Implementation of a Ventilator-Associated Pneumonia Prevention Bundle in a Single PICU*

Cristofano, Analía De; Peuchot, Verónica; Canepari, A.; Franco, Victoria; Pérez, Augusto; Eulmesekian, Pablo

doi:10.1097/pcc.0000000000000714

Cited by 26 publications

(38 citation statements)

References 24 publications

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“…The following eight studies involving at least 3,989 participants were included in this systematic review (Azab et al, ; Bigham et al, ; Brierley et al, ; Brilli et al, ; Ceballos et al, ; DeCristofano et al, ; Haque et al, ; Peña‐López et al, ). One study was excluded from counting the number of participants as the authors did not report the sample size (Ceballos et al, ).…”

Section: Resultsmentioning

confidence: 99%

“…One study was excluded from counting the number of participants as the authors did not report the sample size (Ceballos et al, ). Three of the eight studies were cohort studies (Bigham et al, ; Haque et al, ; Peña‐López et al, ), two were following implementation of ventilator bundles studies (Brierley et al, ; Ceballos et al, ), one was a before‐and‐after intervention prospective study (Azab et al, ), one was a retrospective case control study (Brilli et al, ), and one study was a quasi‐experimental uninterrupted time series (DeCristofano et al, ). Of the eight reviewed studies, three were conducted in the United States (Bigham et al, ; Brilli et al, ; Ceballos et al, ), one in the UK (Brierley et al, ), one in Spain (Peña‐López et al, ), one in Argentina (DeCristofano et al, ), one in Egypt (Azab et al, ) and one in Pakistan (Haque et al, ).…”

Section: Resultsmentioning

confidence: 99%

“…Bigham et al (), Brierley et al () and Haque et al () carried out their research in the multidisciplinary PICU. DeCristofano et al () studied the effectiveness of ventilator bundles implemented in the PICU which provides critical care to medical, surgical (neurosurgeries, cardiovascular and general surgeries) and transplant (bone marrow, heart, liver and small bowel transplant) patients. Similarly, Brilli et al (), conducted their research in the PICU which delivers care to critically ill patients with an underlying medical illness, following emergency trauma surgeries, general surgeries and post organ transplantation.…”

Section: Resultsmentioning

confidence: 99%

“…The preintervention and postintervention VAP rates were defined as the number of VAP episodes per 1,000 ventilator days in each of the eight studies. Five of the eight studies (Azab et al, ; Bigham et al, ; Brilli et al, ; DeCristofano et al, ; Peña‐López et al, ) reported the use of ventilator bundles which resulted in statistically significant decreases in VAP rates in the postintervention phases in mechanically ventilated patients in the NICU and PICU. According to the authors, the p ‐value varied from <.0001 to <.028.…”

Section: Resultsmentioning

confidence: 99%

“…However, there are variations in the ventilator bundle interventions implemented to prevent VAP in paediatric populations. For example, De Cristofano et al () suggest daily interruption of sedatives in mechanically ventilated children, whereas Bigham et al () and Brierley et al () do not include daily sedation vacation for sedated paediatric patients in their ventilator bundles.…”

Section: Introductionmentioning

confidence: 99%

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What are the effects of care bundles on the incidence of ventilator‐associated pneumonia in paediatric and neonatal intensive care units? A systematic review

Niedzwiecka

Patton

Walsh

et al. 2019

Specialist Pediatric Nursing

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Purpose The purpose of this review was to ascertain the impact of ventilator bundles on the incidence of ventilator‐associated pneumonia in mechanically ventilated neonates and children in intensive care units. Methods A systematic review was conducted. Key computerised databases (CINAHL, Medline, Embase and Cochrane) as well as additional sources, with no publication date limitations, were extensively searched in January 2018. Inclusion criteria focused on ventilator bundles used in mechanically ventilated neonates and children aged from 0 to 18 years. After identification and inclusion, all studies were critically appraised for quality. Data were analysed and narratively synthesised. Results Eight studies of observational and nonrandomised interventional methods design were included in the review. However, the validity of five of the eight studies which were reviewed was considered substandard. In addition, there were variations in the care bundles elements studied. Nevertheless, all these studies demonstrated that the incidences of VAP in mechanically ventilated neonates and children were found to be significantly reduced by the use of ventilator bundles. Practice Implications This systematic review determines that ventilator bundles impact positively on the incidence of VAP in critically ill neonates and children in the neonatal intensive care unit and paediatric intensive care unit. However, the variations in the bundle elements and insufficient valid evidence necessitates further research in the area to validate the findings and to ensure standardisation of clinical practice. Prevention of VAP is aimed at avoiding the risk of aspiration in the lungs, colonisation of respiratory tract with pathogenic microorganisms and contamination of respiratory equipment. Moreover, the implementation of evidence‐based interventions grouped together is fundamental to improve patient outcomes. It is recommended that a further bona fide research is required to standardise the components of paediatric ventilator bundles.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

What are the effects of care bundles on the incidence of ventilator‐associated pneumonia in paediatric and neonatal intensive care units? A systematic review

Niedzwiecka

Patton

Walsh

et al. 2019

Specialist Pediatric Nursing

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The Impact of Quality Improvement Interventions in Improving Surgical Infections and Mortality in Low and Middle‐Income Countries: A Systematic Review and Meta‐Analysis

et al. 2021

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Background Morbidity and mortality in surgical systems in low-and middle-income countries (LMICs) remain high compared to high-income countries. Quality improvement processes, interventions, and structure are essential in the effort to improve peri-operative outcomes. Methods A systematic review and meta-analysis of interventional studies assessing quality improvement processes, interventions, and structure in developing country surgical systems was conducted according to the Preferred Reporting Items of Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies were included if they were conducted in an LMIC, occurred in a surgical setting, and measured the effect of an implementation and its impact. The primary outcome was mortality, and secondary outcomes were rates of rates of hospital-acquired infection (HAI) and surgical site infections (SSI). Prospero Registration: CRD42020171542. Result Of 38,273 search results, 31 studies were included in a qualitative synthesis, and 28 articles were included in a meta-analysis. Implementation of multimodal bundled interventions reduced the incidence of HAI by a relative risk (RR) of 0.39 (95%CI 0.26 to 0.59), the effect of hand hygiene interventions on HAIs showed a non-significant effect of RR of 0.69 (0.46-1.05). The WHO Safe Surgery Checklist reduced mortality by RR 0.68 (0.49 to 0.95) and SSI by RR 0.50 (0.33 to 0.63) and antimicrobial stewardship interventions reduced SSI by RR 0.67 (0.48-0.93). Conclusion There is evidence that a number of quality improvement processes, interventions and structural changes can improve mortality, HAI and SSI outcomes in the peri-operative setting in LMICs.

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Can We Achieve Zero Hospital-Acquired Pneumonia?

Alves

Peña-López

Rojas

et al. 2018

Curr Treat Options Infect Dis

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Purpose of Review Ventilator-associated pneumonia (VAP) is still a common complication in intensive care units, being associated with higher costs, increasing hospital length of stay, duration of mechanical ventilation and use of antimicrobials. Ventilator care bundles are key measures to patient care quality improvement, and their implementation contributes to the reduction in the incidence of VAP. The current review focuses on preventive measures of VAP and a potential concept of zero VAP rate. Recent Findings Several reports have documented a decrease in VAP rate with the implementation of ventilator care bundles. Despite the improvement on VAP incidence, risk factors to VAP are numerous and although some are preventable, it is unachievable to eliminate the majority. Summary VAP is not always preventable and thus unlikely to reach zero rate. Several reports have documented a decrease in the incidence of VAP when a bundle is implemented. The major restrain to care bundles implementation is adherence; compliance to them is the achieving goal that can be reached by the use of a maximum of five interventions, with a strong effort on multidisciplinary education and continued feedback. Surveillance, prevention, and education remain a priority in critical care in order to minimize VAP.

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Implementation of a Ventilator-Associated Pneumonia Prevention Bundle in a Single PICU*

Abstract: The implementation over 2 years of a ventilator-associated pneumonia prevention bundle specifically adapted to our unit using quality improvement tools was associated with a reduction in ventilator-associated pneumonia rate of 25% every 6 months and a nil rate in the last semester.

Cited by 26 publications

References 24 publications

What are the effects of care bundles on the incidence of ventilator‐associated pneumonia in paediatric and neonatal intensive care units? A systematic review

What are the effects of care bundles on the incidence of ventilator‐associated pneumonia in paediatric and neonatal intensive care units? A systematic review

The Impact of Quality Improvement Interventions in Improving Surgical Infections and Mortality in Low and Middle‐Income Countries: A Systematic Review and Meta‐Analysis

Can We Achieve Zero Hospital-Acquired Pneumonia?

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