An Educational Intervention to Reduce Ventilator-Associated Pneumonia in an Integrated Health System

Babcock, Hilary M.; Zack, Jeanne E.; Garrison, Teresa; Trovillion, Ellen; Jones, Marilyn C.; Fraser, Victoria J.; Kollef, Marin H.

doi:10.1378/chest.125.6.2224

Cited by 191 publications

(132 citation statements)

References 31 publications

Supporting

Mentioning

119

Contrasting

Unclassified

Order By: Relevance

“…Significant gaps remain in the transfer of research into clinical practice and, although clinical guidelines may improve processes of care, their use alone is insufficient to change clinician behaviour (Sinuff et al, 2008). Although not specifically related to VCB implementation, some studies have demonstrated significant VAP reduction when structured multi-disciplinary education programs were implemented (Babcock et al, 2004;Salahuddin et al, 2004).…”

Section: Discussionmentioning

confidence: 99%

The ventilator care bundle and its impact on ventilator‐associated pneumonia: a review of the evidence

Lawrence

Fulbrook

2011

Nursing in Critical Care

View full text Add to dashboard Cite

Aims and objectives:The aim of this review was to critically analyse recent research that has investigated ventilator care bundle (VCB) use, with the objective of analysing its impact on ventilator-associated pneumonia (VAP) outcomes. Background: The VCB is a group of four evidence-based procedures, which when clustered together and implemented as an 'all or nothing' strategy, may result in substantial clinical outcome improvement. VAP is a nosocomial lung infection associated with endotracheal tube use in ventilated patients. Since the VCB was introduced there have been several studies that have reported significant VAP rate reductions. Search strategy: A comprehensive search for research, published between 2004 and 2009, was conducted using Medline and PubMed. Key words were used to identify English language studies reporting VCB implementation within adult intensive care units (ICU) and associated clinical outcomes. Studies that implemented bundle variations that did not include all four elements were excluded. Conclusions: Because of the limitations of the observational designs used in the studies retrieved, a definitive causal relationship between VCB use and VAP reduction cannot be stated. However, the evidence to date is strongly indicative of a positive association. Several studies reported the use of additional VCB elements. In these cases it is difficult to establish which elements are related to the measured outcomes. Further research is recommended to establish baseline outcome measures using the four-element VCB, before adding further processes singly, as well as research investigating the effect of audit and feedback on VCB compliance and its effect on clinical outcomes. Relevance to clinical practice: A reduction in VAP is associated with VCB use. The evidence to date, whilst not at the highest experimental level, is at the highest ethically permissible level. In the absence of contradictory research, the current evidence suggests that use of the VCB represents best practice for all eligible adult ventilated patients in ICU.

show abstract

Section: Discussionmentioning

confidence: 99%

The ventilator care bundle and its impact on ventilator‐associated pneumonia: a review of the evidence

Lawrence

Fulbrook

2011

Nursing in Critical Care

View full text Add to dashboard Cite

show abstract

“…The presence of a unit policy recommending semirecumbency did not affect backrest elevation. Various studies [33][34][35] have shown that implementation of unit protocols and objective measurement devices can result in improved compliance with semirecumbency. We did not directly assess nurses' awareness of unit protocols or use of measurement devices available to them in our study.…”

Section: Discussionmentioning

confidence: 99%

Semirecumbent Positioning in Ventilator-Dependent Patients: A Multicenter, Observational Study

Rose¹,

Baldwin²,

Crawford³

et al. 2010

American Journal of Critical Care

View full text Add to dashboard Cite

Background Positioning of patients is a modifiable risk factor for ventilator-associated pneumonia. Current guidelines for prevention of ventilator-associated pneumonia recommend semirecumbency at 30º, with 45º preferable unless contraindicated. Objective To assess the use of semirecumbency for ventilator patients in Australian and New Zealand intensive care units. Methods In a multicenter, observational study, backrest elevation, mean arterial pressure, use of inotropic agents, enteral feeding, and weaning status were recorded 3 times per day by using a predetermined randomization schedule for 7 consecutive days (maximum 21 observation episodes). Severity of illness was recorded daily by using the Sepsis-Related Organ Failure Assessment (SOFA) score. Results Measurements (n = 2112) were recorded for 371 ventilator patients in 32 intensive care units. Backrest elevation at ≥45º was noted for 112 of 2112 (5.3%; 95% confidence interval [CI], 4.3-6.3) measurements; elevation ≥30º but <45º for 472 of 2112 (22.3%; 95% CI, 20.6-24.1). Contraindications to semirecumbency were noted during 447 measurements. Increased backrest elevation occurred during enteral feeding (2.2º, P < .001) and weaning (3.1º, P < .001). Decreased backrest elevation was associated with inotropic support (2.8º, P < .001), decreased mean arterial pressure (0.7º/10 mm Hg, P < .001), and organ failure (0.5º/1-point increment in SOFA max score, P < .001). For measurements recorded with no contraindication to semirecumbency, weaning status (P = .003) and SOFA max score (P = .008) remained associated with the degree of backrest elevation. Conclusions The findings of this multicenter, observational study suggest that backrest elevation was less than recommended and was influenced by clinical practices and patient condition.

show abstract

“…Educational programmes have been reported as an essential ingredient for success in other infection control strategies, including the control of ventilator-associated pneumonia [822][823][824][825] reducing needlestick injuries, 826 and the implementation of isolation precautions. 423,827 There are also reports on the effective use of education for hand hygiene promotion strategies outside the acute hospital care setting.…”

Section: Organizing An Educational Programme To Promote Hand Hygienementioning

confidence: 99%

Hand Hygiene

Longtin¹,

Sax²,

Allegranzi³

et al. 2011

N Engl J Med

107

View full text Add to dashboard Cite

An Educational Intervention to Reduce Ventilator-Associated Pneumonia in an Integrated Health System

Cited by 191 publications

References 31 publications

The ventilator care bundle and its impact on ventilator‐associated pneumonia: a review of the evidence

The ventilator care bundle and its impact on ventilator‐associated pneumonia: a review of the evidence

Semirecumbent Positioning in Ventilator-Dependent Patients: A Multicenter, Observational Study

Hand Hygiene

Contact Info

Product

Resources

About