Impact of four sequential measures on the prevention of ventilator-associated pneumonia in cardiac surgery patients

Abstract

IntroductionVentilator-associated pneumonia (VAP) is the most frequent infection in patients admitted to intensive care units.The efficacy of individual measures for the prevention of VAP is well documented, and data on the impact of implementing bundle measures have usually been reported from studies in which several measures are implemented simultaneously in the general intensive care unit (ICU).The objective of our work was to evaluate the impact of four sequentially implemented measures for preventing VAP in a major heart surgery ICU. The measures were a specific training program, aspiration of subglottic secretions (ASSs), introduction of an inclinometer to improve the semirecumbent position, and reinforcement of oral care with chlorhexidine.MethodsWe compared rates of VAP, days on mechanical ventilation (MV), and cost of antimicrobial agents before and during implementation.ResultsWe collected data from 401 patients before the intervention and from 1,534 patients during the intervention. Both groups were comparable. No significant differences in EuroSCORE were observed between the patients of both periods (6.4 versus 6.3; P = 0.7). The rates of VAP (episodes/1,000 days of ventilation) were, respectively, 23.9 versus 13.5 (P = 0.005). Mean number of days of MV/1,000 days of stay was 507 versus 375 (P = 0.001), and the cost of antimicrobial therapy (Euros/1,000 days of stay) was €70,612 versus €52,775 (P = 0.10). The main effect of sequential application of preventive measures in time achieved a relative-rate reduction of VAP of 41% (IRR, 0.41; 95% CI, 0.28 to 0.62). The mortality rate before and during the intervention was 13.0% and 10.2%, respectively.VAP rate was most significantly reduced by training and the use of the inclinometer.ConclusionsA sequentially applied bundle of four preventive measures reduces VAP rates, days of MV, and the cost of antimicrobial therapy in patients admitted to the major heart surgery ICU.Trial registrationClinical Trials.gov: NCT02060045. Registered 4 February 2014.

Infections in patients after Berlin Heart®EXCOR assist device implantation

“…Perioperative antibiotic prophylaxis with cefazolin (3 dosages) or vancomycin (when the patient is allergic to betalactams) was prescribed. All the patients under mechanical ventilation received also appropriate care to avoid ventilator‐associated pneumonia (described elsewhere) as part of our institutional program of ventilator‐associated pneumonia (VAP) prevention . Once the VAD is in place the inflow cannula entrance and outflow cannula exit are systematically clean and swabs were collected for bacterial and fungal culture to exclude cannula colonization, once a week.…”

KPC: an important mechanism of resistance in K. pneumoniae isolates from intensive care units in the Midwest region of Brazil

“…Revisions to protocols associated with ventilatorassociated pneumonia, indwelling catheters, central venous catheters and other preventive measures should be implemented in the studied hospitals to minimize the risk of infection by Kp-MR [29,30].…”

Surveillance of preventive measures for ventilator associated pneumonia (VAP) and its rate in Makkah Region hospitals, Saudi Arabia

“…However, several studies have recommended the use of subglottic secretions drainage and oral care with chlorhexidine to decrease the VAP rate (32,33). In order to eradicate VAP, it is necessary to understand the main risk factors, and therefore implementations of efficient preventive actions against VAP are possible (34).…”