Efficacy of an expanded ventilator bundle for the reduction of ventilator-associated pneumonia in the medical intensive care unit

Blamoun, John; Alfakir, Maria; Rella, Marie E.; Wojcik, Janice M.; Solis, Roberto; Khan, Muhammad Anees; DeBari, Vincent A.

doi:10.1016/j.ajic.2008.05.010

Cited by 65 publications

(42 citation statements)

References 9 publications

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“…There is no consensus on the ideal set of interventions to include in VAP prevention bundles [85][86][87]. Different institutions have developed their own protocols [15][16][17][18][19][20][21].…”

Section: Bundlesmentioning

confidence: 99%

“…The most famous bundle, that of the Institute for Healthcare Improvement, includes elevating the head of the bed, thromboembolism prophylaxis, stress ulcer prophylaxis, daily sedative interruption and daily assessment of patients' readiness to wean from mechanical ventilation. Some institutions, however, take issue with specific components of the bundle (stress ulcer prophylaxis, for example, is associated with an increased risk of hospital-acquired pneumonia and Clostridium difficile infections [13,14]), add additional components (such as frequent oral care with chlorhexidine) or embrace complementary interventions such as selective oral or digestive decontamination, continuous aspiration of subglottic secretions or silver-coated endotracheal tubes [15][16][17][18][19][20][21].…”

mentioning

confidence: 99%

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Prevention of ventilator-associated pneumonia

Klompas¹

2010

Expert Review of Anti-infective Therapy

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Section: Bundlesmentioning

confidence: 99%

mentioning

confidence: 99%

Prevention of ventilator-associated pneumonia

Klompas¹

2010

Expert Review of Anti-infective Therapy

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“…The authors 7 hypothesized that suctioning and/or coughing induced after the instillation of physiological saline may have contributed to the reduced risk for infection. Blamoun et al 8 included regular endotracheal suctioning, defined as suctioning every 4 hours, as part of an expanded ventilator bundle and were successful in reducing the rates of ventilator-associated pneumonia to zero. However, which intervention contributed to the reduction in the rate of pneumonia is not known.…”

Section: Introductionmentioning

confidence: 99%

Clinical Indicators for Endotracheal Suctioning in Adult Patients Receiving Mechanical Ventilation

Sole

Bennett

Ashworth

2015

American Journal of Critical Care

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A closed-book, multiple-choice examination following this article tests your under standing of the following objectives:1. Identify the recommended assessment parameters to determine the need for endotracheal suctioning in patients receiving mechanical ventilation. 2. Explain the potential for inaccurate assessment of the need for endotracheal suctioning based on the most frequently used clinical indicators. 3. Discuss which clinical assessments, according to study findings, best indicate the need for endotracheal suctioning, and why.To read this article and take the CE test online, visit www.ajcconline.org and click "CE Articles in This Issue. " No CE test fee for AACN members.Background Critically ill patients who need mechanical ventilation require endotracheal suctioning. Guidelines recommend coarse crackles over the trachea and/or the presence of a sawtooth pattern on the flow-volume loop of the ventilator waveform as the best indicators. Objective To determine clinical cues for endotracheal suctioning in patients who require mechanical ventilation. Methods A descriptive study of 42 adult patients receiving mechanical ventilation. After baseline endotracheal suctioning with a closed-system device, patients were assessed hourly up to 4 hours for guideline-based cues for endotracheal suctioning and lung sounds were auscultated. Endotracheal suctioning was done when cues were detected or 4 hours after baseline suctioning. Secretions were collected, measured, and weighed. Results Most patients were male (62%) and white (93%). Mean age was 51 years, and mean duration of mechanical ventilation was 7.5 days. The median time to endotracheal suctioning was 2 hours, and a mean of 4.4 mL of secretions was removed. Three patients had no cues identified but had 1.0 mL or more of secretions. The most frequent cues were crackles over the trachea (88%), sawtooth waveform (33%), coughing (29%), and visible secretions (5%). Cues resolved and physiological parameters improved after suctioning. Coarse lung sounds did not improve.Conclusions Patients receiving mechanical ventilation should be routinely assessed for coarse crackles over the trachea, the most common indicator for endotracheal suctioning. Despite common practice, assessment of lung sounds to identify the need for suctioning is not supported. by AACN on May 11, 2018 http://ajcc.aacnjournals.org/ Downloaded from C ritically ill patients treated with mechanical ventilation require an artificial airway, either an endotracheal tube or a tracheostomy tube. These patients often retain tracheobronchial secretions because of impaired cough reflex, decreased mucociliary clearance, and, possibly, increased mucus production. Endotracheal suctioning is essential to remove retained tracheobronchial secretions, and nurses and respiratory care practitioners assume the responsibility for removal. The 2010 clinical practice guidelines 1 for endotracheal suctioning of the American Association of Respiratory Care specify that endotracheal suctioning should be done when clinically ind...

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“…Several educational program have reduced VAP rate such as Zack et al by 57%, 17 Babcock et al by 38-61%, 18 Apisarnthanarak et al by 59%, 16 Salahuddin et al by 51%, 57 Leblebicioglu et al by 46%, 20 Bouadma et al by 43%, 58 Blamoun et al by 100%, 59 Berriel-Cass et al by 60% 60 Lansford et al by 59.4%, 61 and International Nosocomial Infection Control Consortium (IN-ICC) multimodal program by 30.7-79% in several studies. 21,23,[62][63][64] The discrepancy between the adherence rate to VAP preventive practices and VAP rate reduction in those studies precluded any relation between the adherence to our VAP bundle and VAP rate reduction in this study.…”

Section: -50mentioning

confidence: 99%

http://openventio.org/Volume1_Issue1/The_Impact_of_VAP_Staff_Education_on_VAP_Morbidity_and_Mortality_in_Alexandria_University_PRRMOJ_1_105.pdf

EH¹,

AM²,

TH³

et al. 2014

Pulm Res Respir Med Open J

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CitationElmenshawy AM, Elbadawy TH, Abu khaber H, Hafez SF, Fayed AM, Ibrahim EH. The impact of VAP staff education on VAP morbidity and mortality in Alexandria University. ResearchPage 32 ABSTRACT Background: Staff education had several success stories in reducing Ventilator-associated Pneumonia (VAP) rate. However, the stability of supplies and the top management support were not addressed in most of these studies. In addition, both were considered essential in several reviews. Aim: To determine the efficiency (VAP rate) and efficacy (mechanical ventilation morbidity and mortality) of VAP staff education with deficient supplies and lack of top management support. Methods: Quasi-experimental study with before and after prospective cohort in two medical/ surgical ICUs of Alexandria university affiliated hospitals during the period from September 2007 till May 2013. The intervention phase included the provision of supplementary supplies, interactive education for physicians and nurses followed by a VAP campaign. All VAP episodes not only the first one was included. Results: A total of 598 patients were enrolled in the study. The adherence to expanded VAP bundle significantly increased in the post-intervention phase as follows; head of bed elevation (from mean of 40 to 100% with p=0.001), oral care (from mean of 20 to 100% with p=0.001), daily sedation vacation (from mean of 56.5 to 91% with p=0.001), daily assessment of weaning (from mean of 9 to 25% with p=0. 03), peptic ulcer prophylaxis (from mean of 83 to 100% with p=0.001), DVT prophylaxis (from mean of 82 to 100% and p=0.001), cuff pressure measurement (from mean of 9 to 60% with p=0.001), and hand hygiene (from mean of 8 to 28.5% with p=0.001).The VAP rate decreased significantly by 35% (from 66.5 to 43 per 1000 MV days) with p= 0.002 and CI 9.73-37.15 in spite of significant increase of the ventilator utilization ratio (p <0.001) in the post-intervention phase. The MV, antibiotic and ICU days did not change significantly in the post-intervention phase. The distribution of organisms did not differ significantly between both groups (p=0. 465). The sensitivity of most of carbapenems and β-lactam/β-lactamase inhibitors to Acinetobacter, Klebsiella andPseudomonas decreased significantly in the post intervention phase whereas the sensitivity of vancomyicin to Staphylococcus aureus remained the same. Conclusions: In spite of the lack of top management support and fluctuating supplies, VAP staff education was still efficient in reducing VAP without affecting mortality or MV days or ICU length of stay.

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Efficacy of an expanded ventilator bundle for the reduction of ventilator-associated pneumonia in the medical intensive care unit

Cited by 65 publications

References 9 publications

Prevention of ventilator-associated pneumonia

Prevention of ventilator-associated pneumonia

Clinical Indicators for Endotracheal Suctioning in Adult Patients Receiving Mechanical Ventilation

http://openventio.org/Volume1_Issue1/The_Impact_of_VAP_Staff_Education_on_VAP_Morbidity_and_Mortality_in_Alexandria_University_PRRMOJ_1_105.pdf

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