Background and aimsVentilator-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 methodsA 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. ResultsThe 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). DiscussionThe incidence of VAP showed tendency for reduction. The prevalence of nursing-dependent bacteria decreased and compliance in following prevention methods increased.ConclusionThese results underline the importance of education of prevention methods.
Introduction: Infections affect about 30–50% of intensive care unit patients resulting in substantial morbidity and mortality. Multimodal interventions proved to be successful in the prevention of healthcare-associated infections. Appropriate hand hygiene including correct disinfection technique and timing is essential. Aim: The aim of our study was to investigate the hand hygiene practice among the intensive care unit healthcare workers by immediate feedback system implementation and compliance study. Method: A 3-week-long observational study was conducted at the Department of Anaesthesiology and Intensive Therapy, Semmelweis University, during November and December, 2018. Data regarding hand hygiene technique were collected by using the Semmelweis Scanner technology, while compliance data were recorded by direct observations. Statistical analysis was performed by Kruskal–Wallis test, Fisher’s exact test and χ2-test. Results: 604 measurements were recorded by the electronic system. Hand disinfection was appropriate in 86.5% of cases. The median value of coverage was 99.87%. The trend of these indices showed persistently high values. A lower error rate was observed in the physiotherapy group compared to others (doctors: p<0.01, nurses: p = 0.03, assistant nurses: p = 0.03). 162 opportunities were recorded during direct observations. The mean compliance rate was 60.49%, with the lowest among doctors (53.97%). The difference was non-significant compared to nurses (62.92%, p = 0.26). Conclusions: Hand hygiene technique during the study period was found to be highly and permanently appropriate, while compliance was lower than expected. The immediate feedback system may be useful in achieving appropriate hand disinfection technique, although further interventions are needed for higher compliance rates. Orv Hetil. 2019; 160(49): 1957–1962.
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