Use of Ventilator Bundle and Staff Education to Decrease Ventilator-Associated Pneumonia in Intensive Care Patients

Parisi, Maria Cândida Ribeiro; Gerovasili, Vasiliki; Dimopoulos, Stavros; Kampisiouli, Efstathia; Goga, Christina; Perivolioti, Efstathia; Argyropoulou, Athina; Routsi, Christina; Tsiodras, Sotirios; Nanas, Serafeim

doi:10.4037/ccn2016520

Cited by 44 publications

(53 citation statements)

References 41 publications

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“…The recently published Greek study by Parisi et al. [ 19 ] also highlighted the importance of staff education on VAP prevention. They implemented a longer educational program of 3 months every 2 weeks and the compliance of ICU staff was also controlled.…”

Section: Discussionmentioning

confidence: 99%

Ventilator-associated pneumonia and the importance of education of ICU nurses on prevention – Preliminary results

Mogyoródi

Dunai

Gál

et al. 2016

Interventional Medicine and Applied Science

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Background and aimsVentilator-associated pneumonia (VAP) increases intensive care unit (ICU) length of stay, ICU mortality, the number of ventilator days, and costs. We implemented a VAP bundle and investigated its efficacy on prevention. Materials and methodsA prospective observational study was conducted between January 1, 2015 and December 31, 2015 in a 12-bed multidisciplinary ICU. The bundle was implemented on July 02, 2015. Comparative analysis was performed before and after the implementation of the bundle. The compliance of the nurses was also studied. ResultsThe incidence of VAP was 21.5/1,000 ventilator days (95% CI: 14.17–31.10) in the first phase and 12.0/1,000 ventilator days (95% CI: 7.2–19.49) in the second phase. Relative risk reduction was 44% (95% CI: −0.5 to 0.98). Most common bacteria identified during the first phase were Pseudomonas aeruginosa, Stenotrophomonas maltophilia, and Staphylococcus aureus; and in the second phase P. aeruginosa, Acinetobacter baumannii, and S. maltophilia were identified. Significant improvement was achieved in the head-of-bed elevation (p = 0.004), oral care (p = 0.01), hand hygiene (p < 0.001), endotracheal suctioning (p = 0.004), and removal of condensate (p = 0.043). DiscussionThe incidence of VAP showed tendency for reduction. The prevalence of nursing-dependent bacteria decreased and compliance in following prevention methods increased.ConclusionThese results underline the importance of education of prevention methods.

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Section: Discussionmentioning

confidence: 99%

Ventilator-associated pneumonia and the importance of education of ICU nurses on prevention – Preliminary results

Mogyoródi

Dunai

Gál

et al. 2016

Interventional Medicine and Applied Science

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“…Com o objetivo de verificar a incidência de PAVM em dois grupos, um ensaio clínico randomizado publicado em 2001 no Brasil, conseguiu demonstrar a partir de uma amostra de 20 pacientes sendo 12 submetidos à aspiração endotraqueal em sistema aberto e 8 em fechado, que não houve diferença estatisticamente significante na incidência de PAVM entre o grupo 1 (p value =0.12) e 2 (p value =0.18) (16)(17)(18) .…”

Section: Issn: 2238-7234unclassified

“…Um estudo piloto prospectivo randomizado controlado por placebo semelhante publicado em 2012, mostro que os pacientes no grupo placebo apresentaram tempos de ventilação mecânica mais curta em comparação com o grupo clorhexidina (50% contra 17,8%, p=0,03), valor abaixo do encontrado em uma coorte prospectiva de 2006 onde 35,7 casos a cada 1.000 dias de ventilação (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20) .…”

Section: Issn: 2238-7234unclassified

Nursing actions to prevent mechanical ventilation pneumonia in the intensive care unit: review / Ações de enfermagem para prevenir pneumonia por ventilação mecânica na unidade de terapia intensiva: revisão / Acciones de enfermería para prevenir neumonía por ventilación mecánica en la unidad de terapia intensiva..

Maciel

Siqueira

2018

Rev Enferm UFPI

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Objetivo: Levantar as medidas preventivas utilizadas para diminuir o risco de Pneumonia por Ventilação Mecânica na Unidade de Terapia Intensiva. Metodologia: Trata-se de uma revisão integrativa da literatura na qual foram consideradas as seguintes etapas de seleção: identificação da questão da pesquisa, busca na literatura, categorização e avaliação dos estudos, interpretação dos resultados e síntese do conhecimento, sendo selecionados para esta pesquisa artigos publicados entre os anos de 2011 a 2017. Resultados: Foram localizados 108 artigos sendo 101 na base Pubmed e 7 na base de dados Literatura Latino Americana, por meio de cruzamento dos descritores. Após exclusão a partir do título foram selecionados 25 artigos, estes passaram por leitura na íntegra, excluindo-se os duplicados. A amostra obteve um total de 7 artigos que assim entraram nesta revisão de literatura. Conclusão: Os resultados evidenciam que as principais ações para prevenção da Pneumonia por Ventilação Mecânica é a assepsia, seja por higiene das mãos ou por limpeza dos conectores dos ventiladores.Descritores: Ventilação Mecânica; Enfermagem; Pneumonia; Cuidados Intensivos.

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“…Although IDSA/SHEA guidelines suggest bundling interventions to improve compliance with these practices,5 literature on implementing ventilator bundles is mixed 11–15. Improvement teams in two Scottish ICUs reduced VAP rates in both hospitals using different strategies; one changed workflows to close communication gaps between providers, while the other used key opinion leaders and huddles to reinforce desired behaviours 16.…”

Section: Introductionmentioning

confidence: 99%

Reducing the rare event: lessons from the implementation of a ventilator bundle

et al. 2019

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The ventilator-associated event (VAE) is a potentially avoidable complication of mechanical ventilation (MV) associated with poor outcomes. Although rare, VAEs and other nosocomial events are frequently targeted for quality improvement efforts consistent with the creed to ‘do no harm’. In October 2016, VA Greater Los Angeles (GLA) was in the lowest-performing decile of VA medical centres on a composite measure of quality, owing to GLA’s relatively high VAE rate. To decrease VAEs, we sought to reduce average MV duration of patients with acute respiratory failure to less than 3 days by 1 July 2017. In our first intervention (period 1), intensive care unit (ICU) attending physicians trained residents to use an existing ventilator bundle order set; in our second intervention (period 2), we updated the order set to streamline order entry and incorporate new nurse-driven and respiratory therapist (RT)-driven spontaneous awakening trial (SAT) and spontaneous breathing trial (SBT) protocols. In period 1, the proportion of eligible patients with SAT and SBT orders increased from 29.9% and 51.2% to 67.4% and 72.6%, respectively, with sustained improvements through December 2017. Mean MV duration decreased from 7.2 days at baseline to 5.5 days in period 1 and 4.7 days in period 2; statistical process control charts revealed no significant differences, but the difference between baseline and period 2 MV duration was statistically significant at p=0.049. Bedside audits showed RTs consistently performed indicated SBTs, but there were missed opportunities for SATs due to ICU staff concerns about the SAT protocol. The rarity of VAEs, small population of ventilated patients and infrequent use of sedative infusions at GLA may have decreased the opportunity to achieve staff acceptance and use of the SAT protocol. Quality improvement teams should consider frequency of targeted outcomes when planning interventions; rare events pose challenges in implementation and evaluation of change.

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Use of Ventilator Bundle and Staff Education to Decrease Ventilator-Associated Pneumonia in Intensive Care Patients

Abstract: VAP incidence was high in a general intensive care unit in a Greek hospital. However, implementation of a ventilator bundle and staff education has decreased both VAP incidence and length of stay in the unit.

Cited by 44 publications

References 41 publications

Ventilator-associated pneumonia and the importance of education of ICU nurses on prevention – Preliminary results

Ventilator-associated pneumonia and the importance of education of ICU nurses on prevention – Preliminary results

Reducing the rare event: lessons from the implementation of a ventilator bundle

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