“The multimodal approach for ventilator-associated pneumonia prevention”—requirements for nationwide implementation

Abstract

The multimodal approach for ventilator-associated pneumonia (VAP) prevention has been shown to be a successful strategy in reducing VAP rates in many intensive care units (ICU) in some countries.The simultaneous application of several measures or "bundles" to reduce VAP rates has achieved a higher impact than the progressive implementation of the individual interventions. The ultimate objective of recommendation bundles is their integration in the culture of routine healthcare of the staff in charge of ventilated patients for accomplished rates to persist over time. The noteworthy elements of this new strategy include the selection of the individual recommendations of the bundle, education of care workers (HCW) in the culture of patient safety, audit of compliance with the recommendations, commitment of the hospital management to support implementation, nomination and empowerment of local leaders of the projects in ICUs, both physicians and nurses, and the continuous collection of VAP episodes. The implementation of this new strategy is not an easy task, as both its inherent strength and important barriers to its application have become evident, which need to be overcome for maximal reduction of VAP rates.

Risk Factors of Ventilator-Associated Pneumonia in Critically III Patients

“…In fact, the above preventive measures are often used together clinically, called VAP prevention bundle. VAP prevention bundle requires not only multi-preventive measures to be used together, but also requires medical staff and patients to carry out safety education in order to better improve the operational ability of medical staff and patients’ compliance (Álvarez-Lerma and Sánchez García, 2018). Specific preventive measures for the occurrence of various risk factors of VAP are listed in Table 1.…”

Variación de la tasa de infecciones asociadas a la atención sanitaria en neonatos

“…García González et al, 4 reportó en 2017 que los casos de IAAS disminuyen posterior a intervenciones de capacitación en lavado de manos y uso de alcohol gel; dichas acciones previenen la diseminación de gérmenes a través de las manos del personal de salud, siendo la principal causa de brotes 5 . La educación continua es una estrategia para modificar conductas, pero no es suficiente para que la mejora en la atención sea sostenible 6 . Es necesario que no se incorpore como una medida aislada.…”

“…Hay que mencionar, además, que la efectividad de las medidas preventivas mejoradas y su posterior adherencia a la rutina de la atención sanitaria, depende de otros factores como el monitoreo y la supervisión, que suelen estar presentes solo durante la ejecución de las intervenciones, el desarrollarlas paralelamente tiene un valor agrega-do, sobre todo durante el periodo de sostenibilidad 6,7,12,15 .…”

“…Otras causas pueden ser el uso indiscriminado de antibióticos, la escasez de personal sanitario capacitado en cumplir los protocolos de limpieza, así como el lavado y desinfección insuficiente de las manos [4][5] . La incidencia de IAAS reportada en la literatura es del 6,2 % -33 % y una densidad de incidencia de 4,8 -22 casos por cada 1000 días de hospitalización 6 .…”

Infection Prevention and Control

“…Healthcare-associated pneumonia occurs in various patient groups. The most important group is that of patients on ventilators in intensive care units (ICU) [1], where the rate of pneumonia, the main type of infection, is a quality and safety indicator of care [22]. There is a high case fatality rate related to ventilator-associated pneumonia (VAP) although the attributable risk is difficult to determine because of the high patient comorbidity.…”