The results could be used to inform local practice and stimulate debate on measures to prevent ventilator-associated pneumonia. Education, guidelines as well as ventilator bundles and instruments should be developed and updated to improve infection control.
The type of pneumonia (i.e. SCAP, HAP or VAP) had no significant association with hospital mortality, whereas the SCAP patients had the lowest 1-year mortality.
Background: Endotracheal-suctioning (ETS) is a procedure that may constitute a risk factor for ventilator-associated pneumonia (VAP) by increasing microbial colonization of the lower airway. Unsafe ETS practices have been observed worldwide during recent years. Because of adverse reactions, practioners need to take all necessary precautions to ensure patient safety and a high quality of nursing care. The aim of the present study was to evaluate critical-care nurses' performance in relation to current recommendations in their daily practice prior to, during and post ETS events.
Methods:A structured, non-participatory, observational study (n=40) was conducted using a 25-item best-practice information sheet to assess critical-care nurses' ETS practices in a mixed medical-surgical intensive-care unit. Onesample-and independent-samples t-tests were used to compare critical-care nurses' ETS performance against current recommendations within different ICU experience groups.Results: The quality of observed ETS practices was significantly lower than the required quality of care (p<0.001). The most significant discrepancies were observed in ETS practices related to infection-control practices.
Conclusion:Critical-care nurses are currently not following current ETS recommendations. Significant discrepancies, which may constitute a risk factor for VAP by increasing microbial colonization of the lower airway, were identified. Unsafe ETS practices may jeopardize patient safety, and thus the quality of nursing care. Educational interventions, clinical guidelines and adequate support need to be provided to critical-care nurses to assess and improve their professional capabilities and current practice. Regular auditing and prompt feedback would be beneficial.
IntroductionThe aim of this study was to elucidate the impact of intensive care unit (ICU)-acquired infection on hospital mortality.MethodsPatients with a longer than 48 hour stay in a mixed 10 bed ICU in a tertiary-level teaching hospital were prospectively enrolled between May 2002 and June 2003. Risk factors for hospital mortality were analyzed with a logistic regression model.ResultsOf 335 patients, 80 developed ICU-acquired infection. Among the patients with ICU-acquired infections, hospital mortality was always higher, regardless of whether or not the patients had had infection on admission (infection on admission group (IAG), 35.6% versus 17%, p = 0.008; and no-IAG, 25.7% versus 6.1%, p = 0.023). In IAG (n = 251), hospital stay was also longer in the presence of ICU-acquired infection (median 31 versus 16 days, p < 0.001), whereas in no-IAG (n = 84), hospital stay was almost identical with and without the presence of ICU-acquired infection (18 versus 17 days). In univariate analysis, the significant risk factors for hospital mortality were: Acute Physiology and Chronic Health Evaluation (APACHE) II score >20, sequential organ failure assessment (SOFA) score >8, ICU-acquired infection, age ≥ 65, community-acquired pneumonia, malignancy or immunosuppressive medication, and ICU length of stay >5 days. In multivariate logistic regression analysis, ICU-acquired infection remained an independent risk factor for hospital mortality after adjustment for APACHE II score and age (odds ratio (OR) 4.0 (95% confidence interval (CI): 2.0–7.9)) and SOFA score and age (OR 2.7 (95% CI: 2.9–7.6)).ConclusionICU-acquired infection was an independent risk factor for hospital mortality even after adjustment for the APACHE II or SOFA scores and age.
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