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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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Macedo CE, Ferreira AM, Barcelos LDS, Alvim ALS, Carneiro LM, Martins SR, de Andrade D, Rigotti MA, Gasques RP, da Silva VA, de Oliveira LB, de Carvalho HEF, de Sousa AFL. Contamination of equipment and surfaces in the operating room anesthesia workspace: a cross-sectional study. SAO PAULO MED J 2024; 142:e2023177. [PMID: 38422242 PMCID: PMC10885631 DOI: 10.1590/1516-3180.2023.0177.r1.291123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 08/24/2023] [Accepted: 11/29/2023] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Contamination of the breathing circuit and medication preparation surface of an anesthesia machine can increase the risk of cross-infection. OBJECTIVE To evaluate the contamination of the anesthetic medication preparation surface, respiratory circuits, and devices used in general anesthesia with assisted mechanical ventilation. DESIGN AND SETTING Cross-sectional, quantitative study conducted at the surgical center of a philanthropic hospital, of medium complexity located in the municipality of Três Lagoas, in the eastern region of the State of Mato Grosso do Sul. METHODS Eighty-two microbiological samples were collected from the breathing circuits. After repeating the samples in different culture media, 328 analyses were performed. RESULTS A higher occurrence of E. coli, Enterobacter spp., Pseudomonas spp., Staphylococcus aureus, and Streptococcus pneumoniae (P < 0.001) were observed. Variations were observed depending on the culture medium and sample collection site. CONCLUSION The study findings underscore the inadequate disinfection of the inspiratory and expiratory branches, highlighting the importance of stringent cleaning and disinfection of high-touch surfaces.
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Affiliation(s)
- Carlos Eduardo Macedo
- MD. Physician, Postgraduate Program in Nursing, Universidade Federal de Mato Grosso do Sul (UFMS), Campo Grande (MS), Brazil
| | - Adriano Menis Ferreira
- PhD. Nurse, Full Professor, Postgraduate Program in Nursing, Universidade Federal de Mato Grosso do Sul (UFMS), Três Lagoas (MS), Brazil
| | - Larissa da Silva Barcelos
- PhD. Associate Professor, Postgraduate Program in Nursing, Universidade Federal de Mato Grosso do Sul (UFMS), Três Lagoas (MS), Brazil
| | - André Luiz Silva Alvim
- PhD. Associate Professor, Graduate Program in Nursing, Universidade Federal de Juiz de Fora (UFJF), Juiz de Fora (MG), Brazil
| | - Liliane Moretti Carneiro
- MSc, Nurse, Doctoral Student, Postgraduate Program in Nursing, Universidade Federal de Mato Grosso do Sul (UFMS), Campo Grande (MS), Brazil
| | | | - Denise de Andrade
- PhD. Nurse, Full Professor, Ribeirão Preto College of Nursing, Universidade de São Paulo (USP), Ribeirão Preto, São Paulo (SP), Brazil
| | - Marcelo Alessandro Rigotti
- PhD. Nurse, Associate Professor, Postgraduate Program in Nursing, Universidade Federal de Mato Grosso do Sul (UFMS), Três Lagoas (MS), Brazil
| | - Ruberval Peres Gasques
- Nurse. Master Student, Postgraduate Program in Nursing, Universidade Federal de Mato Grosso do Sul (UFMS), Três Lagoas (MS), Brazil
| | - Vanderlei Amaro da Silva
- BS. Biomedic, Postgraduate Program in Nursing, Universidade Federal de Mato Grosso do Sul (UFMS), Campo Grande (MS), Brazil
| | - Layze Braz de Oliveira
- PhD, Nurse, Ribeirão Preto College of Nursing, Universidade de São Paulo (USP), Ribeirão Preto, São Paulo (SP), Brazil
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Thapa D, Chair SY, Chong MS, Poudel RR, Melesse TG, Choi KC, Tam HL. Effects of ventilatory bundles on patient outcomes among ICU patients: A systematic review and meta-analysis. Heart Lung 2024; 63:98-107. [PMID: 37839229 DOI: 10.1016/j.hrtlng.2023.10.002] [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: 07/01/2023] [Revised: 10/02/2023] [Accepted: 10/04/2023] [Indexed: 10/17/2023]
Abstract
BACKGROUND Ventilator bundles are suggested to prevent ventilator-associated pneumonia (VAP), but significant variations in the effects of the bundle on patient outcomes have been reported. OBJECTIVES To synthesize the evidence and evaluate the effects of the ventilator bundle on patient outcomes among critically ill adult patients. METHODS A broad search was performed in seven databases for relevant articles published from January 2002 to November 2022. Randomized controlled trials and quasi-experimental studies investigating the effects of implementing ventilator bundles in adult intensive care units (ICUs) were included. Two independent reviewers performed the study selection, data extraction, and risk of bias assessment. All data for meta-analysis were pooled using the random-effects model. RESULTS After screening, 19 studies were included in the meta-analysis. Evidence of low-to-moderate certainty showed that the ventilator bundle reduced the rate of VAP (risk ratio [RR] = 0.64; P = 0.003), length of ICU stay (mean difference [MD] = -2.57; P = 0.03), mechanical ventilation days (MD = -3.38; P < 0.001), and ICU mortality (RR = 0.76; P = 0.02). Ventilator bundle was associated with improved outcomes, except mortality. CONCLUSIONS The ventilator bundle, especially the IHI ventilator bundle, was effective in decreasing the incidence of VAP and improving most of the VAP-related outcomes. However, given the low-to-moderate certainty of evidence and high heterogeneity, these results should be interpreted with caution. A future study that adopts hybrid implementation trials with high methodological quality is needed to confirm the effects of the ventilator bundle on 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., Room 704B, 7/F Esther Lee Building, 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., Room 704B, 7/F Esther Lee Building, Hong Kong SAR, PR China
| | - Mei Sin Chong
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Room 704B, 7/F Esther Lee Building, Hong Kong SAR, PR China
| | - Rishi Ram Poudel
- Department of Orthopedics, Patan Academy of Health Sciences, Lalitpur, Nepal
| | - Tenaw Gualu Melesse
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Room 704B, 7/F Esther Lee Building, Hong Kong SAR, PR China
| | - Kai Chow Choi
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Room 704B, 7/F Esther Lee Building, Hong Kong SAR, PR China
| | - Hon Lon Tam
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Room 704B, 7/F Esther Lee Building, Hong Kong SAR, PR China.
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Mohammed S, Paliwal N, Jaju R, Bihani P, Rao S, Janweja S. Assessment of Knowledge, Barrier in Implementation, and Compliance to Ventilator Bundle among Resident Doctors and Nurses Working in Intensive Care Units of a Tertiary Care Center of Western India: A Cross-sectional Survey. Indian J Crit Care Med 2023. [DOI: 10.5005/jp-journals-10071-24434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
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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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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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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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Kamel NA, Alshahrani MY, Aboshanab KM, El Borhamy MI. Evaluation of the BioFire FilmArray Pneumonia Panel Plus to the Conventional Diagnostic Methods in Determining the Microbiological Etiology of Hospital-Acquired Pneumonia. BIOLOGY 2022; 11:biology11030377. [PMID: 35336751 PMCID: PMC8945136 DOI: 10.3390/biology11030377] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 02/18/2022] [Accepted: 02/23/2022] [Indexed: 01/13/2023]
Abstract
Hospital-acquired pneumonia (HAP) is a substantial public health issue that is associated with high mortality rates and is complicated by an arsenal of microbial etiologies, expressing multidrug-resistant phenotypes, rendering relatively limited therapeutic options. BioFire FilmArray Pneumonia Panel plus (BFPP) is a simple multiplexed PCR system that integrates sample preparation, nucleic acid extraction, amplification, and analysis of microbial etiology, with a turnaround time of about one hour. In comparison to standard culture methods, BFPP is simpler, easier to perform, and can simultaneously detect the most common pathogens involved in lower respiratory tract infections (34 targets). Accordingly, we evaluated the diagnostic performance of the multiplexed BFPP for the rapid detection of 27 clinically relevant respiratory pathogens and 7 genetic markers among 50 HAP cases admitted to the intensive care unit (ICU), who submitted mini-bronchoalveolar (mBAL) specimens. In comparison to standard culture methods, BFPP showed an overall sensitivity of 100% [95% CI; 90-100] and overall specificity of 90% [95% CI; 87.4-92.5] among all the tested bacterial targets. BFPP identified 11 viral targets (22%) among the tested specimens. The BFPP semi-quantitative analysis showed a concordance rate of 47.4% among positive culture specimens. For the investigation of the antibiotic resistance genes, BFPP showed a positive percent agreement (PPA), a negative percent agreement (NPA), and an overall percent agreement (OPA), reaching 97% [95% CI; 90-100], 95% [95% CI; 91.5-97], and 95% [95% CI; 93-97], respectively, with standard antibiotic sensitivity testing. In conclusion, BFPP has the potential to enhance the rapid microbiological diagnosis of HAP cases, and could aid in tailoring appropriate antibiotic therapies.
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Affiliation(s)
- Noha A. Kamel
- Department of Microbiology, Faculty of Pharmacy, Misr International University (MIU), Cairo P.O. Box 19648, Egypt; (N.A.K.); (M.I.E.B.)
| | - Mohammad Y. Alshahrani
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Khalid University, P.O. Box 61413, Abha 9088, Saudi Arabia;
| | - Khaled M. Aboshanab
- Department of Microbiology and Immunology, Faculty of Pharmacy, Ain Shams University, Organization of African Unity St., Abbassia, Cairo P.O. Box 11566, Egypt
- Correspondence: ; Tel.:+20-1007582620
| | - Mervat I. El Borhamy
- Department of Microbiology, Faculty of Pharmacy, Misr International University (MIU), Cairo P.O. Box 19648, Egypt; (N.A.K.); (M.I.E.B.)
- International Medical Center, Clinical Microbiology Laboratory, Cairo P.O. Box 11451, Egypt
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Bayoumi M, ALaswad Z. Improvement of the nurses' awareness toward ventilator-associated pneumonia based on evidence guidelines. INDIAN JOURNAL OF MEDICAL SPECIALITIES 2022. [DOI: 10.4103/injms.injms_124_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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