Successful prevention of ventilator-associated pneumonia in an intensive care setting

Marra, Alexandre R.; Cal, Ruy Guilherme Rodrigues; Silva, Claudia Vallone; Caserta, Raquel; Paes, Ângela Tavares; Moura, Denis Faria; Santos, Oscar Fernando Pavão dos; Edmond, Michael B.; Durão, Marcelino S.

doi:10.1016/j.ajic.2009.03.009

Cited by 72 publications

(71 citation statements)

References 21 publications

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“…Some of the most frequently cited studies supporting the achievement of zero VAP are based upon surveillance data from one private hospital in São Paulo, Brazil. 138,139 However, even these studies were able to reach a zero VAP rate for only a few months when ventilator bundle adherence was Ͼ 95%. 139 In contrast, the first prospective multi-center study (in a predominantly medical ICU setting) linking bundled preventive care with VAP reduction demonstrated that 95% adherence produced a 59% decrease in VAP, whereas ICUs reporting at least a 20% improvement in VAP bundle adherence had a 45% decrease in VAP.…”

Section: Do Zero Ventilator-associated Pneumonia Ratesmentioning

confidence: 98%

The Vexing Problem of Ventilator-Associated Pneumonia: Observations on Pathophysiology, Public Policy, and Clinical Science

Kallet

2015

Respir Care

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SummaryVentilator-associated pneumonia (VAP) is an acquired infection related primarily to the consequences of prolonged endotracheal intubation. It is considered the most important infectious challenge in the critical care setting. Preventable complications of hospital care are considered an important source of wasted health-care costs believed to consume up to 47% of annual expenditures in the United States. Whether VAP is preventable has become a highly contentious debate since public reporting commenced a decade ago. This selective review focuses on specific aspects of this debate, including the inherent vagaries in the diagnosis of VAP and the marked disparities between VAP rates based on clinical diagnosis versus surveillance data. Also discussed is how this debate has impacted public policy, leading to the new paradigm of ventilator-associated events. The limited ability of artificial airways to prevent microaspiration and biofilm build-up, as well as non-modifiable conditions increasing the risk of VAP, is described in detail. In addition, the origins of the mistaken but widely embraced notion that zero VAP is a realistic achievement are examined.

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Section: Do Zero Ventilator-associated Pneumonia Ratesmentioning

confidence: 98%

The Vexing Problem of Ventilator-Associated Pneumonia: Observations on Pathophysiology, Public Policy, and Clinical Science

Kallet

2015

Respir Care

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“…14 Enhancement of knowledge of evidence-based recommendations to prevent VAP and multifaceted implementation of care bundles focused on measures to prevent VAP may reduce the risk for this pneumonia. [15][16][17][18][19][20][21][22] Yet, because of the high workload and degree of urgency needed in ICUs, proper compliance with recommendations is difficult. Furthermore, the shortage of qualified ICU nurses is a common problem in many European countries.…”

mentioning

confidence: 99%

Patient to Nurse Ratio and Risk of Ventilator-Associated Pneumonia in Critically Ill Patients

Blot

Llauradó-Serra²,

Koulenti³

et al. 2010

American Journal of Critical Care

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Objective To determine how the patient to nurse ratio affects risk for ventilator-associated pneumonia. Methods Data from an earlier study in 27 intensive care units in 9 European countries were examined in a secondary analysis. The initial cohort included 2585 consecutive patients who had mechanical ventilation (1) after admission for treatment of pneumonia or (2) for more than 48 hours irrespective of the diagnosis at admission. In units with variable staffing levels, the highest patient to nurse ratio in a 24-hour period was considered. Patients from 6 units that did not provide data on nurse staffing levels were excluded from the analysis. Results Ventilator-associated pneumonia developed in 393 of the 1658 patients (23.7%) in the secondary cohort. In units with patient to nurse ratios of 1 to 1, 2 to 1, 2.5 to 1, and 3 to 1, rates were 9.3%, 25.7%, 18.7%, and 24.2%, respectively (P = .003). Rates were significantly lower (P = .002) in units with a ratio of 1 to 1 (9.3%) than in units with a ratio of more than 1 patient to 1 nurse (24.4%). After adjustments for confounding covariates, ratios of more than 1 patient to 1 nurse were no longer associated with increased risk for ventilator-associated pneumonia. Conclusions A patient to nurse ratio of 1 to 1 appears to be associated with a lower risk for ventilator-associated pneumonia, but after adjustments for confounding covariates, the difference is not significant.

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“…Marra et al documented that high compliance with policies will inevitably reduce the VAP infection rates and that study observed a significant decrease (58%) in VAP rates when the hospital shifted from no compliance to full compliance (25).…”

Section: Discussionmentioning

confidence: 99%

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

Banjar¹,

Felemban²,

Dhafar³

et al. 2017

Turk J Med Sci

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The overall VAP rate in Makkah Region hospitals was 6.89 cases per 1000 ventilator-days. There was a significant difference in VAP rate among the hospitals of the Makkah Region (P < 0.001). There was no significant difference in the VAP rate among hospitals, which were using only one, two, or all three VAP preventive approaches (P = 0.26) accredited by the Joint Commission International (JCI) and Central Board for Accreditation of Health Care Institution (CBAHI) (P = 0.12), and using the form in intensive care units (ICUs) (P = 0.85). There was a significant difference in the VAP rate among hospitals having different bed capacities (P < 0.001), data regularly collected (P = 0.03), and had a team to supervise the VAP project (P = 0.04). Conclusion:The VAP rate in Makkah Region hospitals is 6.89 cases per 1000 ventilator-days.

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Successful prevention of ventilator-associated pneumonia in an intensive care setting

Cited by 72 publications

References 21 publications

The Vexing Problem of Ventilator-Associated Pneumonia: Observations on Pathophysiology, Public Policy, and Clinical Science

The Vexing Problem of Ventilator-Associated Pneumonia: Observations on Pathophysiology, Public Policy, and Clinical Science

Patient to Nurse Ratio and Risk of Ventilator-Associated Pneumonia in Critically Ill Patients

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

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