Prevention Of Ventilator-associated Pneumonia Research Articles

EFFECTIVENESS OF EDUCATIONAL PROGRAMME ON KNOWLEDGE REGARDING CARE AND PREVENTION OF PRETERM BABIES WITH VENTILATOR ASSOCIATED PNEUMONIA AMONG STAFF NURSES IN NICU, PBMH, BHUBANESWAR, ODISHA

A pre-experimental research design was conducted on NICU staff nurses to assess the knowledge & effectiveness of Educational programme on knowledge regarding care and prevention of Ventilator Associated Pneumonia.

Comparison of polyurethane tracheal tube cuffs and conventional polyvinyl chloride tube cuff for prevention of ventilator-associated pneumonia: A systematic review with meta-analysis.

Background:The aim of this meta-analysis with trial sequential analysis (TSA) was to evaluate the effect of a polyurethane (PU) tracheal tube cuff on the prevention of ventilator-associated pneumonia (VAP).Methods:We performed a systematic search using the MEDLINE database through PubMed, Cochrane Central Register of Controlled Trial, SCOPUS, and Web of Science.Randomized controlled trials comparing the incidence of VAP and clinically relevant outcomes between PU cuff tubes and polyvinyl chloride (PVC) cuff tubes in adult patients. Two authors independently extracted study details, patient characteristics, and clinical outcomes such as incidence of VAP, bacterial colonization of tracheal aspirate, duration of mechanical ventilation, ICU stay, and ICU mortality.Results:From 309 studies identified as potentially eligible, six studies with 1226 patients were included in this meta-analysis. All studies compared the incidence of VAP between PU cuffs and PVC cuffs. Use of a PU cuff was not associated with a reduction in VAP incidence (RR = 0.68; 95% CI, 0.45–1.03) with significant statistical heterogeneity (I2 = 65%). The quality of evidence was “very low.” According to the TSA, the actual sample size was only 15.8% of the target sample size, and the cumulative Z score did not cross the trial sequential monitoring boundary for benefit. No positive impact was reported for the other relevant outcomes for PU cuffs.Conclusions:The use of a PU cuff for mechanical ventilation did not prevent VAP. Further trials with a low risk of bias need to be performed.

Prevention of neonatal ventilator-associated pneumonia through oral care with the combined use of colostrum and sodium bicarbonate.

This study aims to investigate the effect of oral care via the combined use of colostrum and sodium bicarbonate on the prevention of neonatal ventilator-associated pneumonia (VAP). In accordance with the inclusion and exclusion criteria, 120 infant patients who were hospitalized in the neonatal intensive care unit (NICU) from January to October of 2019 were selected and randomly divided into three groups (40 cases in each group), namely, colostrum combined with sodium bicarbonate nursing (experimental group), colostrum (control group I), and sodium bicarbonate (control group II) groups. The primary outcomes measured included incidence rates of VAP and oral infection, positive rate of pathogenic bacteria after sputum culture, mechanical ventilation time, and length of stay (LOS). The incidence rates of VAP and oral infection and the positive rate of pathogenic bacteria after sputum culture of the experimental group, which were 6.67%, 10.00%, and 10.00%, respectively, were significantly different from those of control groups I and II (p < 0.05). The mechanical ventilation time of the experimental group was 156.07 ± 26.67 h, which was shortened by 9.79% and 9.43% compared with those of control groups I and II, respectively. The LOS of the experimental group was 17.6 ± 1.96 days, which was shortened by 17.74% and 17.50% compared with those of control groups I and II, respectively. The differences were statistically significant (p< 0.05). Oral care through the combined use of colostrum and sodium bicarbonate can lower the VAP incidence rate of infant patients and shorten their mechanical ventilation time and LOS.

Impact of Providing a Tape Measure on the Provision of Lung-protective Ventilation.

IntroductionEmergency department (ED) patients are frequently ventilated with excessively large tidal volumes for predicted body weight based on height, which has been linked to poorer patient outcomes. We hypothesized that supplying tape measures to respiratory therapists (RT) would improve measurement of actual patient height and adherence to a lung-protective ventilation strategy in an ED-intensive care unit (ICU) environment.MethodsOn January 14, 2019, as part of a ventilator-associated pneumonia prevention bundle in our ED-based ICU, we began providing RTs with tape measures and created a best practice advisory reminding them to record patient height. We then retrospectively collected data on patient height and tidal volumes before and after the intervention.ResultsWe evaluated 51,404 tidal volume measurements in 1,826 patients over the 4 year study period; of these patients, 1,579 (86.5%) were pre-intervention and 247 (13.5%) were post-intervention. The intervention was associated with a odds of the patient’s height being measured were 10 times higher post-intervention (25.1% vs 3.2%, P <0.05). After the bundle was initiated, we observed a significantly higher percentage of patients ventilated with mean tidal volumes less than 8 cubic centimeters per kilogram (93.9% vs 84.5% P < 0.05).ConclusionPatients in an ED-ICU environment were ventilated with a lung-protective strategy more frequently after an intervention reminding RTs to measure actual patient height and providing a tape measure to do so. A significantly higher percentage of patients had height measured rather than estimated after the intervention, allowing for more accurate determination of ideal body weight and calculation of lung-protective ventilation volumes. Measuring all mechanically ventilated patients’ height with a tape measure is an example of a simple, low-cost, scalable intervention in line with guidelines developed to improve the quality of care delivered to critically ill ED patients.

The prevalence and diagnostic criteria of health-care associated infections in neonatal intensive care units in Turkey: A multicenter point- prevalence study

Healthcare-acquired infections (HAIs) in the neonatal period cause substantial morbidity, mortality, and healthcare costs. Our purpose was to determine the prevalence of HAIs, antimicrobial susceptibility of causative agents, and the adaptivity of the Centres for Disease Control and Prevention (CDC) criteria in neonatal HAI diagnosis. A HAI point prevalence survey was conducted in the neonatal intensive care units (NICUs) of 31 hospitals from different geographic regions in Turkey. The Point HAI prevalence was 7.6%. Ventilator-associated pneumonia (VAP) and central line-associated bloodstream infections (CLABSI) and late onset sepsis were predominant. The point prevalence of VAP was 2.1%, and the point prevalence of CLABSI was 1.2% in our study. The most common causative agents in HAIs were Gram-negative rods (43.0%), and the most common agent was Klebsiella spp (24.6%); 81.2% of these species were extended spectrum beta-lactamase (ESBL) (+). Blood culture positivity was seen in 33.3% of samples taken from the umbilical venous catheter, whereas 0.9% of samples of peripherally inserted central catheters (PICCs) were positive. In our study, 60% of patients who had culture positivity in endotracheal aspirate or who had purulent endotracheal secretions did not have any daily FiO2 change (p=0.67) and also 80% did not have any increase in positive end-expiratory pressure (PEEP) (p=0.7). On the other hand, 18.1% of patients who had clinical deterioration compatible with VAP did not have endotracheal culture positivity (p=0.005). Neonatal HAIs are frequent adverse events in district and regional hospitals. This at-risk population should be prioritized for HAI surveillance and prevention programs through improved infection prevention practices, and hand hygiene compliance should be conducted. CDC diagnostic criteria are not sufficient for NICUs. Future studies are warranted for the diagnosis of HAIs in NICUs.

Mechanical Insufflation-exsufflation for the Prevention of Ventilator-associated Pneumonia in Intensive Care Units: A Retrospective Cohort Study.

AimVentilator-associated pneumonia (VAP) is the most common intensive care unit (ICU)-acquired infection. The current study aimed to assess the efficacy of mechanical insufflation-exsufflation (MI-E) in preventing VAP in critically ill patients.Materials and methodsThis retrospective cohort study was conducted at the ICU of Chiba University Hospital between January 2014 and September 2017. The inclusion criteria were patients who required invasive mechanical ventilation ≥48 hours and those who underwent rehabilitation, including chest physical therapy (CPT). In 2015, the study institution started the use of MI-E in patients with impaired cough reflex. From January to December 2014, patients undergoing CPT were classified under the historical control group, and those who received treatment using MI-E from January 2015 to September 2017 were included in the intervention group. The patients received treatment using MI-E via the endotracheal or tracheostomy tube, with insufflation-exsufflation pressure of 15–40 cm H2O. The treatment frequency was one to three sessions daily, and a physical therapist who is experienced in using MI-E facilitated the treatment.ResultsFrom January 2015 to September 2017, 11 patients received treatment using MI-E. Of the 169 patients screened in 2014, 19 underwent CPT. The incidence of VAP was significantly different between the CPT and MI-E groups (84.2% [16/19] vs 26.4% [3/11], p = 0.011). After adjusting for covariates, a multivariate logistic regression analysis was performed, and results showed that the covariates were not associated with the incidence of VAP.ConclusionThis retrospective cohort study suggests that the use of MI-E in critically ill patients is independently associated with a reduced incidence of VAP.Clinical significanceAssessing the efficacy of MI-E to prevent VAP.How to cite this articleKuroiwa R, Tateishi Y, Oshima T, Inagaki T, Furukawa S, Takemura R, et al. Mechanical Insufflation-exsufflation for the Prevention of Ventilator-associated Pneumonia in Intensive Care Units: A Retrospective Cohort Study. Indian J Crit Care Med 2021;25(1):62–66.

Efficacy of Venner-PneuX endotracheal tube system for prevention of ventilator-associated pneumonia in intensive care units: A protocol for systematic review and meta-analysis.

Background:The pathogenic mechanism and prevention of ventilator-associated pneumonia (VAP) are substantially improved over the past several decades, but VAP remains frequently seen among the critical cases. The Venner-PneuX endotracheal tube system (VPXETS) has been proved to perform better than standard endotracheal tubes (SET) in the prevention of VAP in some studies. Therefore, this systematic review is aimed at evaluating the effectiveness of VPXETS in order to prevent VAP.Methods:Electronic databases, including PubMed, WANFANG, CENTRAL, CNKI, EMBASE, and CINAHL, are used to search relevant randomized controlled trials for evaluating the therapeutic effect of VPXETS on preventing VAP from January 2011 to December 2020. To be specific, related studies are selected, data are extracted, risk of bias is assessed, and meta-analysis is conducted in succession.Results:The present review aims to assess the therapeutic effect of VPXETS on preventing VAP in intensive care units (ICUs). Our outcome measures include the incidence and side reaction of VAP.Conclusions:The present review assesses related studies regarding the therapeutic effect of VPXETS on preventing VAP at ICUs.Dissemination and ethics:Our findings in this work are to be disseminated by means of peer-reviewed publication. No ethical approval is required in our review since it uses the published data. Moreover, anonymity is guaranteed during the data analysis process.OSF Registration number:DOI 10.17605/OSF.IO/6BERJ

Efficiency of different protocols for oral hygiene combined with the use of chlorhexidine in the prevention of ventilator-associated pneumonia

ABSTRACTObjective:In ICU patients on mechanical ventilation (MV), ventilator-associated pneumonia (VAP) is a common infection. However, such infection can be prevented through oral care protocols. The objective of this study was to compare the efficiency of the use of chlorhexidine and oral hygiene protocols (brushing and clinical procedures) with that of the use of chlorhexidine alone (intervention group and control group, respectively) in decreasing the prevalence of VAP in patients ≥ 18 years of age admitted to the ICU and requiring MV. Methods:In this systematic review and meta-analysis, studies were identified through searches of various national and international databases, as well as of the gray literature, and were selected in accordance with eligibility criteria. Results:We evaluated six studies, involving a collective total of 1,276 patients. We classified the risk of bias as low in three studies, high in two, and uncertain in one; among the six risk domains evaluated, a low risk of bias was predominant in five. The results for random risks were similar in terms of direction and statistical magnitude-chi-square = 6.34; risk difference: −0.06 (95% CI: −0.11 to −0.02); I2 = 21%; p = 0.007. There was a decrease in the prevalence of VAP in the intervention group (n = 1,276) included in the meta-analysis. Conclusions:Protocols that include the mechanical removal of oral biofilm in combination with the use of chlorhexidine can reduce the incidence of VAP among ICU patients requiring MV.

Critical care nurses' compliance and barriers toward ventilator-associated pneumonia prevention guidelines: cross-sectional survey

ObjectivesThis study aims to determine the compliance of critical care nurses with the ventilator-associated pneumonia prevention guidelines and the factors that affect their compliance. We also explored the barriers faced by the nurses in the implementation of these guidelines. MethodsA cross-sectional descriptive survey was conducted using a self-administered questionnaire containing 17 recommended strategies to prevent ventilator-associated pneumonia and 15 possible barriers. All critical care nurses of varying qualifications, levels of experience, and nationalities working in adult ICUs were invited. Between January and March 2018, the questionnaire was distributed to 283 nurses at eight ICUs in five public hospitals in Almadinah Almunawwarah, KSA. ResultsA total of 229 invitees responded to the questionnaire. The mean compliance score was 85.9%. More than half (54%) of the sample had a high or acceptable compliance level. The lowest compliance rate was reported for the suctioning of subglottic secretions. The main reported barriers were the shortage of nursing staff, forgetfulness, and hospital cost control policies. Working in general ICUs with the capacity of 10–15 beds or prior education related to ventilator-associated pneumonia prevention influenced the nurses’ compliance. ConclusionIn our study, the overall compliance of the critical care nurses with the ventilator-associated pneumonia prevention guidelines is acceptable. Shortage of nursing staff, forgetfulness, and cost control policies were the main reported barriers to compliance.

Device-associated health care-associated infections: The effectiveness of a 3-year prevention and control program in the Republic of Cyprus.

Device-associated health care-associated infections (DA-HAIs) are a major threat to patient safety, particularly in the Intensive Care Unit (ICU). This study aimed to evaluate the effectiveness of a bundle of infection control measures to reduce DA-HAIs in the ICU of a General Hospital in the Republic of Cyprus, over a 3-year period. We studied 599 ICU patients with a length of stay (LOS) for at least 48 hours. Our prospective cohort study was divided into three surveillance phases. Ventilator-associated pneumonia (VAP), central line-associated blood-stream infections (CLABSI), and catheter-associated blood-stream infections (CAUTI) incidence rates, LOS, and mortality were calculated before, during, and after the infection prevention and control programme. There was a statistically significant reduction in the number of DA-HAI events during the surveillance periods, associated with DA-HAIs prevention efforts. In 2015 (prior to programme implementation), the baseline DA-HAIs instances were 43: 16 VAP (10.1/1000 Device Days), 21 (15.9/1000DD) CLABSIs, and 6 (2.66/1000DD) CAUTIs, (n=198). During the second phase (2016), CLABSIs prevention measures were implemented and the number of infections were 24: 14 VAP (12.21/1000DD), 4 (4.2/1000DD) CLABSIs, and 6 (3.22/1000DD) CAUTIs, (n=184). During the third phase (2017), VAP and CAUTI prevention measures were again implemented and the rates were 6: (3 VAP: 12.21/1000DD), 2 (1.95/1000DD) CLABSIs, and 1 (0.41/1000DD) CAUTIs, (n=217). There was an overall reduction of 87% in the total number of DA-HAIs instances for the period 1 January 2015 to 31 December 2017. The significant overall reduction in DA-HAI rates indicates that a comprehensive infection control programme can affect DA-HAI rates.

Tratamiento de la Neumonía Asociada a la Ventilación Mecánica: cofactor de mortalidad en pacientes COVID-19 positivos

La infección por Sars-CoV-2 produce diversos cuadros clínicos, que incluyen la infección asintomática, enfermedad leve del tracto respiratorio superior y neumonía viral grave con insuficiencia respiratoria e incluso la muerte. La necesidad de internación de los pacientes más comprometidos introduce una complicación adicional, que es el riesgo de adquirir una infección intrahospitalaria. Entre éstas, la neumonía asociada a la ventilación mecánica (NAV) es una de las más frecuentes en las Unidades de Cuidados Intensivos (UCI) y actualmente es una complicación en el cuadro clínico de pacientes COVID-19 positivos que necesitan asistencia de respiración mecánica. La prevención de la NAV es crucial para eliminar este cofactor de morbimortalidad, así como disminuir los costos asociados a la atención de salud (tiempo de internación, antibióticos, elementos descartables, etc.).&#x0D; La NAV ocurre en pacientes que son ventilados por un tubo endotraqueal o por traqueotomía, como respuesta del huésped a la invasión bacteriana. Los pacientes con ventilación mecánica están inconscientes y no hay eliminación de las secreciones en la orofaringe, generando un aumento de la flora oral normal. Los microorganismos colonizadores pasan a lo largo del tubo traqueal formando biofilms en la parte interna y externa del mismo particularmente en la región cercana al bulbo. Finalmente, estos microorganismos son capaces de alcanzar las vías aéreas distales superando la respuesta inmune del huésped y generando neumonía. La propuesta de este trabajo consiste en modificar la superficie de los tubos endotraqueales con agentes antimicrobianos que inhiban la adhesión y proliferación bacteriana actuando como coadyuvantes de los antibióticos administrados por vía sistémica.&#x0D; El objetivo general de este trabajo es contribuir a la prevención de la NAV por medio de la funcionalización de las superficies interna y externa del tubo endotraqueal empleado en la ventilación mecánica. La modificación se realiza mediante el depósito de una delgada película de hidrogeles biocompatibles y biodegradables cargados con agentes antimicrobianos convencionales (antibióticos) y no convencionales (nanopartículas de plata, AgNPs) para combatir la formación de los biofilms bacterianos que generan la NAV. Los hidrogeles proporcionan control espacial y temporal sobre la liberación de los agentes terapéuticos debido a su degradabilidad controlable y capacidad para proteger a los medicamentos lábiles, permitiendo, además, alcanzar concentraciones locales superiores a las obtenidas por administración sistémica. Para alcanzar los objetivos, se ha optimizado la síntesis de un hidrogel en base a polietilenglicol capaz de adherirse fuertemente a la superficie de cloruro de polivinilo del tubo endotraqueal. Se logró recubrir la superficie del tubo con el hidrogel, comprobándose una buena estabilidad mecánica tanto para el hidrogel deshidratado como para el mismo hidratado. Se analizaron diferentes rutas de incorporación de los agentes antimicrobianos, encontrándose que la más adecuada es el agregado de éstos al polímero precursor del hidrogel. Los hidrogeles modificados con AgNPs presentan características de adhesión y estabilidad similares a las de los hidrogeles sin modificar. Al momento de escribir este trabajo se están llevando cabo los experimentos tendientes a determinar la capacidad antimicrobiana de las superficies modificadas.

Attributable Mortality of Ventilator-associated Pneumonia. Replicating Findings, Revisiting Methods

Rationale: Estimating the impact of ventilator-associated pneumonia (VAP) from routinely collected intensive care unit (ICU) data is methodologically challenging.Objectives: We aim to replicate earlier findings of limited VAP-attributable ICU mortality in an independent cohort. By refining statistical analyses, we gradually tackle different sources of bias.Methods: Records of 2,720 adult patients admitted to Ghent University Hospital ICUs (2013–2017) and receiving mechanical ventilation within 48 hours after admission were extracted from linked Intensive Care Information System and Computer-based Surveillance and Alerting of Nosocomial Infections, Antimicrobial Resistance, and Antibiotic Consumption in the ICU databases. The VAP-attributable fraction of ICU mortality was estimated using a competing risk analysis that is restricted to VAP-free patients (approach 1), accounts for VAP onset by treating it as either a competing (approach 2) or censoring event (approach 3), or additionally adjusts for time-dependent confounding via inverse probability weighting (approach 4).Results: A total of 210 patients (7.7%) acquired VAP. Based on benchmark approach 4, we estimated that (compared with current preventive measures) hypothetical eradication of VAP would lead to a relative ICU mortality reduction of 1.7% (95% confidence interval, −1.3 to 4.6) by Day 10 and of 3.6% (95% confidence interval, 0.7 to 6.5) by Day 60. Approaches 1–3 produced estimates ranging from −0.7% to 2.5% by Day 10 and from 5.2% to 5.5% by Day 60.Conclusions: In line with previous studies using appropriate methodology, we found limited VAP-attributable ICU mortality given current state-of-the-art VAP prevention measures. Our study illustrates that inappropriate accounting of the time dependency of exposure and confounding of its effects may misleadingly suggest protective effects of early-onset VAP and systematically overestimate attributable mortality.

Effectiveness of Structured Teaching Program on Knowledge and Practice Regarding Care Bundle on Prevention of Ventilator-Associated Pneumonia among Nurses

Ventilator-Associated pneumonia (VAP) is a major cause of morbidity and mortality and is the second most common nosocomial infection among critically ill patients, affecting 6% to 52% and can reach to 76% in some specific hospital settings. VAP can prolong the patient's length of stay in the hospital and thereby the financial burden. Knowledge and practice run parallel therefore, the present study was conducted to assess the effectiveness of structured teaching Program on knowledge and practice regarding care bundle on prevention of ventilator-associated pneumonia among nurses.

Kajian Literatur: Perawatan Mulut sebagai Intervensi Pencegahan Ventilator-Associated Pneumonia pada Pasien Kritis

Introduction: Ventilator-Associated Pneumonia (VAP) is a nosocomial pneumonia which develops after the patient received 48 hours of mechanical ventilation intubation. VAP raises various problems such as prolong length of stay and ventilator time, increase treatment costs, and increase risk of death. Appropriate and effective oral care is one of the nursing interventions that can reduce the incidence of VAP. The aim of this study was to identify procedure of oral care for prevention of VAP in critical patients. Methods: This research method is a literature review. Literature is searched through electronic database such as EBSCOhost, Scopus, Science Direct, and Proquest. The inclusion criteria of article were randomized controlled trials or randomized clinical trial designs, evaluate oral care effects on the prevention of VAP in critically ill patients, full text articles and publication years from January 2013 to May 2020. Results: Search results found as many as 38 articles, but only 9 articles were eligible to be reviewed. This review indicate that oral care has a significant effect on the prevention of VAP. The combination of toothbrush and swab is the most appropriate equipment. Chlorhexidine 2% was the most influential solution in reducing the incidence of VAP, while the frequency of oral care was most effective when adjusted to the results of the Back Oral Assessment Score (BOAS). Conclusion: This result reinforces the use of chlorhexidine in the oral care of mechanically ventilated patients. Oral care assessment needs to be done by nurses to guide in determining the frequency of oral care.

Knowledge of Nurses Concerning Ventilator-Associated Pneumonia (VAP) Prevention in Mosul Teaching Hospitals

Background: Ventilator-Associated Pneumonia (VAP) is one of the popular Intensive Care Units (ICUs)nosocomial infections with a prevalence rate of ten to seventy percent. The frequency of VAP is abouttwenty percent. Lack of awareness of VAP standards and the low quality of nursing practice can become abarrier to preventing VAP.Objective: The purpose of this study is to assess the knowledge of nurses concerning VAP prevention inMosul teaching Hospitals.Material and Method: A descriptive design study was used to assess knowledge and sources of knowledgeamong nurses about VAP prevention. From Mosul Teaching Hospitals picked 200 respondents workingin different intensive care areas (ICU, CCU, NICU, and PICU) as a sample for the current study usingthe accidental sampling approach. Aquestionnaire developed for nurses have been updated and revised forthe purpose of the study. The questionnaire was tested for validity and reliability and passed for use in thepresent study. Using Microsoft Excel, data coding, entry, cleaning, and analysis were done, and results werepresented using standard frequency distribution tables.Results: In relation to Sociodemographic data of the studied sample is shown in Table 1. The average ageof nurses was founded (26.13 ± 4.25) years, and (62.7 %) had a diploma in nursing (secondary schools).Also, the mean experience period was (7.31 ± 3.81) years. The study found that (67%) of Nurses had poorknowledge about pneumonia and VAP. The highest (86%) of nurse’s little knowledge was gained throughtheir practice of nursing in Mosul hospital.Conclusion: Multieducational and training courses and programs need for nurses to improve their knowledgeabout prevention of VAP and may decrease Pneumonia associated with Ventilator among patients wereconcluded in current study.

Should oral chlorhexidine remain in ventilator-associated pneumonia prevention bundles?

Ventilator-associated pneumonia (VAP) is related with high mortality, duration of mechanical ventilation and costs. Recent studies have questioned the safety and effectiveness of oral chlorhexidine to prevent VAP. We sought to verify whether the adverse effects of this substance outweigh its benefits. We searched several databases and selected studies that investigated the use of oral chlorhexidine and its impact on mortality. No association between oral chlorhexidine and lower VAP rates was found on meta-analyses of double-blind randomized trials, however significant increase in mortality was reported. It is speculated that chlorhexidine can cause damage to several organic sectors and cytotoxicity. Although it still can be beneficial in specific settings, robust evidence to recommend its routine application for all mechanically ventilated patients is lacking; therefore, given the possibility of harm, it would be better to follow the principle of non-maleficence until more studies becomes available.

Effects of Probiotics on Prevalence of Ventilator-Associated Pneumonia in Multitrauma Patients Hospitalized in Neurosurgical Intensive Care Unit: A Randomized Clinical Trial

Background: Probiotics may have a role in preventing ventilator-associated pneumonia (VAP) by inhibiting the natural flora from transforming into pathogenic flora. Objective: Therefore, this study aimed to investigate the effects of probiotics on the prevalence of VAP in multitrauma patients hospitalized in a neurosurgical intensive care unit (ICU). Methods: This randomized clinical trial was performed between 2018 and 2019 with the participation of 150 patients hospitalized in theNeurosurgical ICU. After randomizing the participants (using the permutable blocking method) into the intervention (probiotic) and control (placebo) groups, the interventions were implemented. The participants received one capsule every 12 hours by gavage and their VAP symptoms were evaluated and recorded. Data were inputted into SPSS22 and then compared using the chi-square, independent t-test, Fisher's exact tests, and repeated measures ANOVA. Results: The prevalence of VAP was significantly lower in the intervention group than the control group (p=0.001). A significant difference was observed between the two groups in pH (p=0.029) and WBC (p=0.042). The between-group difference was not significant in other variables. Conclusion: Probiotics are effective in reducing the prevalence of VAP in trauma patients hospitalized in ICU.

A STUDY TO EVALUATE THE EFFECTIVENESS OF PLANNED TEACHING PROGRAMME ON LEVEL OF KNOWLEDGE REGARDING VENTILATOR CARE BUNDLE IN PREVENTION OF VENTILATOR-ASSOCIATED PNEUMONIA IN INTUBATED PATIENTS AMONG B.SC NURSING IIIRD YEAR STUDENTS AT SELECTED SHRI GURU RAM RAI UNIVERSITY, COLLEGE OF NURSING, DEHRADUN

Problem Statement: A study to evaluate the effectiveness of planned teaching programme on level of knowledge regarding ventilator care bundle in preventionofventilator-associatedpneumonia in intubated patients among B.Sc Nursing IIIrd year atselectedShri Guru Ram Rai University, College of Nursing, Dehradun. Objectives: To assess the pre-test knowledge scores of students regarding ventilator care bundle in prevention of ventilator-associated pneumonia in intubated patients using a structured knowledge questionnaire. To evaluate the effectiveness of planned teaching programme for students regarding ventilator care bundle in prevention of ventilator-associated pneumonia in terms of gain in post-test knowledge scores. To associate the knowledge score of students regarding ventilator care bundle in prevention of ventilator-associated pneumonia with selected demographic variables. Methodology: The nature of the study was pre-experimental approach i.e. One group pre-test and post-test without a control group design. The conceptual framework used in this study was based on General System Theory developed by Ludwig Von Bertalanffy. The research design used for this study was based on one group pre-test and post-test without a control group design. The present study attempts to evaluate the effectiveness of planned teaching programme on level of knowledge regarding ventilator care bundle in prevention of ventilator-associated pneumonia in intubated patients among B.Sc Nursing IIIrd year students. This study included 60B.Sc Nursing IIIrd year students and their level of knowledge was assessed by using self-structuredknowledgequestionnaire. Planned teaching programme was implemented through power-point presentation and post-test was conducted after 7 days using same questionnaire. The effectiveness of planned teaching programme was evaluated by comparing the level of knowledge score in pre-test and post-test through descriptive and inferential statistics. Results: Maximum percentage of students 68.3% were in age group between 21-25 years. Highest percentages of students 93.3% were females. Majority of students 80% were Hindu. Most of the students 95% were graduated. Majority of the students 76.7% were residing in urban area. Highest percentages of students 76.7% had not witnessed a case of ventilator-associated pneumonia. Majority of students 85% had not undergone any educational training programme on ventilator-associated pneumonia. Majority of the students 28.3% gained knowledge regarding VAP from electronic media and hospital health information as a source of information. The post-test mean knowledge score percentage was 71.5% was found higher when compared with pre-test mean knowledge score percentage 48.06%. The statistical paired t test indicates that the mean post-test score percentage (71.5%) was significantly higher than the mean pre-test score percentage (48.06%) at the 0.001 level of significance this shows that the planned teaching programme was effective in increasing level of knowledge of students regarding ventilator care bundle in prevention of ventilator-associated pneumonia. There was no significant association between age, gender, religion, academic qualification, locality, have they ever witnessed a case with VAP, have they ever undergone any educational training programme on prevention of VAP and source of information on prevention of VAP with the knowledge score of the students. Conclusion: The results revealed that mean knowledge score percentage in post-test is higher than the mean knowledge score percentage in pre-test. Overall findings shows that there was knowledge deficit among students regarding ventilator care bundle in prevention of ventilator-associated pneumonia and planned teaching programme was effective in improving their level of knowledge.

Do probiotics help prevent ventilator-associated pneumonia in critically ill patients? A systematic review with meta-analysis.

BackgroundProbiotic treatments might contribute to the prevention of ventilator-associated pneumonia (VAP). Due to its unclear clinical effects, here we intend to assess the preventive effect and safety of probiotics on intensive care unit (ICU) patients.MethodsEligible randomised controlled trials were selected in databases until 30 September 2019. The characteristics of the studies were extracted, including study design, definition of VAP, probiotics intervention, category of included patients, incidence of VAP, mortality, duration of mechanical ventilation (MV) and ICU stay. Heterogeneity was evaluated by Chi-squared and I2 tests.Results15 studies involving 2039 patients were identified for analysis. The pooled analysis suggests significant reduction on VAP (risk ratio, 0.68; 95% Cl, 0.60 to 0.77; p<0.00001) in a fixed-effects model. Subgroup analyses performed on the category of clinical and microbiological criteria both support the above conclusion; however, there were no significant differences in duration of MV or length of ICU stay in a random-effects model. Also, no significant differences in total mortality, overall mortality, 28-day mortality or 90-day mortality were found in the fixed-effects model.ConclusionsThe probiotics helped to prevent VAP without impacting the duration of MV, length of ICU stay or mortality.

Talking about Prevention and Control Nursing of Ventilator-Associated Pneumonia

Ventilator-associated pneumonia (VAP) refers to the infection of lung parenchyma in patients undergoing endotracheal intubation or tracheotomy after receiving mechanical ventilation for 48 h, which is the most common complication of patients undergoing mechanical ventilation and has a high mortality rate (21.2%-43.2%). At present, the main measures to prevent and control VAP are to strictly implement hand hygiene, strengthen oral care, raise the bedside, effectively remove secretions from the airbag, implement airbag management and ventilator circuit management, carry out enteral nutrition and cluster intervention strategies according to the actual situation of hospitals. This article reviews the characteristics, diagnosis, prevention and control of VAP, aiming to provide reference for better prevention and control of VAP.