 ± 4.16)d, (15.24 ± 3.77)d, t = 8.4383, P ≤ 0.001). The hospitalization cost of the VPA group was substantially higher than that of the non-VAP Group ((45.8 ± 10.4) thousand Yuan, (33.2 ± 4.3) thousand Yuan, t = 10.6822, P ≤ 0.001). Conclusion Children admitted to the pediatric ICU have a high VAP incidence. The primary pathogenic bacteria are Gram-negative bacteria. As the occurrence of VAP is closely related to a variety of factors, we should take targeted nursing countermeasures to reduce the duration of mechanical ventilation and the frequency of invasive operations and use the hormone and antacids rationally to reduce the risk of VAP and improve the prognosis.
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Automatic Continuous Control of Cuff Pressure and Subglottic Secretion Suction Used Together to Prevent Pneumonia in Ventilated Patients-A Retrospective and Prospective Cohort Study. J Clin Med 2021; 10:jcm10214952. [PMID: 34768471 PMCID: PMC8584498 DOI: 10.3390/jcm10214952] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 10/19/2021] [Accepted: 10/21/2021] [Indexed: 11/17/2022] Open
Abstract
The ventilator bundle consists of multiple methods to reduce ventilator-associated pneumonia (VAP) rates in Intensive Care Units (ICU). The aim of the study was to evaluate how the continuous automatic pressure control in tapered cuffs of endotracheal/tracheostomy tubes applied along with continuous automatic subglottic secretion suction affect the incidence of VAP. In the prospective cohort (n = 198), the standard VAP bundle was modified by continuous automatic pressure control in taper-shaped cuff of endotracheal/tracheostomy tubes and subglottic secretion suction. VAP incidence, time to VAP onset, invasive mechanical ventilation days/free days, length of ICU stay, ICU mortality, and multidrug-resistant bacteria were assessed and compared to the retrospective cohort (n = 173) with the standard bundle (intermittent cuff pressure of standard cuff, lack of subglottic secretion suction). A smaller incidence of VAP (9.6% vs. 19.1%) and early onset VAP (1.5% vs. 8.1%) was found in the prospective compared to the retrospective cohort (p < 0.01). Patients in the prospective cohort were less likely to develop VAP (RR = 0.50; 95% CI: 0.29 to 0.85) and early-onset VAP (RR = 0.19; 95% CI: 0.05 to 0.64) and had longer time to onset VAP (median 9 vs. 5 days; p = 0.03). There was no significant difference (p > 0.05) between both cohorts in terms of invasive mechanical ventilation days/free days, length of ICU stay, ICU mortality and multidrug-resistant bacteria. Modification of the bundle for prevention of VAP can reduce early-onset VAP and total incidence of VAP and delay the time of VAP occurrence.
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Kumari M, Verma S, Venkatesh V, Gupta P, Tripathi P, Agarwal A, Siddiqui SS, Arshad Z, Prakash V. Emergence of blaNDM-1 and blaVIM producing Gram-negative bacilli in ventilator-associated pneumonia at AMR Surveillance Regional Reference Laboratory in India. PLoS One 2021; 16:e0256308. [PMID: 34495985 PMCID: PMC8425556 DOI: 10.1371/journal.pone.0256308] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 08/03/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Ventilator-associated pneumonia (VAP) may be a life threatening nosocomial infection encountered in intensive care units. Currently the emergence of carbapenem-resistant Gram-negative pathogens has become worrisome threat worldwide. MATERIAL AND METHODS Endotracheal aspirates samples were collected from patients who were under mechanical ventilation for > 48 h. The bacterial isolates were identified by MALDI-TOF-MS and antibiotic susceptibility testing performed. All carbapenem resistant isolates were tested by Modified Hodge test (MHT), modified carbapenem inactivation method (mCIM), and EDTA-CIM (eCIM) and PCR were performed to detect blaIMP, blaVIM and blaNDM producing MBL genes. RESULTS VAP occurred in 172/353(48.7%), 23.3% had early-onset VAP and 76.7% had late-onset VAP. Males (69.2%) were found to suffer more from VAP. Prior antibiotic therapy, CPI>6, prior surgery and tracheostomy were associated with VAP. The mortality in VAP (58.1%) contrasted with non-VAP (40%). 99/169 (58.6%) Gram-negative isolates were resistant to carbapenems. Acinetobacter baumannii, Pseudomonas aeruginosa and Klebsiella pneumoniae were common pathogens found in late onset VAP, whereas K. pneumoniae, A. baumannii and Staphylococcus aureus were common in early onset VAP. The PCR results detected blaNDM in 37/172(21.5%) and blaVIM in 30/172(17.4%); 15/172(8.7%) isolates carried both genes. CONCLUSION The blaNDM-1 and blaVIM genes are the main antibiotic-resistance genes that induce resistance patterns to carbapenems in VAP, highlighting CRE strains of potential public health concern and therapeutic challenge. Diagnostic laboratories in India must get on high caution for early MBL detection as it may limit the wide dispersal of MBL genes.
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Affiliation(s)
- Mithlesh Kumari
- Department of Microbiology, King George’s Medical University, Lucknow, Uttar Pradesh, India
| | - Sheetal Verma
- Department of Microbiology, King George’s Medical University, Lucknow, Uttar Pradesh, India
| | - Vimala Venkatesh
- Department of Microbiology, King George’s Medical University, Lucknow, Uttar Pradesh, India
| | - Prashant Gupta
- Department of Microbiology, King George’s Medical University, Lucknow, Uttar Pradesh, India
| | - Piyush Tripathi
- Department of Microbiology, King George’s Medical University, Lucknow, Uttar Pradesh, India
| | - Avinash Agarwal
- Department of Critical Care Medicine, King George’s Medical University, Lucknow, Uttar Pradesh, India
| | - Suhail Sarwar Siddiqui
- Department of Critical Care Medicine, King George’s Medical University, Lucknow, Uttar Pradesh, India
| | - Zia Arshad
- Department of Anesthesiology & Critical Care, King George’s Medical University, Lucknow, Uttar Pradesh, India
| | - Ved Prakash
- Department of Pulmonary & Critical Care Medicine, King George’s Medical University, Lucknow, Uttar Pradesh, India
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Ladbrook E, Khaw D, Bouchoucha S, Hutchinson A. A systematic scoping review of the cost-impact of ventilator-associated pneumonia (VAP) intervention bundles in intensive care. Am J Infect Control 2021; 49:928-936. [PMID: 33301781 DOI: 10.1016/j.ajic.2020.11.027] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 11/27/2020] [Accepted: 11/30/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Evidence-based economic decision making is key in health care. Presently, however, studies reporting financial outcomes of ventilator-associated pneumonia (VAP) care bundles have not been systematically evaluated. METHOD This scoping review investigated the characteristics and findings of studies of the economic impact of VAP bundle implementation. A systematic search of electronic databases (MEDLINE, CINAHL) for relevant English language studies was undertaken (January 2000-February 2020). Methodological quality was evaluated using a Joanna Briggs Institute quality appraisal checklist. Article screening and quality appraisals were performed by 2 reviewers. Reference lists of included studies were hand-searched for additional articles. Reporting followed PRISMA Extension for Scoping Reviews (PRISMA-ScR) standards. RESULTS From 181 citations, 10 articles met inclusion criteria. Eight studies evaluated cost impacts on acute care and there were 2 cost-modeling studies. Results consistently indicated that effective VAP bundle implementation decreased healthcare costs. However, studies were heterogeneous with respect to research methods and objectives and were judged to have a moderate-to-high risk of bias. DISCUSSION Effective implementation of VAP care bundles was associated with superior clinical and economic outcomes. However, despite finding a moderate volume of research, study heterogeneity inhibited strong conclusions being drawn regarding the degree of associated cost savings. CONCLUSION Additional research involving multisite/multijurisdiction studies using experimental designs are needed to progress the field and overcome gaps in the existing literature.
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Acosta ADS, Barbosa SDFF, Dal Sasso GTM. Nursing research priorities in critical care in Brazil: Delphi Study. Rev Lat Am Enfermagem 2020; 28:e3370. [PMID: 33027404 PMCID: PMC7529444 DOI: 10.1590/1518-8345.4055.3370] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 05/28/2020] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE to analyze the nursing research priorities in critical care in Brazil identified by specialists and researchers in the area, as well as to establish the consensus of the topics suggested by the experts. METHOD a descriptive study, using the e-Delphi technique in three rounds. The research participants were 116 Brazilian nurses who are experts in critical care in the first round, ending up with 68 participants in the third round of the study. Descriptive statistics were used to analyze the demographic variables and the results of the research topics in the second round. In the final analysis, the Kappa agreement coefficient was calculated, comparing the answers between rounds two and three. RESULTS 63 research topics were generated, grouped into 14 domains of intensive care practice in the first round, and consensus was settled in the subsequent rounds. Topics such as humanization of care (0.56), bloodstream infection control (0.54), and nursing care for polytrauma patients (0.51) were items rated above 0.50 in the agreement analysis between the topics in the two rounds using the Kappa coefficient. CONCLUSION this study provides an important guideline for nursing research in critical care in Brazil, guiding for future research efforts in the area.
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