Strategies to prevent ventilator-associated pneumonia, ventilator-associated events, and nonventilator hospital-acquired pneumonia in acute-care hospitals: 2022 Update

Klompas, Michael; Branson, Richard D.; Cawcutt, Kelly; Crist, Matthew B.; Eichenwald, Eric C.; Greene, Linda; Lee, Grace; Maragakis, Lisa L.; Powell, Krista M.; Priebe, Gregory P.; Speck, Kathleen; Yokoe, Deborah S.; Berenholtz, Sean M.

doi:10.1017/ice.2022.88

Cited by 117 publications

(113 citation statements)

References 392 publications

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“…Of note, at the time the survey was conducted antimicrobial mouth rinse was still an accepted element of VAP prevention bundles. Since then, updated Compendium VAP prevention guidelines have been published, which no longer recommend antimicrobial mouth rinse as a preventive measure [ 19 ]. We note also that VAP prevention and surveillance are not nationally mandated in Israel, but are rather prioritized and managed at the institutional level, at the discretion of hospital management.…”

Section: Discussionmentioning

confidence: 99%

Healthcare-associated infection prevention and control practices in Israel: results of a national survey

et al. 2022

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Background Healthcare-associated infection (HAI) is a common and largely preventable cause of morbidity and mortality. The COVID-19 pandemic has presented unprecedented challenges to health systems. We conducted a national survey to ascertain hospital characteristics and the use of HAI prevention measures in Israel. Methods We e-mailed surveys to infection prevention and control (IPC) leads of acute care hospitals in Israel. The survey included questions about the use of practices to prevent catheter-associated urinary tract infection (CAUTI), central line-associated bloodstream infection (CLABSI), ventilator-associated pneumonia (VAP), and Clostridioides difficile infection (CDI). The survey also assessed COVID-19 impact and healthcare worker well-being. Results IPC leads from 15 of 24 invited hospitals (63%) completed the survey. Only one-third of respondents reported strong support for IPC from hospital leadership. Although several prevention practices were used by all hospitals (e.g., maximum sterile barrier precautions for CLABSI and real-time assessment of environmental cleaning for CDI), use of other practices was suboptimal—particularly for CAUTI and VAP. COVID-19 had a profound impact on Israeli hospitals, with all hospitals reporting opening of new units to care for COVID patients and most reporting moderate to extreme financial hardship. All hospitals reported highly successful plans to vaccinate all staff and felt confident that the vaccine is safe and effective. Conclusion We provide a status report of the IPC characteristics and practices Israeli hospitals are currently using to prevent HAIs during the COVID-19 era. While many globally accepted IPC practices are widely implemented, opportunities to increase the use of certain IPC practices in Israeli hospitals exist. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-022-07721-8.

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Section: Discussionmentioning

confidence: 99%

Healthcare-associated infection prevention and control practices in Israel: results of a national survey

et al. 2022

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“…Therefore, since they cannot be modified, we cannot obtain any impact on these variables to reduce mortality. But, on the other hand, we have found some variables that are feasible to be modified, and they are indwelling time of CL-days, indwelling time of UC-days, MV-utilization ratio, UC-utilization ratio, and implement an evidence-based set of HAI prevention recommendations [36,37]. HAIs in ICUs in Latin America are several times higher than those in high-income countries [12][13][14][15][16][17][18][19], and a greater effort should be made to reduce the rates of HAIs, and thus be able to reduce this high mortality rate.…”

Section: Discussionmentioning

confidence: 99%

“…As HAI rates in Latin America are significantly higher than in the US, there is room for improvement [ 12 – 19 ]. Based on our findings, it is suggested that we focus on strategies to reduce indwelling time of CL-days, UC-days, MV-utilization ratio, UC-utilization ratio, and implement an evidence-based set of HAI prevention recommendations, such as those recently published by IDSA/SHEA/APIC [ 36 , 37 ]. Also, the high rate of HAIs prevalent in the Latin America [ 12 – 19 ] can be reduced by utilizing a strategy of monitoring compliance with recommendations and providing performance feedback to healthcare personnel, as demonstrated by INICC in several ICUs of Latin America [ 38 – 45 ].…”

Section: Discussionmentioning

confidence: 99%

Multinational Prospective Cohort Study of Mortality Risk Factors in 198 ICUs of 12 Latin American Countries over 24 Years: The Effects of Healthcare-Associated Infections

Rosenthal

Yin

Valderrama-Beltrán

et al. 2022

J Epidemiol Glob Health

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Background The International Nosocomial Infection Control Consortium (INICC) has found a high ICU mortality rate in Latin America. Methods A prospective cohort study in 198 ICUs of 96 hospitals in 46 cities in 12 Latin American countries to identify mortality risk factors (RF), and data were analyzed using multiple logistic regression. Results Between 07/01/1998 and 02/12/2022, 71,685 patients, followed during 652,167 patient-days, acquired 4700 HAIs, and 10,890 died. We prospectively collected data of 16 variables. Following 11 independent mortality RFs were identified in multiple logistic regression: ventilator-associated pneumonia (VAP) acquisition (adjusted odds ratio [aOR] = 1.17; 95% CI: 1.06–1.30; p < 0.0001); catheter-associated urinary tract infection (CAUTI) acquisition (aOR = 1.34; 95% CI: 1.15–1.56; p < 0.0001); older age, rising risk 2% yearly (aOR = 1.02; 95% CI: 1.01–1.02; p < 0.0001); longer indwelling central line(CL)-days, rising risk 3% daily (aOR = 1.03; 95% CI: 1.02–1.03; p < 0.0001); longer indwelling urinary catheter(UC)-days, rising risk 1% daily (aOR = 1.01; 95% CI: 1.01–1.26; p < 0.0001); higher mechanical ventilation (MV) (aOR = 6.47; 95% CI: 5.96–7.03; p < 0.0001) and urinary catheter-utilization ratio (aOR = 1.19; 95% CI: 1.11–1.27; p < 0.0001); lower-middle level income country (aOR = 2.94; 95% CI: 2.10–4.12; p < 0.0001); private (aOR = 1.50; 95% CI: 1.27–1.77; p < 0.0001) or public hospital (aOR = 1.47; 95% CI: 1.24–1.74; p < 0.0001) compared with university hospitals; medical hospitalization instead of surgical (aOR = 1.67; 95% CI: 1.59–1.75; p < 0.0001); neurologic ICU (aOR = 4.48; 95% CI: 2.68–7.50; p < 0.0001); adult oncology ICU (aOR = 3.48; 95% CI: 2.14–5.65; p < 0.0001); and others. Conclusion Some of the identified mortality RFs are unlikely to change, such as the income level of the country, facility ownership, hospitalization type, ICU type, and age. But some of the mortality RFs we found can be changed, and efforts should be made to reduce CL-days, UC-days, MV-utilization ratio, UC-utilization ratio, and lower VAPs and CAUTI rates.

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“…is an emerging pathogen. Among gram-positive organisms, MRSA is the major pathogen [ 19 ]. Organisms causing CAUTI are more resistant to antibiotics, and 3% of CAUTI patients are at risk of developing bacteremia.…”

Section: Epidemiologymentioning

confidence: 99%

Infections in Critically Ill Children

et al. 2022

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Health care–associated infections (HAI) directly influence the survival of children in pediatric intensive care units (PICU), the most common being central line–associated bloodstream infection (CLABSI) 25–30%, followed by ventilator-associated pneumonia (VAP) 20–25%, and others such as catheter-associated urinary tract infection (CAUTI) 15%, surgical site infection (SSI) 11%. HAIs complicate the course of the disease, especially the critical one, thereby increasing the mortality, morbidity, length of hospital stay, and cost. The incidence of HAI in Western countries is 6.1–15.1% and in India, it is 10.5 to 19.5%. The advances in healthcare practices have reduced the incidence of HAIs in the recent years which is possible due to strict asepsis, hand hygiene practices, surveillance of infections, antibiotic stewardship, and adherence to bundled care. The burden of drug resistance and emerging infections are increasing with limited antibiotics in hand, is still a dreadful threat. The most common manifestation of HAIs is fever in PICU, hence the appropriate targeted search to identify the cause of fever should be done. Proper isolation practices, judicious handling of devices, regular microbiologic audit, local spectrum of organisms, identification of barriers in compliance of hand hygiene practices, appropriate education and training, all put together in an efficient and sustained system improves patient outcome.

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Strategies to prevent ventilator-associated pneumonia, ventilator-associated events, and nonventilator hospital-acquired pneumonia in acute-care hospitals: 2022 Update

Cited by 117 publications

References 392 publications

Healthcare-associated infection prevention and control practices in Israel: results of a national survey

Healthcare-associated infection prevention and control practices in Israel: results of a national survey

Multinational Prospective Cohort Study of Mortality Risk Factors in 198 ICUs of 12 Latin American Countries over 24 Years: The Effects of Healthcare-Associated Infections

Infections in Critically Ill Children

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