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2011, Number 4

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Enf Infec Microbiol 2011; 31 (4)

Ventilator-associated pneumonia in an Intensive Care Unit, before and after an intervention

Barrita OHB, Aguilar MG, Zamudio LI, Martínez MB, Alvarado DMA, Miranda NMG

Language: Spanish
References: 30
Page: 114-120
PDF size: 167.20 Kb.


ABSTRACT

Introduction. Ventilator-associated pneumonia (VAP) is one of the main health-care associated infections. objective. To compare the incidence of VAP in two time periods, before and after an intervention, in order to implement a bundle of preventive measures.
Material and methods. Design: temporal series. In the first period (January to July 2007), an educational intervention was performed with the health care workers of the pediatric intensive care unit. Second period (January to July 2011). In both periods the compliance with preventive measures was registered, and the incidence of VAP/1000 ventilator-days was compared.
Results. The compliance was evaluated in 100 patients for the first period, and 50 patients in the second period. 50% of the patients were admitted to receive postoperative care. Intensive care unit stay was longer for patients in the first period (median 8 vs 4 days). Compliance with eight preventive measures was 79% in the first period, and 70% in the second period, difference was not statistically significant (OR 1.61, IC95% 0.69-3.74, p=0.22). Incidence of VAP was 26.51/1000 ventilatordays in the first period in comparison with 7.5 /1000 ventilator-days for the second one, with a statistically significant difference: AR reduction 72.33% (CI 95% 62.55-2.11), RR reduction 76% (CI 95% 24-92), p = 0.009.
Conclusions. Implementation of a bundle of preventive measures was effective to reduce VAP incidence. A feedback system is necessary to improve compliance with some measures.


REFERENCES

  1. Rosenthal V, Maki DG, Jamulitrat S, Medeiros EA, Todi SK, Yepes Gomez D, et al. “International Nosocomial Infection Control Consortium (INICC) report, data summary for 2003-2008, issued June 2009”. Am J Infect Control 2010; 38: 95-106.

  2. Díaz E, Planas K, Rello J. “Infecciones asociadas a dispositivos utilizados para la ventilación asistida”. Enferm Infecc Microbiol Clin 2008; 26: 465-470.

  3. Daren K. Debora J. “Prevention of ventilator-associated pneumonia: Current practice in Canadian intensive care units”. J Crit Care 2002; 17: 161-167.

  4. NOM-045-SSA2-2005 para la vigilancia epidemiológica, prevención y control de las infecciones nosocomiales. Diario Oficial de la Federación.

  5. Heather JZ, Cotton MK. “Nosocomial pneumonia in pediatric patients: practical problems and rational solutions”. Pediatric Drugs 2002; 4: 73-83.

  6. Rello J, Lode H, Cornaglia G, Masterton. “A European care bundle for prevention of ventilator- associated pneumonia”. Intensive Care Med 2010; 773-780.

  7. Ángeles Garay U, Zacate Palacios Y, López Herrera JR, Hernández Sánchez EA, Jaril Quijada MD, Alcantar Curiel MD. “Brote de Neumonía asociada a ventilador por Staphylococcus aureus meticilino resistente en una unidad de cuidados intensivos de adultos”. Enf Inf Microbiol 2011; 31: 17-25.

  8. Li Bassi G, Zanella A, Cressoni M, Stylianou M, Kolobow T. “Following tracheal intubation, mucus flow is reversed in the semirecumbent position: Possible role in the pathogenesis of ventilator- associated pneumonia”. Crit Care Med 2007; 36: 518-525.

  9. Centers for Disease Control and Prevention. “Guidelines for preventing health-care-associated pneumonia, 2003: recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee”. MMWR Recomm Rep 2004; 53(RR-3): 1-36.

  10. Resar R, Pronovost P, Haraden C, Simmonds T, Rainey T, Nolan T. “Using a bundle approach to improve ventilator care processes and reduce ventilator-associated pneumonia”. Jt Comm J Qual Patient Saf 2005; 31: 243-248.

  11. Di Filippo A, Casini A, De Gaudio AR. “Infection prevention in the intensive care unit: Review of the recent literature on the management of invasive devices”. Scand J Infect Dis 2011; 43: 243-250.

  12. Gurskis V, Asembergiene J, Kevalas R, Miciuleviciene J, Pavilonis A, Valinteliene R, et al. “Reduction of nosocomial infections and mortality attributable to nosocomial infections in pediatric intensive care units in Lithuania”. Medicina (Kaunas) 2009; 45: 203- 213.

  13. Korbkitjaroen M, Vaithayapichet S, Kachintorn K, Jintanothaitavorn D, Wiruchkul N, Thamlikitkul V. “Effectiveness of comprehensive implementation of individualized bundling infection control measures for prevention of health care-associated infections in general medical wards”. Am J Infect Control 2011; 39: 471-476 DOI: 10.1016/j.ajic.2010.09.017

  14. Kollef MH, Afessa B, Anzueto A, Veremakis C, Kerr KM, Margolis BD, et al. “Silver-coated endotracheal tubes and incidence of ventilator-associated pneumonia: the NASCENT randomized trial”. JAMA 2008; 300: 805-813.

  15. Smet AM de, Kluytmans JA, Cooper BS, Mascini EM, Benus RF, van der Werf T, et al. “Decontamination of the digestive tract and oropharynx in ICU patients”. N Engl J Med 2009; 360: 20-31.

  16. Aly H, Badawy M, El-Kholy A, Nabil R, Mohamed A. “Randomized, controlled trial on tracheal colonization of ventilated infants: can gravity prevent ventilator-associated pneumonia?” Pediatrics 2008; 122: 770-774.

  17. Díaz Ramos R, Solórzano Santos F, Padilla BG, Miranda Novales MG, González R, Trejo y Pérez JA. “Infecciones nosocomiales. Experiencia en un hospital pediátrico de tercer nivel”. Salud Pública de Méx 1999; 41: S12-S17.

  18. Barcelos R, Miranda-Novales MG. “Factores de riesgo para letalidad en pacientes con neumonía nosocomial en la unidad de terapia intensiva”. Tesis para obtener el diploma de especialista en Medicina del paciente pediátrico en estado crítico. México, Facultad de Medicina, UNAM, 2005.

  19. “Registros de la División de Epidemiología Hospitalaria”. Unidad Médica de Alta Especialidad, Hospital de Pediatría, Centro Médico Nacional, Siglo XXI IMSS.

  20. Aguilar Martínez G, Miranda Novales MG, Alvarado Díez MA. “Impacto de la implementación de medidas de prevención para la neumonía nosocomial asociada a ventilador en pacientes pediátricos de la unidad de terapia intensiva pediátrica, UMAE Centro Médico Nacional Siglo XXI”. Tesis para obtener el título de especialista en Medicina del paciente pediátrico en estado crítico. México, Facultad de Medicina UNAM 2008. http: //p8080-132.248.9.195.pbidi.unam.mx: 8080/tesdig2/Procesados_tesis_2009/marzo/0641471/Index.html

  21. Tablan OC, Anderson LJ, Besser R, et al; CDC; Healthcare Infection Control Practices Advisory Committee. “Guidelines for preventing health-care-associated pneumonia, 2003: recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee”. MMWR 2004; 53 (RR-3): 1-36.

  22. Babcock H, Zack J, Garrison T, Trovillion E, Jones M, Fraser V, et al. “An educational intervention to reduce ventilator-associated pneumonia in an integrated health system: A comparison of effects”. Chest 2004; 125: 2224-2231. DOI 10.1378/chest.125.6.2224

  23. Al-Tawfiq. J, Abed M. “Decreasing ventilator-associated pneumonia in adult intensive care units using the Institute for Healthcare Improvement bundle”. Am J Infect Control 2010; 38: 552-556. DOI: 10.1016/j.ajic.2010.01.008

  24. Bird D, Zambuto A, O´Donnell C, Silva J, Korn C, Burke P, et al. “Adherence to ventilator-associated pneumonia bundle and incidence of ventilator- associated pneumonia in the surgical intensive care unit”. Arch Surg 2010; 145 (5): 465-470.

  25. Tolentino- De los Reyes A, Ruppert S, K.Shiao S. “Evidence-based practice: Use of the ventilator bundle to prevent ventilator-associated pneumonia”. Am J Crit Care 2007; 16: 20-27.

  26. Maier R, Mitchell D, Gentilello L. “Optimal Therapy for stress gastritis”. Ann Surg 1994; 3: 353-363.

  27. Pedreira ML, Kusahara DM, de Carvalho WB, Núñez SC, Peterlini MA. “Oral care interventions and oropharyngeal colonization in children receiving mechanical ventilation”. Am J Crit Care 2009; 18: 319-328.

  28. Jácomo AD, Carmona F, Matsuno AK, Manso PH, Carlotti AP. “Effect of oral hygiene with 0.12% clorhexidine gluconate on the incidence of nosocomial pneumonia in children undergoing cardiac surgery”. Infect Control Hosp Epidemiol 2011; 32: 591-596.

  29. Edwards JR, Peterson KD, Andrus ML, Dudeck MA, Pollock DA, Horan TC. “National Healthcare Safety Network (NHSN) report, data summary for 2006 through 2007, issued November 2008”. Am J Infect Control 2008; 36: 609-626.

  30. Brierley J, Highe L, Hines S, Dixon G. “Reducing VAP by instituting a care bundle using improvement methodology in a UK Paediatric Intensive Care Unit”. Eur J Pediatrics 2011. (online first) DOI: 10.1007/s00431-011-1538-y.




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