Effectiveness of a multidimensional approach for prevention of ventilator-associated pneumonia in adult intensive care units from 14 developing countries of four continents

Rosenthal, Víctor D.; Rodrigues, Camilla; Álvarez-Moreno, Carlos; Madani, N.; Mitrev, Zan; Ye, Guxiang; Salomão, Reinaldo; Ülger, Fatma; Garcell, Humberto Guanche; Kanj, Souha S.; Cuéllar, Luis; Higuera, Francisco; Mapp, Trudell; Fernández-Hidalgo, Rosalía

doi:10.1097/ccm.0b013e3182657916

Cited by 123 publications

(86 citation statements)

References 47 publications

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“…18,48 A recent study by the International Nosocomial Infection Control Consortium (INICC) that used the CDC/NHSN diagnostic criteria (and employed intensive preventive measures) reported a 22% relative reduction in VAP; nonetheless, VAP rates remained 5 times higher than in the United States. 45 Interestingly, the INICC post-intervention rates are similar to those reported in Europe, where, until approximately 2012, public reporting of VAP was not required in many countries (Fig. 2).…”

Section: Socioeconomic Context Of Ventilator-associated Pneumonia Repsupporting

confidence: 62%

“…99 In a contemporaneous survey of clinicians, the average duration of weaning ranged from 5 to 18 d, with the longest duration associated with synchronized intermittent mandatory ventilation combined with pressure support ventilation. 100 However, more contemporary studies have reported that the average duration of mechanical ventilation now is ϳ5-7 d. 45,46,[101][102][103] This invites speculation that the incidence of VAP likely was much greater before modern weaning and sedation practices.…”

Section: Weaning and Sedation Strategiesmentioning

confidence: 99%

“…35 The response to these trends in the medical literature has been one of pervasive skepticism. 26,27,33,[36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51] In fact, VAP experts have pointedly criticized the growing misperception that administrative surveillance methods reflect the true incidence of ventilatorassociated tracheobronchitis/VAP. 29 This skepticism is buttressed by observations that validation studies examining surveillance techniques have found that infection-control surveyors miss almost one third of VAP cases.…”

Section: Socioeconomic Context Of Ventilator-associated Pneumonia Repmentioning

confidence: 99%

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The Vexing Problem of Ventilator-Associated Pneumonia: Observations on Pathophysiology, Public Policy, and Clinical Science

Kallet

2015

Respir Care

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SummaryVentilator-associated pneumonia (VAP) is an acquired infection related primarily to the consequences of prolonged endotracheal intubation. It is considered the most important infectious challenge in the critical care setting. Preventable complications of hospital care are considered an important source of wasted health-care costs believed to consume up to 47% of annual expenditures in the United States. Whether VAP is preventable has become a highly contentious debate since public reporting commenced a decade ago. This selective review focuses on specific aspects of this debate, including the inherent vagaries in the diagnosis of VAP and the marked disparities between VAP rates based on clinical diagnosis versus surveillance data. Also discussed is how this debate has impacted public policy, leading to the new paradigm of ventilator-associated events. The limited ability of artificial airways to prevent microaspiration and biofilm build-up, as well as non-modifiable conditions increasing the risk of VAP, is described in detail. In addition, the origins of the mistaken but widely embraced notion that zero VAP is a realistic achievement are examined.

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Section: Socioeconomic Context Of Ventilator-associated Pneumonia Repsupporting

confidence: 62%

Section: Weaning and Sedation Strategiesmentioning

confidence: 99%

Section: Socioeconomic Context Of Ventilator-associated Pneumonia Repmentioning

confidence: 99%

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The Vexing Problem of Ventilator-Associated Pneumonia: Observations on Pathophysiology, Public Policy, and Clinical Science

Kallet

2015

Respir Care

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“…The introduction of preventive recommendations and monitoring of respiratory tract infections associated with mechanical ventilation is an element of surveillance in patients undergoing mechanical ventilation. These approaches decrease infection incidence, shorten hospitalisations, reduce treatment costs and improve patient safety [15,16].…”

mentioning

confidence: 99%

Monitorowanie zapalenia płuc związanego z wentylacją mechaniczną według projektu INICC — doświadczenia jednego ośrodka

Duszyńska¹,

Rosenthal²,

Dragan³

et al. 2015

Anaesthesiol Intensive Ther

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Background: Pneumonia is a common complication of hospitalisation in severely ill patients who need mechanical ventilation. The aim of this study was to assess the usefulness of the International Nosocomial Infection Control Consortium programme for the surveillance of ventilator-associated pneumonia (VAP). Methods: A prospective study (1 Jan 2012−30 June 2014) was conducted in the 20-bed ICU. The device utilisation ratios for lung ventilation and the frequency (density and incidence) and aetiology of VAP were estimated in ICU patients. Results: From a total of 1097 patients, VAP infections were diagnosed in 93. Thirty percent of patients with VAP died. The incidence index was 8.47 per 100 admissions to the ICU. VAP infections accounted for 46% of the overall count of device-associated healthcare-associated infections. Mechanical ventilation was used in 71 ± 8 patients during the 11 862 patient days and 8425 ventilation days. The rate of VAP per 1000 ventilator days was 11.15/9.34/10.23 in years 2012/2013/2014 (half a year), respectively. The main VAP pathogens were Acinetobacter baumannii (45%) and Pseudomonas aeruginosa (17%). Conclusion: During the reported time span, the incidence of VAP was lower than in the INICC report (2007−2012), but it was tenfold higher than in the NHSN/CDC report (dated 2012). Because of the unchanged VAP level during the 2.5-year observation period, the root cause needs to be determined and action should be taken to resolve this issue.

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“…Implementation by Rosenthal et al [7] of the multi-dimensional approach to VAP of the International Nosocomial Infection Control Consortium (INICC) produced notable differences in the incidence of VAP (a 55.8% reduction) in both developed and developing countries, with rates three-to five-fold lower in health care settings with limited resources after the program was implemented. Multi-faceted approaches were the most successful, although without regular reinforcement efforts, the gains they produced were short-lived.…”

Section: Surveillance and Intervention Bundles For Ventilator-associamentioning

confidence: 99%

Management of Infections in Critically Ill Patients

Hranjec

Sawyer

2014

Surgical Infections

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Background: Critically ill patients have an increased risk of developing infections and infectious complications, sometimes followed by death. Despite a substantial investment of resources in outcomes improvement, optimum treatment for such patients remains unclear for practicing intensivists. Methods: We conducted a review that highlights the most recent developments in the prevention, diagnosis, and management of infection and the evaluation of its outcomes. The review examines the prevention of infection, such as through daily bathing with chlorhexidine and the addition of probiotics to treatment regimens, and questions the previous standards of care, including the monitoring of gastric residuals and treatment of severely ill patients with drotrecogin alfa (activated). It also discusses novel approaches to the treatment of severely ill infected patients with extra-corporeal membrane oxygenation and the earlier normalization of body temperature. Results: The development of new antibiotics continues at a slow pace, with the likelihood that alternative approaches to the management of infection, including changes in the quality of patient care, are producing needed improvements. Conclusions: Clinical outcomes of infection are improving slowly as medical teams strive for better patient care. Lack of reimbursement is unnecessary as a punitive approach to infectious diseases.

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Effectiveness of a multidimensional approach for prevention of ventilator-associated pneumonia in adult intensive care units from 14 developing countries of four continents

Cited by 123 publications

References 47 publications

The Vexing Problem of Ventilator-Associated Pneumonia: Observations on Pathophysiology, Public Policy, and Clinical Science

The Vexing Problem of Ventilator-Associated Pneumonia: Observations on Pathophysiology, Public Policy, and Clinical Science

Monitorowanie zapalenia płuc związanego z wentylacją mechaniczną według projektu INICC — doświadczenia jednego ośrodka

Management of Infections in Critically Ill Patients

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