Ventilator-associated Pneumonia Prevention Bundle Research Articles

The Impact of Nursing Education on Ventilator-Associated Pneumonia Prevention Bundle to Reduce Incidence of Infection: A Quality Improvement Project.

Ventilator-associated pneumonia (VAP) is a health care-acquired infection that leads to poor patient outcomes, increased length of hospital stay, exhaustion of health care resources, and unnecessary increases in health care costs. This project was designed to educate registered nurses on the importance of an evidence-based VAP prevention bundle that reduces the overall incidence of VAP infections. Patients (N = 146) were enrolled in this quasi-experimental project that took place in a 14-bed neuro trauma surgical burn intensive care unit (ICU) at a level 1 trauma center. Data were collected from the chart review of patients admitted to the neuro trauma surgical burn ICU prior to and after nursing education intervention. The difference in VAP rate and enhanced nursing knowledge were the primary outcome measures. Data suggest improvement in several patient outcomes. Ventilator days were shortened from 17.45 days to 13.42 days (P = .085), and ICU length of stay decreased from 24.77 days to 17.62 days (P = .035). Patient laboratory data show improved white blood cell values (P < .001), less oxygen requirements (P < .001), and fewer patients meeting the diagnostic criteria for VAP (P = .073). Results suggest there were no statistically significant changes in the knowledge of registered nurses or oral care bundle compliance; however, improvements in patient data following the provider education suggest that continued education to nursing staff will have a positive impact on reducing hospital stay and significant costs associated with a VAP infection.

The Effect of Ventilator-Associated Pneumonia Prevention Bundles on Ventilator-Associated Event Rate in the Intensive Care Units of a Tertiary Care Hospital

Amaç: Ventilatör ilişkili pnömoni (VİP) önlem demetlerine uyum ile VİP insidansının azaldığı gösterilmiştir. Ancak bu demetlerin Ventilatör ilişkili olay (VİO) insidansına olan etkisi hala tartışmalıdır. Bu çalışmanın amacı, bir eğitim araştırma hastanesinin yoğun bakım ünitelerinde (YBÜ) belirli bir dönemdeki VİO insidansı ve VİP önleme demetine uyumun araştırılmasıdır. Materyal ve metod: Bu çalışma, üçüncü basamak bir eğitim ve araştırma hastanesinin YBÜ’ lerinde Nisan - Haziran 2019 arasında VİO insidansı ve VİP önleme demetlerine uyumun araştırıldığı prospektif gözlemsel bir vaka kontrol çalışmasıdır. VİP önleme demeti oluşturuldu; VİO insidansı ise 2013 Amerika Birleşik Devletleri Hastalık Kontrol ve Önleme Merkezi (CDC) sürveyans kriterlerine göre belirlendi. Hasta özelliklerinin ve YBÜ’ lerdeki hasta dağılımının ve VİO gelişimi üzerine etkileri araştırıldı. Bulgular: Araştırma 98 hasta ile tamamlandı. VİP önleme demetlerine uyum oranının YBÜ’ ler arasında %65 ile %85 arasında değiştiği saptandı. VİP önleme demetine uyumdaki her %10 azalmanın VİO gelişme riskini artırdığı diğer önemli risk faktörleri ile gösterildi. Sonuç: Hastanemiz YBÜ’ lerinde 2013 CDC kriterlerine göre VIO insidansı %20,4’tür. VIO gelişme riski, VİP önleme demetine düşük uyum, hasta özellikleri ve YBÜ tedavilerinden kaynaklanan birçok faktör ile artmaktadır. YBÜ’ lerinde VİP önlem demetlerine uyum bakımından farklılıklar konu ile ilgili eğitim faaliyetlerinin gerekliliğini göstermektedir.

The ongoing challenge of ventilator-associated pneumonia: epidemiology, prevention, and risk factors for mortality in a secondary care hospital intensive care unit

Ventilator-associated pneumonia (VAP) is a leading cause of morbidity and mortality among intensive care unit infections. Despite various preventive measures, the incidence of VAP remains high. This study aimed to explore the epidemiology and risk factors for VAP associated mortality in a secondary care hospital, comparing outcomes before and after implementing a VAP prevention bundle. This retrospective study was conducted from July 1, 2021, to June 30, 2023, at a secondary care hospital. Patients over 18 years old who underwent mechanical ventilation for more than 48 hours were included. The study compared the incidence, microbiological etiology, and outcomes of VAP before and after implementing the VAP prevention bundle and analyzed risk factors for mortality from VAP. A total of 83 patients diagnosed with VAP were included. Despite concerted efforts to implement the VAP prevention bundle, there was no significant decrease in the VAP rate per 1000 ventilator days, early-onset VAP, secondary bloodstream infections, acute respiratory distress syndrome, and 30-day mortality. The microbiological etiology of VAP remained consistent between the two periods. A decrease in lymphocyte count and albumin level were identified as independent risk factors for 30-day mortality. Concerted efforts to implement a VAP prevention bundle did not significantly reduce the incidence or improve outcomes of VAP in this secondary care hospital setting. The microbiological etiology remained unchanged. Monitoring lymphocyte count and albumin level may help identify patients at high mortality risk. Further research is needed to develop more effective VAP prevention and management strategies.

Knowledge Regarding Evidence-Based Guidelines on Ventilator-Associated Pneumonia Prevention Bundle among Critical Care Nurses

Background: In critical care units, ventilator-associated pneumonia is still a frequent and possibly fatal consequence of ventilator therapy. Choosing the most urgent care and knowing how to prevent ventilator-associated pneumonia may help nurses become more alert, which will improve the quality of care and prevent a serious problem in Nepal. Thus, this study aimed to assess the knowledge regarding evidence-based guidelines on ventilator-associated pneumonia prevention bundle among critical care nurses.&#x0D; Materials and Methods: Data were collected through a self-administered structured questionnaire using the non-probability total enumerative sampling technique among 132 critical care nurses. Data analysis was carried out using SPSS version 20. For descriptive statistics frequency, percentage, mean, and standard deviation were calculated. For inferential statistics, the Chi-square test was used to find out the association between the levels of knowledge regarding Evidence-Based Guidelines on the VAP Prevention Bundle among Critical Care Nurses.&#x0D; Results: One hundred and thirty-two critical nurses participated in this study. 51.5 % had a poor level of knowledge, whereas, 45.5 % had an average level of knowledge and only 3.0 % had a good level of knowledge. There was a statistically significant association between the level of knowledge and the respondents’ working experience.&#x0D; Conclusion: According to the study's findings, the majority of respondents had inadequate knowledge. Regular formal training and interactive educational sessions are required to evaluate knowledge of the VAP prevention bundle, particularly in light of the high nurse turnover rate.

Causative bacteria of ventilator-associated pneumonia in intensive care unit in Bahrain: Prevalence and antibiotics susceptibility pattern.

Ventilator-associated pneumonia (VAP) is defined as pneumonia that occurs two calendar days following endotracheal intubation or after that. It is the most common infection encountered among intubated patients. VAP incidence showed wide variability between countries. To define the VAP incidence in the intensive care unit (ICU) in the central government hospital in Bahrain and review the risk factors and the predominant bacterial pathogens with their antimicrobial susceptibility pattern. The research was a prospective cross-sectional observational study over six months from November 2019 to June 2020. It included adult and adolescent patients (> 14 years old) admitted to the ICU and required intubation and mechanical ventilation. VAP was diagnosed when it occurred after 48 h after endotracheal intubation using the clinical pulmonary infection score, which considers the clinical, laboratory, microbiological, and radiographic evidence. The total number of adult patients admitted to the ICU who required intubation and mechanical ventilation during the study period was 155. Forty-six patients developed VAP during their ICU stay (29.7%). The calculated VAP rate was 22.14 events per 1000 ventilator days during the study period, with a mean age of 52 years ± 20. Most VAP cases had late-onset VAP with a mean number of ICU days before the development of VAP of 9.96 ± 6.55. Gram-negative contributed to most VAP cases in our unit, with multidrug-resistant Acinetobacter being the most identified pathogen. The reported VAP rate in our ICU was relatively high compared to the international benchmark, which should trigger a vital action plan for reinforcing the implementation of the VAP prevention bundle.

Analysis on the knowledge of the ventilator-associated pneumonia prevention bundle at a teaching hospital in Distrito Federal

Introduction: Healthcare services have implemented major improvements in adherence to measures to prevent healthcare-associated infections. Ventilator-associated pneumonia (VAP) is among the most common infections in adult intensive care units (ICU). Objective: To analyze the knowledge of healthcare professionals about the Ventilator-Associated Pneumonia Prevention bundle in the Adult Intensive Care Unit of a Teaching Hospital in the Federal District (DF). Method: A quasi-experimental research of quantitative nature. A questionnaire was applied to 93 health professionals in the ICU (physicians, nurses, physical therapists, nursing technicians and dentists), with questions about the items of the VAP prevention bundle, from August to October 2022. Results and Discussion: the overall average of correct answers was 74.6%. Final considerations: Healthcare professionals considered that among the difficulties mentioned to perform VAP prevention care, the most difficult was to maintain the adequate position of the filter and trachea and to perform oral hygiene. Therefore, it is considered that the bundle alone does not ensure the reduction of VAP rates, and should be implemented together with a group of actions with the same objective.

SG-APSIC1064: The role of infection control activities on healthcare-associated infections during 2017-2021 at intensive care units in Cho Ray Hospital

Objectives: Healthcare-associated infections (HAIs) are one of the greatest challenges and concerns in Vietnam and around the world. Many studies have shown that HAIs may result in an increase in hospital length of stay, antibiotic use, multidrug-resistant organism (MDROs) infections, treatment costs, and mortality. Therefore, in the past 5 years, the Department of Infection Control of Cho Ray Hospital has carried out many infection and prevention control (IPC) activities to reduce the rates of HAI and MDRO infection. We evaluated IPC activities and results achieved in these efforts at Cho Ray Hospital during 2017–2021. Methods: We described the implemented IPC activities and retrospectively collected data from HAIs surveillance reports during 2017–2021 for 3 intensive care units (ICUs): ICU-B, ICU-D, and the NICU. Results: In the past 5 years, we implemented synchronous IPC activities, including promoting hand hygiene training and surveillance, environmental cleaning surveillance, carrying out improvement projects such as a ventilator-associated pneumonia (VAP) prevention bundle, an MDRO prevention bundle, and an environmental cleaning quality improvement project. Many positive results were achieved, although a slight increase in the HAI incidence occurred in 2021 due to the COVID-19 pandemic. Overall, the hand hygiene compliance rate increased from 49.7% to 83.8%. The rate of HAIs per 1,000 patient days decreased steadily from 5.4 to 2.4. The VAP rate fell from 30.5 to 17.2 per 1,000 patient days, and the central-line–associated bloodstream infection (CLABSI) rate decreased gradually from 5.4 to 2.4 per 1,000 patient days. The catheter-associated urinary tract infection (CAUTI) rate decreased from 2.9 to 0.9 per 1,000 patient days, and the MDRO infection rate decreased significantly from 32.7 to 11.3 per 1,000 patient days. Conclusions: The synchronous implementation of HAI prevention bundles promoting hand hygiene and environmental cleaning achieved significant effects in the efforts to decrease HAIs and MDROs in the ICUs of Cho Ray Hospital.

Implementation of Ventilator-Associated Pneumonia Prevention Bundle among ICU Nurses in Salmaniya Medical Complex, Bahrain: A Quasi-Experimental Study

Objective: To evaluate the effectiveness of an educational intervention to improve the knowledge regarding ventilator-associated pneumonia (VAP) and practices of VAP prevention bundle among the intensive care unit (ICU) nurses in Salmaniya Medical Complex in Bahrain. Methods: A quasi- experimental study was conducted in the main ICU of Salmaniya Medical Complex in Bahrain from October 2021 to January 2022. A convenience sampling technique was used, and 58 ICU staff nurses were enrolled in the study. Tools used for data collection were a self-administered questionnaire to assess ICU nurses knowledge and an observational checklist to assess the adherence of ICU nurses to the VAP prevention bundle. Results: Of 58 total study subjects, almost three-quarters of the ICU nurses 42 (72%) had poor knowledge of VAP prior to the educational intervention. However, after the implementation, the proportion increased with 46 (79%) of the nurses acquiring good knowledge about the VAP and 56 (97%) of the ICU nurses acquiring good knowledge of the VAP prevention bundle. Overall, there was a significant improvement in the median score of adherences to the VAP prevention bundle elements before and after the intervention (p-value ≤ 0.05). Conclusion: This study concluded that the levels of knowledge about VAP and practices of the VAP prevention bundle can be improved by implementing a relevant educational program for ICU nurses. The findings of this study also provide evidence of the importance of a continuous training program for ICU nurses to ensure quality patient care in the critical care units.

Effect of an educational intervention on compliance with care bundle items to prevent ventilator-associated pneumonia

ObjectivesWe aimed to evaluate the effectiveness of our ventilator-associated pneumonia prevention bundle implemented by education of the nursing staff, and to describe the tendency of knowledge retention. Research methodologyA prospective, before-and-after study was performed. The ventilator-associated pneumonia prevention bundle was implemented through a single educational intervention of the nursing staff. The risk of ventilator-associated pneumonia over time was estimated using a Cox proportional cause-specific hazard model. Compliance to preventive measures was assessed at three time-points: before education, at three months and 12 months after education. SettingA 29-bed mixed medical-surgical intensive care unit. Main outcome measuresVentilator-associate pneumonia incidence densities, the risk of ventilator-associated pneumonia, and compliance to preventive measures in the pre-implementation and post-implementation periods. ResultsWe analyzed the data of 251 patients. The incidence density of pneumonia decreased from 29.3/1000 to 15.3/1000 ventilator-days after the implementation of the prevention program. Patients in the post-implementation period had significantly lower risk to develop pneumonia (hazard ratio 0.34, 95 % confidence interval 0.19–0.61, p = 0.001). At 3 months of implementation, a significant improvement was detected to all the individual bundle components. Complete compliance increased from 16.2 % to 62.2 % (p < 0.001). Compliance with bundle components decreased to baseline levels after 12 months of implementation apart from head-of-bed elevation. ConclusionThis study supports existing evidence that educational interventions improve compliance. The gained knowledge was well translated into clinical practice reflected by the decreasing ventilator-associated pneumonia rate. It may be assumed that a refresher educational session within 12 months after implementation is needed.

Efficacy of Modified Ventilator-Associated Pneumonia Prevention Bundles on Ventilator-Associated Pneumonia Incidence Rate in the Intensive Care Unit

Ventilator-associated pneumonia (VAP) is defined as pneumonia that develops in an intubated patient after 48 h of mechanical ventilation. In India, there is a paucity of literature in terms of compliance to VAP prevention bundles and their benefits. The aim of this study was to compare the reduction of VAP incidence rates amongst patients who received existing VAP prevention bundles and modified VAP prevention bundles. This pilot study was conducted in the adult intensive care unit of a tertiary care hospital. There were 60 patients in all, 30 patients in each group. The diagnosis of VAP was based on the clinical presentation and correlation with Clinical Pulmonary Infection Score. The incidence of VAP was 3/435 ventilator days (6.80%) in the patients receiving a modified VAP prevention bundle. In the conventional VAP prevention bundle group, the incidence of VAP was six episodes per 439 ventilator days (13.60%). Our study concluded that the modified VAP prevention bundle is effective in reducing the incidence of VAP amongst intubated patients.

Effects of Ventilator-Associated Pneumonia Among Saudian’s Critically Ill Patients, Systemic Review

Introduction: Mechanically ventilated patients are vulnerable to infectious diseases, such as ventilator-associated pneumonia (VAP), due to the breach of normal defence mechanisms and relative immune paralysis during ventilation. This study aimed to determine the risk factors for developing VAP among ventilated patients, as well as the incidence and effects of VAP in Saudi Arabia. Methods: A systematic review design was used. The included studies were published after 2015 in the English language and relevant to the topic of concern. Results: Eleven articles were selected for inclusion in the study. The incidence of VAP in Saudi Arabia was low during the study period. Risk factors for developing VAP included a lack of adequate nurse training, a failure to closely supervise ventilated patients, chest and rib injuries, reintubation, the supine position, and old age. VAP led to increased rates of sepsis, multi-drug-resistant infections, mortality, and longer ICU and hospital stays, as well as developing complications Conclusion: The use of the VAP prevention and treatment bundle and other strategies reduced the risk of ventilated patients developing VAP.

Impact of the COVID-19 Pandemic on Levels of Device-Associated Infections and Hand Hygiene Compliance.

BackgroundHealthcare-associated infections (HAIs) have been a major issue in intensive care units (ICUs), contributing to increased morbidity and mortality. They affect patients during the delivery of health care in hospitals where such infections were not present at the time of admission. Meanwhile, the course of coronavirus disease 2019 (COVID-19) may necessitate the transfer of critically ill patients to ICUs. Patients who need ICU services due to COVID-19 share similar underlying comorbidities, making them prone to microbiological infection. We aim to investigate the impact of the COVID-19 emergence period on device-associated infections (DAIs), the compliance of healthcare workers with hand hygiene, and other prevention bundles in ICU.Materials and methodsThis retrospective observational study analyzes secondary data from the infection control department in a single 500-bed hospital, including 80 adult ICU beds. DAI data from 2019, the pre-COVID-19 period, were compared to DAI data during the pandemic in 2020. In addition, prevention bundles and hand hygiene (HH) compliances for the same periods (before and after the COVID-19 pandemic) were compared.ResultsNo significant impact was statistically detected in monthly and yearly comparisons of DAIs between 2019 and 2020. Similarly, HH compliance analysis revealed no significant difference between the two periods (p-value > 0.05). However, the data distribution for HH compliance displays a narrower range of measures. Nevertheless, only compliance with ventilator-associated pneumonia (VAP) prevention bundle of 2020 notably improved in comparison to 2019.ConclusionThe impact of the COVID-19 pandemic was not evident over the DAIs. However, the compliance of healthcare workers to prevention bundles and HH in ICU was improved. Strict following and adherence to infection prevention and control (IPC) measures generally reduce the event of DAIs even on a non-significant scale.

Improvement of the nurses' awareness toward ventilator-associated pneumonia based on evidence guidelines

Background: Ventilator Associated Pneumonia (VAP) is a common hospital acquired infection that occurs as complication in patients who are connected to Mechanical Ventilation (MV). Nurses in intensive care unit (ICU) should be updated with the latest evidence-based practice to prevent such complication. This study aimed to assess improvement of the nurses' awareness toward ventilator-associated pneumonia based on latest evidence guidelines. Methods: A quantitative pretest-posttest design has been conducted. Using a convenience sample of 58 nurses who are working in the ICU were recruited. Tools: A self-administrative questionnaire was adapted to assess the nurse's knowledge about VAP and VAP prevention bundle. Results: The results highlighted that all ICU nurses had improvement of knowledge level pre-post regarding VAP (p <0.001), VAP prevention (p <0.001), and the overall knowledge score improvement revealed significantly higher after the educational program (p <0.001). Conclusion: Periodic refreshing on-services education program should be provided to nurses in ICU to improve their knowledge and to maintain high level of information, moreover hospital policies should include updated guidelines for VAP prevention bundle and protocol from international evidence.

Comparison of three interventional approaches to prevent ventilator-associated pneumonia in intensive care units (ICUs): A clinical trial study.

Background: Ventilator-associated pneumonia (VAP) is an infectious pulmonary disease that develops after 48 hours of ventilation. To date, several methods have been proposed to reduce VAP occurrence, such as the VAP prevention bundle, which involves raising the head of the bed, reducing sedation, avoiding deep vein thrombosis, and preventing peptic ulcer in the gastrointestinal system. The purpose of this study was to evaluate the role of personnel in hand washing, case airway suctioning, and systematic monitoring in the prevention of VAP.Methods: In the current clinical trial, 129 patients hospitalized and intubated at Vali-e-Asr Hospital ICU in Arak, Iran, were included in the study and randomized to one of the three VAP prevention methods: group A, VAP prevention bundle measures; group B, group A measures plus washing of patients’ mouth with 0.12% chlorhexidine and suction of secretion every six hours; and finally group C, group B measures plus 72-hour suction package. Demographic information, VAP diagnosis, and outcome of each patient were recorded in the special checklist.Results: The age of the patients ranged from 18 years to 93 years with a mean of 54.6 ± 21.8 years. There was no significant difference in age, sex, Clinical Pulmonary Infection Score (CPIS), and Glasgow Coma Scale (GCS) between the three groups. However, there is a significant relationship between chest X-ray (CXR) index and pneumonia in the three groups (p < 0.05). The prevalence of pneumonia is generally seen to be higher in patients who were local, diffuse, or patchy than those who had no infiltration (p < 0.05).Conclusion: This study showed that the application of VAP prevention bundle measures, mouthwash with chlorhexidine, personnel hand washing, airway suctioning, and systematic monitoring is an efficient approach to the prevention of VAP in ICUs.

Preventive bundle approach decreases the incidence of ventilator-associated pneumonia in newborn infants.

ObjectiveWe hypothesized that the implementation of evidence-based interventions shaping a bundle approach could significantly reduce the incidence of ventilator-associated pneumonia (VAP) in the neonatal intensive care unit.Study designWe conducted a prospective observational cohort study including neonates undergoing mechanical ventilation >48 h. VAP rate and endotracheal intubation ratio were compared before (pre-period) and after (post-period) applying VAP prevention bundle strategies.ResultOne hundred seventy-four neonates were included in pre-period (30 months) and 106 in post-period (17 months). Demographic characteristics were comparable and device use ratios were similar. Twenty-eight VAP episodes were diagnosed, 25 in the first period and 3 after the implementation of prevention bundle. This represents a reduction in the incidence rate from 11.79 to 1.93 episodes/1000 ventilator days (p < 0.01).ConclusionThe implementation of an educational evidence-based program using a bundle approach to prevent VAP has shown a statistically significant reduction in its incidence density.

Knowledge of Nurses Working in Critical Care Areas Regarding Ventilator Associated Pneumonia Prevention Bundles in a Tertiary Level Cardiac Centre

Introduction: Prevention of ventilator associated pneumonia (VAP) is influenced by the knowledge and practices of nurses. This study was conducted to assess the knowledge of nurses working in critical care areas of a tertiary level cardiac centre regarding VAP prevention bundles. Methods: In this descriptive study, 57 nurses working in critical care areas were included, they completed a self-administered questionnaire containing demographic information followed by 18 multiple response questions. With the respondents choosing one or more correct answers, the percentage of correct answer for each options was obtained. For each questions, the correct percentage for all the options were averaged and expressed as average knowledge percent. The significance of association was tested using chi-square and Fisher exact test, with level of significance established at 95%. Data analysis was done using SPSS version 21. Results: With a mean age of 26.8 years, the majority of the nurses had completed Bachelor’s degree (75.4%). Though 91.3% nurses had experience of more than a year in critical care, 87.7% of them had not obtained VAP or infection control training. The mean knowledge score of VAP was 70±7.5%, and 97.4% had satisfactory knowledge. There was no association between knowledge scores on prevention of VAP and educational qualification (p=0.26) and years of experience in intensive care unit (p=0.41). Conclusion: Almost all of the nurses working in critical care areas had satisfactory knowledge regarding VAP bundle, however, they had lower knowledge on the definition and approach to prevent VAP. This study recommends to incorporate more nurses in training related to infection and VAP prevention.

Knowledge of Nurses Working in Critical Care Areas Regarding Ventilator Associated Pneumonia Prevention Bundles in a Tertiary Level Cardiac Centre

Introduction Prevention of ventilator associated pneumonia (VAP) is influenced by the knowledge and practices of nurses. This study was conducted to assess the knowledge of nurses working in critical care areas of a tertiary level cardiac centre regarding VAP prevention bundles.&#x0D; MethodsIn this descriptive study, 57 nurses working in critical care areas were included, they completed a self-administered questionaire containing demographic information followed by 18 multiple response questions. With the respondents choosing one or more correct answers, the percentage of correct answer for each options was obtained. For each questions, the correct percentage for all the options were averaged and expressed as average knowledge percent. The significance of association was tested using chi-square and Fisher exact test, with level of significance established at 95%. Data analysis was done using SPSS version 21.&#x0D; ResultsWith a mean age of 26.8 years, the majority of the nurses had completed Bachelor’s degree (75.4%). Though 91.3% nurses had experience of more than a year in critical care, 87.7% of them had not obtained VAP or infection control training. The mean knowledge score of VAP was 70±7.5%, and 97.4% had satisfactory knowledge. There was no association between knowledge scores on prevention of VAP and educational qualification (p=0.26) and years of experience in intensive care unit (p=0.41).&#x0D; ConclusionAlmost all of the nurses working in critical care areas had satisfactory knowledge regarding VAP bundle, however, they had lower knowledge on the definition and approach to prevent VAP. This study recommends to incorporate more nurses in training related to infection and VAP prevention.

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.

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.

Prevention of Ventilator-Associated Pneumonia in the Intensive Care Unit: A Review of the Clinically Relevant Recent Advancements

Ventilator-associated pneumonia (VAP) is one of the most commonly encountered hospital-acquired infections in intensive care units and is associated with significant morbidity and high costs of care. The pathophysiology, epidemiology, treatment and prevention of VAP have been extensively studied for decades, but a clear prevention strategy has not yet emerged. In this article we will review recent literature pertaining to evidence-based VAP-prevention strategies that have resulted in clinically relevant outcomes. A multidisciplinary strategy for prevention of VAP is recommended. Those interventions that have been shown to have a clinical impact include the following: (i) Non-invasive positive pressure ventilation for able patients, especially in immunocompromised patients, with acute exacerbation of chronic obstructive pulmonary disease or pulmonary oedema, (ii) Sedation and weaning protocols for those patients who do require mechanical ventilation, (iii) Mechanical ventilation protocols including head of bed elevation above 30 degrees and oral care, and (iv) Removal of subglottic secretions. Other interventions, such as selective digestive tract decontamination, selective oropharyngeal decontamination and antimicrobial-coated endotracheal tubes, have been tested in different studies. However, the evidence for the efficacy of these measures to reduce VAP rates is not strong enough to recommend their use in clinical practice. In numerous studies, the implementation of VAP prevention bundles to clinical practice was associated with a significant reduction in VAP rates. Future research that considers clinical outcomes as primary endpoints will hopefully result in more detailed prevention strategies.