Prevention of ventilator-associated pneumonia in intensive care units: an international online survey

Abstract

BackgroundOn average 7% of patients admitted to intensive-care units (ICUs) suffer from a potentially preventable ventilator-associated pneumonia (VAP). Our objective was to survey attitudes and practices of ICUs doctors in the field of VAP prevention.MethodsA questionnaire was made available online in 6 languages from April, 1st to September 1st, 2012 and disseminated through international and national ICU societies. We investigated reported practices as regards (1) established clinical guidelines for VAP prevention, and (2) measurement of process and outcomes, under the assumption “if you cannot measure it, you cannot improve it”; as well as attitudes towards the implementation of a measurement system. Weighted estimations for Europe were computed based on countries for which at least 10 completed replies were available, using total country population as a weight. Data from other countries were pooled together. Detailed country-specific results are presented in an online additional file.ResultsA total of 1730 replies were received from 77 countries; 1281 from 16 countries were used to compute weighted European estimates, as follows: care for intubated patients, combined with a measure of compliance to this guideline at least once a year, was reported by 57% of the respondents (95% CI: 54–60) for hand hygiene, 28% (95% CI: 24–33) for systematic daily interruption of sedation and weaning protocol, and 27% (95%: 23–30) for oral care with chlorhexidine. Only 20% (95% CI: 17–22) were able to provide an estimation of outcome data (VAP rate) in their ICU, still 93% (95% CI: 91–94) agreed that “Monitoring of VAP-related measures stimulates quality improvement”. Results for 449 respondents from 61 countries not included in the European estimates are broadly comparable.ConclusionsThis study shows a low compliance with VAP prevention practices, as reported by ICU doctors in Europe and elsewhere, and identifies priorities for improvement.

Monitorowanie zapalenia płuc związanego z wentylacją mechaniczną według projektu INICC — doświadczenia jednego ośrodka

“…In one of the studies, the patients diagnosed by BAL had a lower number of confirmed VAP (6.1 vs. 25.5/1000 ventilation days) compared to those diagnosed with non-protective aspiration, which was characterised by 90% sensitivity and only 14% specificity [24]. The literature data indicate that VAP prophylaxis, in the form of the ventilation bundle, can result in notable effects, i.e., decreased incidence [3,15,23,25]; however, studies confirming the lack of infections of this type in a given period are sparse [17,26]. Moreover, the complete elimination of VAP has been questioned [27].…”

“…The incidence of VAP compared with the total number of hospitalised patients is highly varied [2,3]. According to the findings of American studies, the incidence reaches 2.5−22.8% [4,5], whereas in a European study involving a smaller population, VAP was recognised in 9.3% of patients (from a total of 9080 hospitalised patients).…”

“…Pneumonia occurs in 7-20% of mechanically ventilated patients [2,3]. The incidence of VAP compared with the total number of hospitalised patients is highly varied [2,3].…”

Valuation and Records of Oral Hygiene of Intubated Patients in Intensive Care Units

“…2 Nas UTIs, as infecções respiratórias, predominantemente a pneumonia associada à ventilação mecânica (PAVM), é um sério problema para os pacientes em estado crítico, pois resultam em prolongamento do tempo de internação, com aumento dos custos e da mortalidade nas UTIs. 3 Frente à relevância da infecção respiratória relacionada ao uso da VMI, o Institute for Healthcare Improvement (IHI) recomenda intervenções consideradas como cuidados de nível um de evidência científica (fortemente recomendadas) para erradicar ou minimizar o problema. Destacam-se a elevação da cabeceira da cama entre 30 e 45°, a interrupção da sedação/despertar diário e a higiene oral (HO) diária com solução de clorexidine.…”

Recent Advances in Multidisciplinary Critical Care

“…despite the distribution of international guidelines and all the efforts invested in prevention, 67 health care-associated infection continues to pose a threat to patients' outcomes, [68][69][70] not to mention the societal costs associated with this complication. 11,[71][72][73][74][75] prolonged mechanical ventilation is an obvious risk factor, and a proactive approach to extubate patients as early as possible on basis of daily sedation breaks has been demonstrated to reduce the risk of pneumonia.…”