Implementation and Enforcement of Ventilator-Associated Pneumonia Prevention Strategies in Trauma Patients

Heimes, Jessica; Braxton, Carla C.; Nazir, Niaman; Shik, Nina; Carlton, Elizabeth; Lansford, Todd; Alley, John R.; McDonnell, Jessica; Rogers, Tracy; Moncure, Michael

doi:10.1089/sur.2009.028

Cited by 18 publications

(15 citation statements)

References 21 publications

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“…11-14,22 While a causal inference remains elusive, these bundles are likely effective, because they provide a clear and manageable set of expectations in a complex health care environment. Bundles help providers translate evidence into practice by summarizing and simplifying the strongest evidence, and providing reminders to adhere to evidence-based practices.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, a 7-item VAP prevention protocol decreased VAP in trauma patients, but the origins of this protocol are not described. 14 In contrast, the development of a European VAP prevention bundle that uses multi-criteria decision analysis (MCDA) is described in detail; 4 however, this bundle may not reflect the perceptions of US providers.…”

Section: Discussionmentioning

confidence: 99%

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A systematic approach for developing a ventilator-associated pneumonia prevention bundle

Speck

Rawat

Weiner

et al. 2016

American Journal of Infection Control

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Background Ventilator-associated pneumonia (VAP) is among the most common health care associated infections in the intensive care unit, and is associated with significant morbidity and mortality. Existing VAP prevention intervention bundles vary widely on the interventions included, as well as in the approaches used to develop these bundles. Objective To develop a new VAP prevention bundle using a systematic approach that elicits clinician perceptions on which interventions are most important and feasible to implement. Methods We identified potential interventions to include through a review of current guidelines and literature. We implemented a two-step modified Delphi method to gain consensus on the final list of interventions. An interdisciplinary group of clinical experts participated in the Delphi process, which was guided by a technical expert panel. Results We identified 65 possible interventions. Through the Delphi method, we narrowed that list to 19 interventions that included 5 process and 14 structural measures. Conclusion We described a structured approach for developing a new VAP prevention bundle. Obtaining clinician input on what interventions to include increases the likelihood that providers will adhere to the bundle.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A systematic approach for developing a ventilator-associated pneumonia prevention bundle

Speck

Rawat

Weiner

et al. 2016

American Journal of Infection Control

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“…Secondly, controversial issues of practice aimed at reducing nosocomial infection like the timing of tracheostomy, trans-pyloric feeding, stress ulcer prophylaxis, and early extubation take on a new importance. (32, 33) Most studies have concluded that early vs. late tracheostomy in the setting of severe TBI does not change mortality, however, there is converging evidence showing that early tracheostomy decreases ventilation days (34) and evidence-based protocols for early extubation can decrease incidence of pneumonia. (32, 33) We cannot comment widely, however, on the mechanism that may underlie the long-term effect of HAP.…”

Section: Discussionmentioning

confidence: 99%

Hospital-acquired pneumonia is an independent predictor of poor global outcome in severe traumatic brain injury up to 5 years after discharge

Kesinger

Kumar

Wagner

et al. 2015

Journal of Trauma and Acute Care Surgery

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Objectives Long-term outcomes following traumatic brain injury (TBI) correlate with initial head injury severity and other acute factors. Hospital-acquired pneumonia (HAP) is a common complication in TBI. Little information exists regarding the significance of infectious complications on long-term outcomes post-TBI. We sought to characterize risks associated with HAP on outcomes 5 years post-TBI. Methods Ddata from the merger of an institutional trauma registry and the TBI Model Systems outcome data. Individuals with severe head injuries (Abbreviated Injury Scale≥4), who survived to rehabilitation were analyzed. Primary outcome was Glasgow Outcome Scaled-Extended (GOSE) at 1, 2, and 5 years. GOSE was dichotomized into LOW (GOSE<6) and HIGH (GOSE≥6). Logistic regression was utilized to determine adjusted odds of LOW-GOSE associated with HAP after controlling for age, sex, head and overall injury severity, cranial surgery, Glasgow Coma Scale (GCS), ventilation days, and other important confounders. A general estimating equation (GEE) model was used to analyze all outcome observations simultaneously while controlling for within-patient correlation. Results A total of 141 individuals met inclusion criteria, with a 30% incidence of HAP. Individuals with and without HAP had similar demographic profiles, presenting vitals, head injury severity, and prevalence of cranial surgery. Individuals with HAP had lower presenting GCS. Logistic regression demonstrated that HAP was independently associated with LOW-GOSE scores at follow-up (1year: OR=6.39, 95%CI: 1.76-23.14, p=0.005; 2-years: OR=7.30, 95%CI 1.87-27.89, p=0.004; 5-years: OR=6.89, 95%CI: 1.42-33.39, p=0.017). Stratifying by GCS≤8 and early intubation, HAP remained a significant independent predictor of LOW-GOSE in all strata. In the GEE model, HAP continued to be an independent predictor of LOW-GOSE (OR: 4.59; 95%CI: 1.82-11.60′ p=0.001). Conclusion HAP is independently associated with poor outcomes in severe-TBI extending 5 years post-injury. This suggests precautions should be taken to reduce the risk of HAP in individuals with severe-TBI. Level III Retrospective Study Pneumonia TBI

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“…Two studies provided data on program infrastructure costs, and 1 study estimated reductions in total costs for patients requiring long-term mechanical ventilation and reductions in direct cost per case. 15,16 Strategies to Improve Adherence…”

Section: Resultsmentioning

confidence: 99%

Strategies to Enhance Adoption of Ventilator-Associated Pneumonia Prevention Interventions: A Systematic Literature Review

Goutier

Holzmueller

Edwards

et al. 2014

Infect. Control Hosp. Epidemiol.

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Implementation and Enforcement of Ventilator-Associated Pneumonia Prevention Strategies in Trauma Patients

Cited by 18 publications

References 21 publications

A systematic approach for developing a ventilator-associated pneumonia prevention bundle

A systematic approach for developing a ventilator-associated pneumonia prevention bundle

Hospital-acquired pneumonia is an independent predictor of poor global outcome in severe traumatic brain injury up to 5 years after discharge

Strategies to Enhance Adoption of Ventilator-Associated Pneumonia Prevention Interventions: A Systematic Literature Review

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