Preventing Ventilator-Associated Pneumonia

O’Grady, Naomi P.; Murray, Patrick R.; Ames, Nancy J.

doi:10.1001/jama.2012.6445

Cited by 56 publications

(17 citation statements)

References 51 publications

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“…Hospital-acquired infections (HAI) are infections acquired in hospitals and other healthcare facilities. HAIs are common complications among patients admitted to intensive care units (ICUs), especially those requiring endotracheal intubation with mechanical ventilation [ 1 ]. Ventilator-associated pneumonia (VAP) results from an invasion of the lower respiratory tract and lung parenchyma by microorganisms.…”

Section: Introductionmentioning

confidence: 99%

Risk Factors for Pneumonia in Ventilated Trauma Patients with Multiple Rib Fractures

Park

Kang

Moon

et al. 2017

Korean J Thorac Cardiovasc Surg

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BackgroundVentilator-associated pneumonia (VAP) is a common disease that may contribute to morbidity and mortality among trauma patients in the intensive care unit (ICU). This study evaluated the associations between trauma factors and the development of VAP in ventilated patients with multiple rib fractures.MethodsWe retrospectively and consecutively evaluated 101 patients with multiple rib fractures who were ventilated and managed at our hospital between January 2010 and December 2015, analyzing the associations between VAP and trauma factors in these patients. Trauma factors included sternal fracture, flail chest, diaphragm injury, traumatic aortic dissection, combined cardiac injury, pulmonary contusion, pneumothorax, hemothorax, hemopneumothorax, abbreviated injury scale score, thoracic trauma severity score, and injury severity score.ResultsForty-six patients (45.5%) had at least 1 episode of VAP, 10 (21.7%) of whom died in the ICU. Of the 55 (54.5%) patients who did not have pneumonia, 9 (16.4%) died in the ICU. Using logistic regression analysis, we found that VAP was associated with severe lung contusion (odds ratio, 3.07; 95% confidence interval, 1.12 to 8.39; p=0.029).ConclusionSevere pulmonary contusion (pulmonary lung contusion score 6–12) is an independent risk factor for VAP in ventilated trauma patients with multiple rib fractures.

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Section: Introductionmentioning

confidence: 99%

Risk Factors for Pneumonia in Ventilated Trauma Patients with Multiple Rib Fractures

Park

Kang

Moon

et al. 2017

Korean J Thorac Cardiovasc Surg

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“…1,2,5,8-10,21 The U.S. government has further incentivized hospitals to enhance the safety of their patients through infection prevention since CMS no longer reimburses hospitals for the additional costs of caring for patients who develop certain infections during hospitalization. 22 In order to reach their fullest potential for impact, however, guidelines should be implemented into everyday practice by taking into account the contextual factors at each hospital, including such factors as perceived strength of evidence supporting the use of a particular practice.…”

Section: Discussionmentioning

confidence: 99%

“…Importantly, the evidence base supporting VAP preventive practices appears to be substantially less robust than that for CLABSI as highlighted in a recent article. 21 …”

Section: Discussionmentioning

confidence: 99%

Perceived strength of evidence supporting practices to prevent health care-associated infection: Results from a national survey of infection prevention personnel

Saint

Greene

Olmsted

et al. 2013

American Journal of Infection Control

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Background Limited data describing the perceived strength of evidence behind practices to prevent common healthcare-associated infections (HAIs) exist. We conducted a national survey of infection prevention personnel to assess perception of the evidence for various preventive practices. We were also curious if lead infection preventionist certification in infection prevention and control (CIC) correlated with perceptions of the evidence. Methods In 2009, we mailed surveys to 703 infection prevention personnel using a national random sample of U.S. hospitals and all VA hospitals; the response rate was 68%. The survey asked the respondent to grade the strength of evidence behind prevention practices. We considered “strong” evidence as being 4 and 5 on a Likert scale. Multivariable logistic regression models assessed associations between CIC status and the perceived strength of the evidence. Results The following practices were perceived by 90% or more of respondents as having strong evidence: alcohol-based hand rub, aseptic urinary catheter insertion, chlorhexidine for antisepsis prior to central venous catheter insertion, maximum sterile barriers during central venous catheter insertion, avoiding the femoral site for central venous catheter insertion, and semi-recumbent positioning of the ventilated patient. CIC status was significantly associated with the perception of the evidence for several practices. Conclusions Successful implementation of evidence-based practices should consider how key individuals in the translational process assess the strength of that evidence.

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“…Based on previous studies, [7,19,23] that have documented the factors that could interfere with the incidence of VAP, the following variables were recorded, age, gender, diagnosis, characteristics of sputum (amount in ccs and color) and antibiotics administered. Physiological parameters were recorded every 3 hours for 5 days and included: HR, RR, BP, while arterial oxygen saturation (SaO 2 ), FiO 2 and PEEP were recorded electronically every hour and the daily minimum FiO 2 and PEEP that are maintained for at least one hour were recorded for 5 days.…”

Section: Methodsmentioning

confidence: 99%

“…The diagnosis of VAP is challenging and opinions are divided on the optimal method for diagnoses with considerable inter-observer variability. [13,19] A combination of clinical, radiographic, and microbiological criteria are often used for diagnosis but, the accurate diagnosis and treatment of VAP remains controversial. The 2015, CDC criteria, [5] used to diagnose Ventilator Associated Events (VAE) include three tiers within the VAE algorithm: 1) Ventilator-Associated Condition (VAC); 2) Infection-related Ventilator Associated Complication (IVAC); and 3) Possible VAP (PVAP).…”

Section: Introductionmentioning

confidence: 99%

The effect of different suctioning modalities on physiologic measures and the incidence of ventilator associated pneumonia

Hussein

Zahran²,

Badr³

et al. 2016

JNEP

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Objective: To compare physiologic measures and the incidence of ventilator associated pneumonia (VAP) using different modalities of endotrachael tube (ETT) suctioning. Methods: A Quasi-experimental design was used with 80 adults in an intensive care unit. Two modalities of suctioning were compared: 1) not instilling normal saline (NS) into the ETT before suctioning, and 2) instilling NS into the ETT tube before suctioning. The outcome variables were: physiologic measures (heart rate, respiratory rate and blood pressure and oxygen saturation), the incidence of Ventilator Associated Condition (VAC) and Possible Ventilator Associated Pneumonia (PVAP) at day 5 after mechanical ventilation. Results: There were no differences in the physiologic measures assessed at day 5 and a significantly higher rate of VAC in patients who had NS installed (p = .009). Four patients developed PVAP compared to 10 patients in group 2 where NS was installed but that did to reach significance (p = .077). Factors associated with VAC were age, WBC > 12,000, antibiotic use, amount of secretions, and NS installation. The same factors were associated with the development of PVAP with the exception of NS installation which did not reach significance. Conclusions: Installing NS in the ETT tube did not result in significant physiologic changes at day 5, and more rates of VAC and PVAP were noted. Therefore, the use of this procedure is questionable and further studies are needed to provide conclusive evidence.

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Preventing Ventilator-Associated Pneumonia

Cited by 56 publications

References 51 publications

Risk Factors for Pneumonia in Ventilated Trauma Patients with Multiple Rib Fractures

Risk Factors for Pneumonia in Ventilated Trauma Patients with Multiple Rib Fractures

Perceived strength of evidence supporting practices to prevent health care-associated infection: Results from a national survey of infection prevention personnel

The effect of different suctioning modalities on physiologic measures and the incidence of ventilator associated pneumonia

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