National Nosocomial Infection Surveillance System: From Benchmark to Bedside in Trauma Patients

Miller, Preston R.; Johnson, James C.; Karchmer, Tobi B.; Hoth, J. Jason; Meredith, J. Wayne; Chang, Michael

doi:10.1097/01.ta.0000196379.74305.e4

Cited by 53 publications

(34 citation statements)

References 13 publications

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“…Also in our study, the kappa values were poor between physicians' diagnoses and the other two methods; 0.42 for B and 0.49 for C. It has been recently shown, when three infection control reviewers retrospectively analyzed cases by CDC criteria (criterion B) in pneumonia surveillance, that the kappa value for identification of VAP among 50 patients suspected to have VAP was only 0.40 [26]. In another study, among 292 trauma patients, the kappa value between CDC criteria and quantitative bronchoalveolar lavage (BAL) was high, 0.73 [27]. Although both methods gave almost identical numbers of VAP cases (200 by CDC and 189 by BAL), 32 cases were positive with CDC and negative by BAL, and 30 positive cases by BAL were missed by the second method.…”

Section: Discussionmentioning

confidence: 95%

The Occurrence of Pneumonia Diagnosis Among Neurosurgical Patients: The Definition Matters

et al. 2011

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There was great variability in the presence of pneumonia among neurosurgical patients, depending on the criteria used. Our results support the idea that a more exact method for pneumonia diagnosis should be implemented to obtain more reliable results in this important infection of hospitalized patients, which is also used for benchmarking purposes. Furthermore, it seems important to treat all clinically suspected pneumonia cases whether or not the surveillance criteria are fulfilled.

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Section: Discussionmentioning

confidence: 95%

The Occurrence of Pneumonia Diagnosis Among Neurosurgical Patients: The Definition Matters

et al. 2011

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“…20,21 However, a study of patients in our institution indicated that, while specific patients may differ, the rates of pneumonia were similar whether bronchoscopic or National Healthcare Safety Network criteria were used. 22 While this study was designed to be powered to detect a 50% reduction in the VAP rate, this was predicated on a historical VAP rate of 5.8 Ϯ 1.47 per 1,000 ventilator days, present in early 2010 during study planning. The observed baseline rate was only 3.29/1,000 ventilator days.…”

Section: Discussionmentioning

confidence: 99%

The Impact of Hospital-Wide Use of a Tapered-Cuff Endotracheal Tube on the Incidence of Ventilator-Associated Pneumonia

Bowton¹,

Hite

Martin³

et al. 2013

Respir Care

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BACKGROUND: Aspiration of colonized oropharyngeal secretions is a major factor in the pathogenesis of ventilator-associated pneumonia (VAP). A tapered-cuff endotracheal tube (ETT) has been demonstrated to reduce aspiration around the cuff. Whether these properties are efficacious in reducing VAP is not known. METHODS: This 2-period, investigator-initiated observational study was designed to assess the efficacy of a tapered-cuff ETT to reduce the VAP rate. All intubated, mechanically ventilated patients over the age of 18 were included. During the baseline period a standard, barrel-shaped-cuff ETT (Mallinckrodt Hi-Lo) was used. All ETTs throughout the hospital were then replaced with a tapered-cuff ETT (TaperGuard). The primary outcome variable was the incidence of VAP per 1,000 ventilator days. RESULTS: We included 2,849 subjects, encompassing 15,250 ventilator days. The mean ؎ SD monthly VAP rate was 3.29 ؎ 1.79/ 1,000 ventilator days in the standard-cuff group and 2.77 ؎ 2.00/1,000 ventilator days in the tapered-cuff group (P ‫؍‬ .65). While adherence to the VAP prevention bundle was high throughout the study, bundle adherence was significantly higher during the standard-cuff period (96.5 ؎ 2.7%) than in the tapered-cuff period (90.3 ؎ 3.5%, P ‫؍‬ .01). CONCLUSIONS: In the setting of a VAP rate very near the average of ICUs in the United States, and where there was high adherence to a VAP prevention bundle, the use of a tapered-cuff ETT was not associated with a reduction in the VAP rate.

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“…Successful extubation was defined as remaining free of mechanical ventilation until discharge. Nosocomial pneumonia was defined according to the National Nosocomial Infections Surveillance System (NNIS) definition [25]. Systemic infection was defined as presence of fever, white blood cell count >12,000, and positive blood, urine, or sputum cultures without other identified cause of fever and elevated white blood cell count.…”

Section: Definitionsmentioning

confidence: 99%

A Clinical Description of Extubation Failure in Patients with Primary Brain Injury

et al. 2011

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The extubation failure rate in our neurocritical care unit is low. In patients with encephalopathy and primary brain injury who were reintubated, respiratory distress caused by altered mental status was the most common cause of reintubation. These patients demonstrated signs disrupted ventilation usually with periods of prolonged hypoventilation. Increased work of breathing from lung injury due to pneumonia or aspiration was not the most common cause of reintubation in this population.

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National Nosocomial Infection Surveillance System: From Benchmark to Bedside in Trauma Patients

Cited by 53 publications

References 13 publications

The Occurrence of Pneumonia Diagnosis Among Neurosurgical Patients: The Definition Matters

The Occurrence of Pneumonia Diagnosis Among Neurosurgical Patients: The Definition Matters

The Impact of Hospital-Wide Use of a Tapered-Cuff Endotracheal Tube on the Incidence of Ventilator-Associated Pneumonia

A Clinical Description of Extubation Failure in Patients with Primary Brain Injury

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