The effectiveness of a bundle in the prevention of ventilator-associated pneumonia

Ferreira, Cléria Rodrigues; Souza, Denis Fabiano de; Cunha, Thulio Marques; Tavares, Marcelo; Reis, Samir Seme Arab; Pedroso, Reginaldo dos Santos; Röder, Denise Von Dolingër de Brito

doi:10.1016/j.bjid.2016.03.004

Cited by 41 publications

(53 citation statements)

References 19 publications

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“…Ferreira et al (2) evaluated the clinical impact of a good practice bundle in ICU patients and found a decreased occurrence of VAP (P<0.01), a significant reduction in hospital costs (P<0.05) and lower mortality (P<0.01) as well as significantly less days of antibiotic use (P<0.0001). Rosenthal et al (37) demonstrated the effectiveness of a multidimensional approach for prevention of VAP in adult ICUs (VAP rate evolved from 22.0 to 17.2, P=0.0004) and a simultaneous pooled reduction in antibiotic consumption.…”

Section: Vap Rates and Antibiotic Consumptionmentioning

confidence: 99%

“…Ventilator-associated pneumonia (VAP) is one of the most common health care-associated infections (HAI) and accounts for 25% to 42% of all infections that occur in intensive care units (ICUs) (1)(2)(3). It can hit 10% to 25% of all ICU patients (4,5), being associated with longer duration of mechanical ventilation, longer ICU and hospital stays, increased healthcare costs and increased morbidity and mortality (6,7).…”

Section: Introductionmentioning

confidence: 99%

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Antibiotic consumption and ventilator-associated pneumonia rates, some parallelism but some discrepancies

Nora¹,

Póvoa²

2017

Ann. Transl. Med.

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Ventilator-associated pneumonia (VAP) is a common infection in intensive care units (ICUs) but its clinical definition is neither sensitive nor specific and lacks accuracy and objectivity. New defining criteria were proposed in 2013 by the National Healthcare Safety Network (NHSN) in order to more accurately conduct surveillance and track prevention progress. Although there is a consistent trend towards a decrease in VAP incidence during the last decade, significant differences in VAP rates have been reported and are persistently lower in NHSN and other American reports (0.0 to 4.4 VAP per 1,000 ventilator-days in 2012) compared to the European Centre for Disease Prevention and Control (ECDC) data (10 VAP per 1,000 ventilator-days in 2014). In the United States, VAP has been proposed as an indicator of quality of care in public reporting, and the threat of financial penalties for this diagnosis has put pressure on hospitals to minimize VAP rates that may lead to artificial lower values, independently of patient care. Although prevention bundles may contribute for encouraging reductions in VAP incidence, both pathophysiologic and epidemiologic factors preclude a zero-VAP rate. It would be expected from the trend of reduction of VAP incidence that the consumption of antibiotics would also decrease in particular in those hospitals with lowest VAP rates. However, ICU reports show a steadily use of antibiotics for nosocomial pneumonia in 15% of patients and both ECDC and NHSN data on antibiotic consumption showed no significant trend. Knowledge of bacterial epidemiology and resistance profiles for each ICU has great relevance in order to understand trends of antibiotic use. The new NHSN criteria provide a more objective and quantitative data based VAP definition, including an antibiotic administration criterion, allowing, in theory, a more comprehensive assessment and a reportable benchmark of the observed VAP and antibiotic consumption variability.

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Section: Vap Rates and Antibiotic Consumptionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Antibiotic consumption and ventilator-associated pneumonia rates, some parallelism but some discrepancies

Nora¹,

Póvoa²

2017

Ann. Transl. Med.

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“…VAP is the second most common healthcare-associated infection in the United States (2). VAP occurs in patients who are receiving mechanical ventilation for more than 48 hours (3).…”

Section: Introductionmentioning

confidence: 99%

“…Endotracheal tube significantly disturbs the mechanism for airway protection and causes local inflammation (7). Therefore, the prevention of VAP would be a major challenge and priority in the care of critically ill patients (2,8).…”

Section: Introductionmentioning

confidence: 99%

The Comparison of the Effect of the Head of Bed Elevation to 30 and 45 Degreess on the Incidence of Ventilator Associated Pneumonia and the Risk for Pressure Ulcers: A Controlled Randomized Clinical Trial

Ghezeljeh¹,

Kalhor²,

Moghadam³

et al. 2017

Iran Red Crescent Med J

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Background: The prevention of ventilator-associated pneumonia (VAP) can decrease the duration of mechanical ventilation, length of hospital stay, mortality, and healthcare costs. Objectives: The aim of this study was to compare the effect of the elevation of head of bed (HOB) to 30 and 45 degreess on the incidence of VAP. Methods: This study was a 3 group controlled randomized clinical trial. It consisted of 120 patients who were under mechanical ventilation and hospitalized in the intensive care unit (ICU) from February to July 2016 in the selected governmental hospitals of Iran University of Medical Sciences. The patients were allocated into 3 groups. The patients of intervention groups received interventions consisting of HOB elevation to 30 and 45 degreess for 3 consecutive days. The patients in the control group were in the routine position in the bed for 3 consecutive days. The HOB elevation was measured using the goniometer and recorded by nurses in perticular forms. At the end of the third day, VAP and pressure ulcers were evaluated using the clinical pulmonary infection score (CPIS) as well as Braden scales. The data were analyzed using descriptive and inferential statistics. Results: Statistically significant differences were reported in terms of VAP between the groups of the HOB evelation to 30 degrees (32.50%) and 45 degrees (20.00%) and control groups (52.50%) (P = 0.01). However, the mean scores of pressure ulcer showed no statistically significant differences between the groups (P = 0.625). The greatest change in position was performed by the staff nurses

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“…11 These practices are commonly deployed together as part of a ventilator bundle, and in many studies ventilator bundles have been associated with a reduction in VAP rates. [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] In 2007, our institution developed a real-time ventilator bundle compliance dashboard that tracks the status of all bundle practices and serves to remind bedside caregivers when a specific practice is due. A major advantage of this approach is that it captures compliance over the entire duration of ventilation in real time as opposed to other methods such as spot audits.…”

mentioning

confidence: 99%

Ventilator Bundle Compliance and Risk of Ventilator-Associated Events

Harris

Thomas

Greene

et al. 2018

Infect. Control Hosp. Epidemiol.

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OBJECTIVEVentilator bundles encompass practices that reduce the risk of ventilator complications, including ventilator-associated pneumonia. The impact of ventilator bundles on the risk of developing ventilator-associated events (VAEs) is unknown. We sought to determine whether decreased compliance to the ventilator bundle increases the risk for VAE development.DESIGNNested case-control study.SETTINGThis study was conducted at 6 adult intensive care units at an academic tertiary-care center in Tennessee.PATIENTSIn total, 273 patients with VAEs were randomly matched in a 1:4 ratio to controls by mechanical ventilation duration and ICU type.METHODSControls were selected from the primary study population at risk for a VAE after being mechanically ventilated for the same number of days as a specified case. Using conditional logistic regression analysis, overall cumulative compliance, and compliance with individual components of the bundle in the 3 and 7 days prior to VAE development (or the control match day) were examined.RESULTSOverall bundle compliance at 3 days (odds ratio [OR], 1.15; P=.34) and 7 days prior to VAE diagnosis (OR, 0.96; P=.83) were not associated with VAE development. This finding did not change when limiting the outcome to infection-related ventilator-associated complications (IVACs) and after adjusting for age and gender. In the examination of compliance with specific bundle components increased compliance with chlorhexidine oral care was associated with increased risk of VAE development in all analyses.CONCLUSIONSVentilator bundle compliance was not associated with a reduced risk for VAEs. Higher compliance with chlorhexidine oral care was associated with a greater risk for VAE development.Infect Control Hosp Epidemiol 2018;39:637-643.

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The effectiveness of a bundle in the prevention of ventilator-associated pneumonia

Cited by 41 publications

References 19 publications

Antibiotic consumption and ventilator-associated pneumonia rates, some parallelism but some discrepancies

Antibiotic consumption and ventilator-associated pneumonia rates, some parallelism but some discrepancies

The Comparison of the Effect of the Head of Bed Elevation to 30 and 45 Degreess on the Incidence of Ventilator Associated Pneumonia and the Risk for Pressure Ulcers: A Controlled Randomized Clinical Trial

Ventilator Bundle Compliance and Risk of Ventilator-Associated Events

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