Guidelines for the prevention of ventilator-associated pneumonia and their implementation. The Spanish “Zero-VAP” bundle

Nursing workload and compliance with non‐pharmacological measures to prevent ventilator‐associated pneumonia: a multicentre study

“…Before the observation period, all ICU staff nurses completed a knowledge questionnaire. Both ICUs had carried out educational programmes on VAP prevention consisting of 60‐min lectures on non‐pharmacological measures for VAP prevention; moreover, both ICUs had participated in the Spanish national ‘Zero‐VAP’ programme the year before (Álvarez Lerma et al, ). The nation‐wide ‘Zero‐VAP’ programme sought to reduce the mean incidence of VAP to nine episodes per 1000 days of mechanical ventilation.…”

“…Ventilator‐associated pneumonia (VAP) is the most common severe infectious complication of mechanical ventilation; reported incidences range from 1·2 to 18·3 episodes per 1000 days of mechanical ventilation, varying depending on the study population, the definition used for the diagnosis (Magill et al, ; Skrupky et al, ) and the preventive measures applied in the reporting intensive care unit (ICU) (Álvarez Lerma et al, ; Sinuff et al, ). Likewise, the mortality attributable to VAP varies widely, initially ranging from 33% to 50%, although recent studies have reported much lower values, ranging from 6% to 13% (Melsen et al, ; Melsen et al, ; Timsit et al, ).…”

“…Nurses play a crucial role in non‐pharmacological preventive measures that are directly related to extrinsic risk factors. However, despite evidence‐based guidelines (Álvarez Lerma et al, ; Tablan et al, ), the application of these measures remains inadequate, and various studies show heterogeneous practices and insufficient compliance with the guidelines (Akın Korhan et al, ; Jansson et al, ; Lawrence and Fulbrook , ). Among the reasons that nurses report for failing to apply scientific evidence in their practice are routine‐based, rather than evidence‐based, working arrangements, lack of knowledge, demotivation, lack of time, excessive workloads and aspects related to the working environment and organizational structure of the system (Ali et al, ; Hassan and Wahsheh, ; Hugonnet et al, ; Jansson et al, ; Stone et al, ).…”

Combatting resistance in intensive care: the multimodal approach of the Spanish ICU “Zero Resistance” program

“…“Zero Bacteremia” and “Zero VAP” were both promoted by the Spanish Ministry of Health, more than 200 ICUs participated, and the programs consisted of the implementation of evidence-based infection prevention bundles for catheter-related bloodstream infection and VAP. Highly successful results for both initiatives confirmed that these practices could be systematically implemented across Spain, could reduce the rates of these infections and could contribute to diminish antimicrobial use in the participating ICUs [12,13]. …”

Subglottic secretion suction for preventing ventilator-associated pneumonia: an updated meta-analysis and trial sequential analysis

“…SSS has been recommended in several guidelines to prevent the occurrence of VAP [9, 10]. Previous meta-analyses reported that SSS was associated with a lower rate of VAP [11–16].…”