Prevention Of Ventilator-associated Pneumonia Research Articles

A Literature Review on Strategies Preventing Ventilator-Associated Pneumonia: Role of Endotracheal Cuff Pressure, Cuff Material, and Cuff Shape

ObjectivesTo provide an overview of existing literature regarding the effects of ETT cuff pressure, cuff material, and cuff shape on VAP prevention in adult ventilated patients.BackgroundVentilated patients are at risk of ventilator-associated pneumonia (VAP), which can result in many adverse consequences, such as increased length of stay, mortality, and hospital cost. Endotracheal tube (ETT) insertion is a commonly used measure for mechanical ventilation. However, ETT cuff pressure, special cuff material, and special cuff shape may affect the occurrence of VAP in ventilated patients, but the evidence for their effects on VAP prevention has not been synthesized.MethodsA literature review was conducted.FindingsTwenty-two studies involving 8,809 patients were included in this literature review. The reviewed studies showed inconsistent findings of the effects of continuous ETT cuff pressure monitoring (compared with intermittent pressure monitoring), polyurethane ultrathin tracheal tube (compared with polyvinyl chloride tracheal tube), and taper-shaped cuff (compared with conical-shaped cuff) on the prevention of VAP. Two studies reported consistent findings that silver-coated ETT significantly reduced bacterial load and incidence of VAP compared with uncoated ETT, but the evidence level was relatively weak.ConclusionThis literature review provides an initial and brief overview of the effects of ETT cuff pressure, cuff material, and cuff shape on preventing VAP. However, the effectiveness of these interventions remains inconclusive due to the inadequate evidence and low quality of previous studies. The intervention effects should be synthesized using a quantitative method and laboratory studies with rigorous design are needed to provide more solid evidence.

Application study on improving the methods of endotracheal cuff pressure measurement to prevent ventilator-associated pneumonia

To compare the intra cuff pressure changes during improved and the traditional method of cuff pressure measurement, then evaluate the effects of ventilator-associated pneumonia (VAP) prevention. The results highlighted practical recommendations in the process of ETT cuff pressure measurement. (1) Experimental studies were carried out on the tracheal model with two groups: traditional pressure measurement group and improved pressure measurement group. The traditional pressure measurement group was connected to a handheld pressure gauge with the indicate cuff to get the intra-cuff pressure. The improved method was to insert a 3-way stopcock between the handheld pressure gauge and the indicate cuff. The 3-way stopcock to stabilize handheld pressure gauge reading at 32 cmH2O (1 cmH2O = 0.098 kPa) before measure the intra-cuff pressure. The pressure loss caused by two pressure measurement methods and the leakage of liquid on the balloon after 10 minutes was compared. (2) Clinical researches: a historic cohort study, patients with mechanical ventilation (MV) admitted to intensive care unit (ICU) of Guangxi Medical University Cancer Hospital from June 2014 to May 2018 were enrolled. The control group (249 cases) was treated with traditional method during June 2014 to May 2016, and the observation group (314 cases) was treated with improved method during June 2016 to May 2018. Clusters of strategies and actions of VAP prevention were applied in both groups. Incidence of VAP, duration of MV, and the length of ICU stay were compared between the two groups. (1) Experimental study: the pressure leakage of the traditional pressure measurement group was (10.18±0.47) cmH2O, and that of the improved pressure measurement group was (1.33±0.42) cmH2O, with statistically significant difference between the two groups (t = 32.535, P = 0.000). All fluid on the cuffs leak after 10 minutes of traditional ways of measurement, however, no visible fluid on the cuffs leaked with improved procedures. (2) Clinical research: the incidence of VAP in the observation group was slightly lower than that in the control group, however there was no significant difference [5.10% (16/314) vs. 8.43% (21/249), P > 0.05]. The duration of MV and the length of ICU stay in the observation group were significantly shorter than those in the control group (days: 9.93±3.14 vs. 16.77±5.45, 11.63 ±2.28 vs. 19.12±5.10, both P < 0.01). The improved procedures of intra-cuff pressure measurement is a practical method to avoid the pressure leakage and fluid leakage, and the clinical course of MV patients can be significantly improved by combining the clusters of nursing strategies and actions.

ZAP-VAP: A Quality Improvement Initiative to Decrease Ventilator-Associated Pneumonia in the Neonatal Intensive Care Unit, 2012-2016.

Ventilator-associated pneumonia (VAP) is the second most frequent hospital-acquired infection in neonatal intensive care units (NICUs) and significantly affects neonatal morbidity and mortality. The population most at risk for VAP are extremely preterm infants. The objectives of this quality improvement project were to create and evaluate the effectiveness of a VAP prevention bundle ("ZAP-VAP") in reducing VAP. The development of the ZAP-VAP bundle and creation of audit tools were documented. A targeted gestational age less than 29 weeks was selected for this study. Electronic medical record review was used to determine the preintervention baseline for patient outcomes. Patient medical record data were analyzed retrospectively to measure patient outcomes preimplementation. VAP rates (number of VAP cases per 1000 ventilator days) were calculated pre- and postintervention. After implementation, data were analyzed prospectively to measure patient outcomes between neonates who developed VAP and those who did not. The VAP rate significantly decreased from 8.5 (2010-2011) to 2.5 (P= .0004) postintervention (2016). Median mechanical ventilation days decreased among VAP cases (47 vs 33 days) and slightly increased among non-VAP cases (19 vs 24 days) during the intervention period. Median length of stay decreased for VAP cases (136 vs 100 days) but remained unchanged for non-VAP cases (85 vs 84 days). The intervention was implemented from 2012 to 2016. The protocol was readily accepted by our neonatal intensive care unit (NICU) team through education and practice changes. ZAP-VAP is an effective and straightforward protocol that improved VAP outcomes in our level IIIB NICU. An interdisciplinary team successfully implemented this intervention for mechanically ventilated infants of all gestational ages in our unit and has been a model for these practice changes in other units and other hospitals. Future studies should focus on how to create sustainable interventions to decrease VAP in NICUs and to expand the approaches to other units in our hospital and other hospitals in our city among patients at risk for VAP.

Ventilator Bundles in Transition: From Prevention of Ventilator-Associated Pneumonia to Prevention of Ventilator-Associated Events

Implementation of ventilator bundles is associated with reductions in ventilator-associated pneumonia (VAP). However, the new surveillance model of ventilator-associated events (VAEs) has shifted the focus from VAP to objective, generalized signs of pulmonary decompensation not specific to VAP. This raises the question of whether the ventilator bundle also is effective in reducing VAE. This narrative review examined 6 studies published since 2013 that assessed the impact of ventilator bundles on the incidence of VAE, and a seventh study that examined its impact on mortality. All 7 studies were low-level evidence, and only 1 study was prospective. The findings among the studies were inconsistent, and the only prospective study found no difference in bundle adherence between those who did and did not develop VAE. However numerous factors may explain the apparent lack of efficacy. Most of these factors were related to the retrospective nature of the studies, such as suboptimal documentation of bundle procedures and the presence of potential non-modifiable risk factors, as well as insufficient performance of most bundle components. In some studies, low VAE incidence also raised uncertainty about the veracity of results. Despite these limitations, there was evidence suggesting that stress ulcer prophylaxis may increase VAE risk, and oral care with chlorhexidine may increase both VAE and mortality risk. The largest study found significant reductions in duration of intubation with weaning, sedation, and head of bed elevation, as well as reduced mortality risk with weaning and sedation bundle elements. Nonetheless, these studies should be useful in designing future prospective controlled studies to determine what elements of a future prevention bundle might be effective in reducing VAEs. At this juncture, and based on the limited evidence to date, it appears that incorporating daily sedation interruptions and spontaneous breathing trials are the factors most likely to reduce VAEs.

Emergency nurses’ knowledge about ventilator-associated pneumonia

IntroductionGiven the increasing number of patients requiring mechanical ventilation in emergency departments in recent years, prevention of ventilator-associated pneumonia is very important. Nurses play a significant role in prevention of ventilator-associated pneumonia. This study aimed to determine the emergency nurses knowledge about prevention of ventilator-associated pneumonia. MethodsThe present descriptive study was conducted in Iran, from July to October 2018. All the nurses with at least a bachelor degree, who are working in two emergency departments of two teaching hospitals, were asked to participate in this study. The “knowledge about ventilator-associated pneumonia” questionnaire consisting of 9 items was used to assess the knowledge of nurses. The results were analyzed using SPSS-16. ResultsIn total, 53 nurses participated in this study. The mean score of correct answers of nurses to these 9 items was 4.4 ± 1.6. Nurses give the most correct answer to the item about patient's position on the bed so as to reduce the risk of pneumonia with a correct answer of 72.9%. The least correct answer was also given to the item about how humidifier was changed with a correct answer of 1.9%. None of the nurses participating in the study were able to answer all the items correctly. The mean score of knowledge of nurses who had participated in workshops about taking care of patients on mechanical ventilation was significantly higher than those who had not participated in such workshops (4.8 vs. 3.8) (p = 0.045). The mean score of knowledge in nurses who were familiar with the international guidelines for ventilator-associated pneumonia prevention was significantly higher than those who were not familiar with such guidelines (5.1 vs. 4.1) (p = 0.045). ConclusionEmergency nurses participated in this study had inadequate knowledge about the prevention of ventilator-associated pneumonia. Nurse’s knowledge affected by participation in related workshop and familiarity with ventilator-associated pneumonia guidelines. Considering the importance of this issue, it is necessary to improve the knowledge of the emergency nurses in this matter by holding training courses.

Clinical epidemiology and outcomes of ventilator-associated pneumonia in critically ill adult patients: protocol for a large-scale systematic review and planned meta-analysis

BackgroundAn increasing number of studies have investigated the clinical epidemiology and outcomes of ventilator-associated pneumonia (VAP) in intensive care units. However, these findings have not been clearly defined in broad subgroups of mechanically ventilated adults. Hence, this protocol for a systematic review and meta-analysis is designed to better understand the clinical and epidemiological features of VAP in these patient populations by establishing its overall prognosis of and risk factors for morbidity and mortality and to determine the differences in clinical and economic outcomes between VAP and non-VAP patients.MethodsThis present review will systematically search available full-text articles without date and language restrictions and indexed in PubMed, CENTRAL, CINAHL, Web of Science, and EMBASE databases. In addition, reference lists and citations of retrieved articles and relevant medical and nursing journals will be manually reviewed. Supplementary search in other databases involving trials, reviews, and grey literatures, including conference proceedings, theses, and dissertations, will be performed. Study investigators will be contacted to clarify missing or unpublished data. All prognostic studies meeting the pre-defined eligibility criteria will be included. The study selection, risk of bias assessment, data extraction, and grading of the quality of evidence will be carried out in duplicate, involving independent evaluation by two investigators with consensus or a third-party adjudication. The degree of inter-rater agreement will be calculated using the kappa statistic. For meta-analysis, dichotomous and continuous outcome measures will be pooled using odds ratios and standardized mean differences with 95% confidence intervals, respectively. The Mantel-Haenszel or inverse variance methods with random effects model will be used as a guide for analysis. The heterogeneity of each outcome measure will be assessed using both X2 and I2 statistics. In addition, sensitivity and subgroup analyses will be performed to ensure consistency of pooled results. The review protocol described herein is in accordance with the PRISMA-P standards.DiscussionThe investigation of the epidemiological profiles, prognostic factors, and outcomes associated with VAP is critical for the identification of high-risk groups of mechanically ventilated patients and evaluation of possible clinical endpoints. This may provide substantial links for improved VAP prevention practices targeting modifiable risk factors. Implications for future research directions are discussed.Systematic review registrationPROSPERO CRD42017048158

Hippocampal Damage During Mechanical Ventilation in Trendelenburg Position: A Secondary Analysis of an Experimental Study on the Prevention of Ventilator-Associated Pneumonia.

We previously corroborated benefits of the Trendelenburg position in the prevention of ventilator-associated pneumonia (VAP). We now investigate its potential effects on the brain versus the semirecumbent position. We studied 17 anesthetized pigs and randomized to be ventilated and positioned as follows: duty cycle (TI/TTOT) of 0.33, without positive end-expiratory pressure (PEEP), placed with the bed oriented 30° in anti-Trendelenburg (control group); positioned as in the control group, with TI/TTOT adjusted to achieve an expiratory flow bias, PEEP of 5 cm H2O (IRV-PEEP); positioned in 5° TP and ventilated as in the control group (TP). Animals were challenged into the oropharynx with Pseudomonas aeruginosa. We assessed hemodynamic parameters and systemic inflammation throughout the study. After 72 h, we evaluated incidence of microbiological/histological VAP and brain injury. Petechial hemorrhages score was greater in the TP group (P = 0.013). Analysis of the dentate gyrus showed higher cell apoptosis and deteriorating neurons in TP animals (P < 0.05 vs. the other groups). No differences in systemic inflammation were found among groups. Cerebral perfusion pressure was higher in TP animals (P < 0.001), mainly driven by higher mean arterial pressure. Microbiological/histological VAP developed in 0%, 67%, and 86% of the animals in the TP, control, and IRV-PEEP groups, respectively (P = 0.003). In conclusion, the TP prevents VAP; yet, we found deleterious neural effects in the dentate gyrus, likely associated with cerebrovascular modification in such position. Further laboratory and clinical studies are mandatory to appraise potential neurological risks associated with long-term TP.

A quality assessment of evidence-based guidelines for the prevention and management of ventilator-associated pneumonia: a systematic review.

Numerous evidence-based guidelines (EBGs) pertaining to ventilator-associated pneumonia (VAP) have been published by domestic and international organizations, but their qualities have not been reported. A systematic search of the literature was performed up to July 2018 for relevant guidelines. Guidelines were eligible for inclusion if they incorporated recommendation statements for prevention and/or management in adults or children with VAP and were developed on a systematic evidence-based method. Four reviewers evaluated each guideline using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument, which comprises 23 items organized into six domains in addition to two overall items. Thirteen EBGs were identified for review. An overall high degree of agreement among reviewers was reached [intra-class correlation coefficient (ICC), 0.885; 95% CI, 0.862-0.905] during their review. The scores (mean, range) for the six AGREE domains were: scope and purpose (61%, 51-74%), stakeholder involvement (36%, 18-68%), rigor of development (41%, 22-59%), clarity and presentation (56%, 47-71%), applicability (38%, 21-59%) and editorial independence (50%, 0-77%). Only two EBGs (15.4%) were rated "recommended" for clinical practice. Approximately 86% of recommendations were based on moderate or low levels of evidence (levels B-D were 46.2%, 19.0%, and 21.2%, respectively). The recommendations for prevention and management of VAP were similar among the different EBGs. The overall quality of the identified EBGs pertaining to VAP was classified as moderate. The management of VAP varied by guideline. More high-quality evidence is needed to improve guideline recommendations.

Efficacy of toothbrushing procedures performed in intensive care units in reducing the risk of ventilator-associated pneumonia: A systematic review.

The aim of this systematic review (SR) was to assess whether toothbrushing-based oral heath measure (OHM), performed in intensive care units, can reduce the risk of ventilator-associated pneumonia (VAP). Dental biofilm removal has been considered important to prevent VAP. PUBMED, SCOPUS, WEB OF SCIENCE and Cochrane Central Register of Controlled Trials (CENTRAL) databases were searched up to and including December 2018 to identify randomized clinical trials (RCT) on the use of toothbrushing procedures in the prevention of VAP. Search was conducted by two independent reviewers. The risk of bias of each included study was assessed using the Cochrane Collaboration's domain-based, two-part tool. Random effects meta-analyses were conducted thoroughly. Search strategy identified 215 potentially eligible articles, of which 12 RCT were included. All studies evidenced the importance of OHM in mechanically ventilated patients in order to prevent VAP. Seven RCT (58.3%) found some degree of positive association between toothbrushing, alone or associated to oral topical chlorhexidine (CHX), and a potential reduction of mechanical ventilation-related outcomes and dental biofilm/oral bacteria. However, pooled estimates did not identify an additional decrease of VAP incidence for any of the tested procedures (ie, toothbrushing+CHX versus swab/gauze cleaning+CHX or toothbrushing+CHX versus toothbrushing alone or+placebo). Toothbrushing does not seem to promote a reduction of VAP-outcomes compared to swab/gauze cleaning, when topic CHX is applied for oral hygiene of patients submitted to mechanical ventilation.

Lessons learned from a rapid implementation of a ventilator-associated pneumonia prevention bundle.

Ventilator-associated pneumonia (VAP) is a common avoidable healthcare associated infection in ventilated critical care patients that can have a detrimental impact on patient recovery. To increase uptake at a local level, care bundles should be designed and implemented in collaboration with the end-users who will implement the bundle into practice. The aim in this study was to evaluate critical care nurses' perceptions of the usability of a respiratory care bundle as an effective approach to VAP prevention. An exploratory descriptive qualitative study was conducted. A respiratory care bundle consisting of five components was implemented over a 4-week period. Following implementation, a focus group and semi-structured interviews were conducted to obtain nurses' feedback on the useability of the care bundle. Seven intensive care nurses caring for ventilated patients participated in the study. Participants confirmed that using a care bundle provided a structured approach to nursing care of a ventilated patient and that the use of checklist reminders at the bedside was useful in a busy practice environment. Barriers to uptake and implementation of the bundle were that the unit culture did not prioritise preventative care and the need for a structured interdisciplinary approach to sedation and weaning of mechanical ventilation. To successfully imbed all elements of a respiratory care bundle into practice; an interdisciplinary approach is needed in which there is a strong emphasis on preventative care. These findings highlight the advantages of involving end-users in the development of strategies to decrease VAP.

Evaluating probiotics for the prevention of ventilator-associated pneumonia: a randomised placebo-controlled multicentre trial protocol and statistical analysis plan for PROSPECT

IntroductionVentilator-associated pneumonia (VAP) is the most common healthcare-associated infection in critically ill patients. Prior studies suggest that probiotics may reduce VAP and other infections in critically ill patients; however, most...

CLINICAL, LABORATORY CHARACTERISTICS AND TREATMENT RESULTS OF VENTILATOR-ASSOCIATED PNEUMONIA AT HUE UNIVERSITY OF MEDICINE AND PHARMACY HOSPITAL

Background: Ventilator-associated pneumonia (VAP) are frequently nosocomial infections at intensive care units (ICU). VAP result in increasing ICU stay, cost and mortality rate. Microorganisms which caused VAP were variety, change of state continously with high rate antibiotic-resistance. For the high quality of treatment therapy, physians must be care about etiology, clinical and laboratory characteristics of VAP for prevention and target treatment. Objectives: To describe the clinical and laboratory characteristics of VAP and comment the result of VAP treatment. Materials and method: Cross-section study of 30 patients who were diagnosed VAP from 04/01/2017 to 04/01/2018 at Anesthesia and Critical Care Department of Hue University of Medicine and Pharmacy Hospital. Results: Mean age of patients was 72.3 ± 14.3. Early VAP was 30%, lately VAP was 70%. Fever and increase mucus sputum were main clinical characteristics of VAP. Microorganisms which caused disease were A. baumannii, S. aureus, P. aeruginosa and Enterobacter spp with high rate antibiotic resistance. Mean mechanical ventilation was 16.8 ± 9.3 days. Mean ICU treatment was 23.7 ± 11.7 days. The mortality of VAP was 46.6%. Conclusion: VAP caused increase ICU stay and mortality rate of patients. It’s essential in a bundle care for VAP prevention and early treatment based on VAP etiology. Key words: Ventilator-associated pneumonia (VAP)

Lack of bundled care intervention training program will trip up rates of ventilator associated pneumonia: the contemporary trend

Background: Ventilator associated pneumonia (VAP) is the deadliest hospital acquired infection in many low resource settings of developing countries. For VAP prevention, the concept of bundle of care was defined. Evidence based resources showed it enabled great successes in VAP prevention. It has been observed in clinical practice due to insufficient compliance, there is a need to address related issues in order to define easier-to-apply procedures.Methods: It is a retrospective analytical secondary data based study. It was conducted in a tertiary care hospital of Bhopal city.Results: T value of Mann Whitney/U test was found to be statistically significant and is indicating need of “Bundle Care Intervention” training for the prevention of increase in ventilator associated pneumonia rates in any health care setting.Conclusions: Expanded bevy of options related to infect

Risk Factors of Ventilator-Associated Pneumonia in Critically III Patients.

Ventilator-associated pneumonia (VAP), a hospital acquired pneumonia that occurs more than 48 h after mechanical ventilation, is a common complication of mechanical ventilation with a high mortality rate. VAP can cause patients to have difficulty weaning off the ventilator and to stay in the hospital longer, which results in a huge financial burden to patients and a huge demand for medical resources. Several strategies, such as drugs including chlorhexidine, β-lactam antibiotics and probiotics, have been used to prevent VAP in clinic. The incidence and the mortality rate of VAP have been decreased with the development of preventative strategies in the past decades, but VAP remains one of the most common causes of nosocomial infections and death in the intensive care unit. Current challenges in the management of VAP involved the lack of a gold standard for diagnosis, the absence of effective preventative strategies, and the rise in antibiotic resistance. Therefore, in order to reduce the incidence of VAP and improve the outcome of patients with mechanical ventilation, it is necessary to clarify the risk factors of VAP for clinical prevention and control of VAP. This paper reviews the international risk factors of VAP occurrence reported in recent years, including patient characteristics, increased mechanical ventilation time and prolonged length of hospital stay, disorders of consciousness, burns, comorbidities, prior antibiotic therapy, invasive operations, gene polymorphisms, and mentions the corresponding preventive measures. Each factor is not only an independent risk factor of VAP, but also has an influence on each other. A better understanding of risk factors for VAP is helpful for predicting the occurrence of VAP, improving the prevention and control of VAP, and reducing the morbidity and mortality rates of patients with VAP.

Investigating the Role of Subglottic Secretions Suctioning in the Prevention of ‎Ventilator Associated Pneumonia in Patients With Invasive Mechanical ‎Ventilation

BACKGROUND: development of ventilator associated pneumonia (VAP) leads to &amp;lrm;prolonged hospital stay, increased health care cost, and mortality rates. Subglottic &amp;lrm;secretion drainage through a dedicated endotracheal tube has been advocated as a mean &amp;lrm;to decrease the incidence of VAP and thereby assisting in &amp;lrm;the decrease of morbidity associated with invasive mechanical ventilation.&amp;lrm;&#x0D; &#x0D; OBJECTIVE: Investigate the role of subglottic secretion suctioning in the prevention of VAP in mechanically ventilated patients in intensive care unit.&amp;lrm;&#x0D; &#x0D; METHODS: A cross sectional study done in the intensive care unit of Ghazi Al-Hariri &amp;lrm;hospital for surgical specialties in medical city complex, 30 patients who &amp;lrm;are in need for invasive mechanical ventilation were intubated with endotracheal tube &amp;lrm;that have special port for subglottic secretion suctioning. Daily monitoring of patients &amp;lrm;clinical and radiological data to detect features of VAP was &amp;lrm;done, and if there was a suspicion of pneumonia, culture for tracheal aspirate performed &amp;lrm;to confirm diagnosis.&amp;lrm;&#x0D; &#x0D; RESULTS: &amp;lrm;Patient&amp;rsquo;s age was 37.1 &amp;plusmn; &amp;lrm;&amp;lrm;15.39 years, the highest proportion of study patients was found in &amp;lrm;age group &amp;lt; 30 and &amp;lrm;&amp;lrm;30&amp;ndash;49 years (40% in &amp;lrm;each group), most of the patients were males (70%) with a male to female ratio of &amp;lrm;&amp;lrm;2.33:1&amp;lrm;&amp;rlm;, &amp;rlm;Subglottic secretion suctioning lead to reduction in VAP by relative risk (95%CI) of &amp;rlm;&amp;lrm;0.167 (0.045&amp;ndash;0.559)&amp;lrm;&amp;rlm;, p-&amp;rlm;value = 0.001. &amp;rlm;Twenty eight patients didn&amp;rsquo;t show any sign, symptoms &amp;lrm;or radiological features suggesting a &amp;lrm;diagnosis of pneumonia while two patients developed &amp;lrm;features of pneumonia (suggestive signs and &amp;lrm;symptoms, radiological features and &amp;lrm;positive culture of tracheal aspirate).&amp;lrm;&#x0D; &#x0D; CONCLUSION: the use of endotracheal tube with subglottic &amp;lrm;secretions suctioning can have a role in the prevention of VAP in mechanically ventilated patients.&amp;lrm;

Adhesión al bundle de prevención de neumonía asociada a la ventilación mecánica

Introducción: Evaluar la adhesión y el cumplimiento de las prácticas que conforman el bundle de prevención de la Neumonía Asociada a la Ventilación Mecánica en una Unidad de Terapia Intensiva de adulto. Materiales y Métodos: Se trata de un estudio descriptivo con enfoque prospectivo, en el que se hizo seguimiento a los pacientes internados en la Unidad de Cuidados Intensivos de una Fundación Pública, bajo ventilación mecánica, en los meses de octubre a noviembre de 2017. La muestra fue no probabilística y correspondió a la observación de los cuidados que conforman el Protocolo de Prevención de Neumonía Asociada a la Ventilación Mecánica. Resultados: Se observaron 30 pacientes bajo ventilación mecánica, para un total de 44 días de observación, durante los que se realizaron 2.002 observaciones. Durante el período de estudio, 3 (50%) de las prácticas se mantuvieron por encima del 80% de la adhesión, lo que demuestra la importancia del monitoreo de los cuidados incluidos en el bundle. Discusión y Conclusiones: Se observó que el cumplimiento de algunas prácticas se encuentra por debajo de lo esperado, lo que demuestra la necesidad de estrategias educativas que promuevan la calidad de todos los cuidados.&#x0D; Como citar este artigo: Barros FRB. Adesão ao bundle de prevenção de pneumonia associada à ventilação mecânica. Rev Cuid. 2019; 10(2): e746. http://dx.doi.org/10.15649/cuidarte.v10i2.746

Characteristics, diagnosis and treatment of the most common bacterial diseases of the oral cavity

Billions of microorganisms can be found in the oral cavity, from which bacteria are the most frequent. More than 600 bacterial species can be isolated. Most of them are harmless, moreover, some species prove themselves to be specifically useful. However, in the case of a weakened immune status or inappropriate oral hygiene, they may cause many types of soft and hard tissue disorders. Caries and periodontal diseases are the most common bacterial diseases of the oral cavity. In both cases, the dental biofilm gives rise to the disorder, which is caused by the insufficient oral hygiene. Dental caries are mainly caused by cariogenic streptococci and lactobacilli. In the case of serious periodontal diseases, anaerob parodonto-pathogen microorganisms play the major role. Untreated caries may result in the necrosis of the pulp, which can cause an inflammation expanding towards the parodontium. This can be characterized as a focal infection, like the untreated periodontal pockets. Dental foci may have lots of systemic consequences such as cardiovascular diseases, diabetes, pneumonia, arthritis, preterm birth and alopecia areata. When these diseases occur, dental foci should always be considered. The professional plaque control and chlorhexidine rinsing before the proposed surgeries have an outstanding role in the prevention of ventilator-associated pneumonia. Oral cancer is multicausal; more and more researchers are analyzing the role of certain bacteria in the carcinogenesis of oral cancer. In addition to the mentioned clinical aspects, we are planning to describe the relatively rare, but diverse and diagnostically challenging bacterial soft tissue disorders in another publication. Orv Hetil. 2019; 160(19): 739-746.

What US hospitals are currently doing to prevent common device-associated infections: results from a national survey

BackgroundDespite focused initiatives to reduce device-associated infection among hospitalised patients, the practices US hospitals are currently using are unknown. We thus used a national survey to ascertain the use of...

Prevalence of Ventilator Associated Pneumonia in Neonates in A Tertiary Care Hospital in Western Nepal

Ventilator-associated pneumonia is a serious problem which needs to be addressed for a better outcome of the ventilated babies. The present study is undertaken to find out the prevalence of ventilator-associated pneumonia in neonates in a tertiary care hospital in western Nepal. A descriptive cross-sectional study was carried out in a tertiary care hospital in the western region of Nepal from March 2016 to February 2019 after approval from the Institutional review committee. Sample size was calculated and convenience sampling was done to reach the sample size. Data were collected from hospital records and entered in Statistical Package for the Social Sciences, point estimate at 95% confidence interval was calculated along with frequency and proportion for binary data. Out of 95 patients ventilated in neonatal intensive care unit in the last 3 years, 23 (24.01%) developed ventilator-associated pneumonia. Prevalence of ventilator-associated pneumonia is 23 (24.01%) at 95% (14%-34%). Late onset ventilator associated pneumonia was seen in 15 (15.78%) while early onset ventilator associated pneumonia was seen in 8 (8.42%). Prevalence of ventilator associated pneumonia in neonates in tertiary care hospital is high compared to other studies conducted in neonates.

Strategies for preventing ventilator-associated pneumonia: an integrative review.

to identify studies about strategies for prevention of ventilator-associated pneumonia deployed in health services and classify their level of evidence. integrative review of the literature, in 7 databases, which included the following descriptors: Prevention and Control AND Pneumonia Ventilator-Associated AND Intensive Care Units AND Bundle AND Patient Care. twenty-three scientific productions were included. Of the preventive measures identified, 9 (39.1%) correspond from three to five strategies. The most frequent were: 22 (95.6%) lying with head elevated, 19 (82.6%) oral hygiene with chlorhexidine and 14 (60.8%) reduction of sedation whenever possible. the application of measures based on scientific evidence is proven to be effective when carried out in conjunction, impacting the reduction of the incidence of ventilator-associated pneumonia.