[Non-pharmacological prevention of ventilator-associated pneumonia].

Geisinger Health System, Danville, Pennsylvania, USA.
Archivos de Bronconeumología (Impact Factor: 2.17). 10/2009; 46(4):188-95. DOI: 10.1016/j.arbres.2009.08.001
Source: PubMed

ABSTRACT Ventilator-associated pneumonia (VAP) is the first cause of mortality due to nosocomial infections in the intensive care unit. Its incidence ranges from 9% to 67% of patients on mechanical ventilation. Risk factors are multiple and are associated with prolonged stays in hospital and intensive care units. Additional costs for each episode of VAP range from 9,000 euro to 31,000 euro. Thus, its prevention should be considered as a priority. This prevention could decrease associated morbidity, mortality, costs, and increase patient safety.

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    ABSTRACT: A ventilação mecânica invasiva representa um fator de risco para o desenvolvimento da pneumonia associada ao ventilador (PAV), que se desenvolve 48 horas ou mais após a admissão hospitalar, em doentes ventilados através de traqueostomia ou intubação endotraqueal. A PAV é a infeção adquirida na unidade de cuidados intensivos (UCI) mais frequente entre os doentes submetidos a ventilação mecânica invasiva. Contribui para o aumento da mortalidade hospitalar, da duração da ventilação mecânica e do tempo de internamento na UCI e no hospital. Por conseguinte, agrava o estado de saúde do doente crítico e aumenta o custo total da hospitalização. A adoção de medidas preventivas é imprescindível, de modo a garantir o controlo e a diminuição da incidência da PAV. As medidas preventivas incidem sobre os fatores de risco modificáveis, sendo aplicadas estratégias não farmacológicas e farmacológicas baseadas na evidência e recomendadas por guidelines. As medidas preventivas têm como finalidade diminuir o risco associado à intubação endotraqueal e prevenir a microaspiração de microrganismos patogénicos para as vias aéreas inferiores.
    Revista portuguesa de pneumologia 01/2014; · 0.56 Impact Factor
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    ABSTRACT: OBJECTIVE: /st>The objective of the study was to reduce the ventilator-associated pneumonia (VAP) incidence rates through a rational prevention program. DESIGN: /st>The study was a non-controlled clinical trial with a set of interventions in mechanically ventilated patients from April 2006 until June 2008. Pneumonia rates were analyzed as time series and their mean risks of development were compared before and after the interventions with a non-concurrent cohort using the same time frame (January 2004-March 2006). SETTING: /st>The study was conducted in a 14-bed medical intensive care unit of private general hospital in Rio de Janeiro, Brazil. PARTICIPANTS: /st>The study included invasively ventilated patients (n = 224; intervention group) compared with 294 controls (historical cohort). INTERVENTIONS: /st>An educational module about VAP prevention was introduced at the start of the trial (April 2006). A bundle checklist was used daily concomitantly with a standardized oral care in all patients afterwards.Main outcome measureThe main outcome measure was reduction in VAP incidence rates. RESULTS: /st>The observed mean rate before the intervention was 18.6 ± 7.8/1000 ventilator-days (95% CI 8.7-14.9), decreasing to 11.8 ± 7.8/1000 ventilator-days (95% CI 15.5-21.7) (P = 0.002) after the interventions. Under the adoption of non-informative prior distributions for the parameters of the proposed statistical model, there was a 70% posterior probability in favor of the hypothesis of risk reduction associated with the interventions, regardless their seasonality or secular trends. There was a 38% relative risk reduction. CONCLUSIONS: /st>A reduction in VAP rates and on their risk after a set of preventive tools was observed. However, some other co-interventions not related to the primary interventions may have contributed to these results.
    International Journal for Quality in Health Care 03/2013; · 1.79 Impact Factor
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    ABSTRACT: Ventilator-associated pneumonia constitutes a significant concern for ventilated patients in the intensive care unit. This study was planned to evaluate the knowledge of nurses working in general intensive care units concerning evidence-based measures for the prevention of ventilator-associated pneumonia. This study design is cross-sectional. It was carried out on nurses working in the general intensive care units of anesthiology and re-animation clinics. Collection of research data was performed by means of a Nurse Identification Form and a Form of Evidence-Based Knowledge concerning the Prevention of Ventilator-Associated Pneumonia. Characterization statistics were shown by percentage, median and interquartile range. Chi-square and Wilcoxon tests and Kruskal-Wallis tests were used as appropriate. The median value of total points scored by nurses on the questionnaire was 4.00 ± 2.00. The difference between the nurses' education levels, duration of work experience and participation in in-service training programmes on ventilator-associated pneumonia prevention and the median value of their total scores on the questionnaire was found to be statistically significant (p < 0.05). The conclusion of the study was that critical care nurses' knowledge about ventilator-associated pneumonia prevention is poor.
    Nursing in Critical Care 01/2014; 19(1):26-33. · 0.95 Impact Factor


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Jun 1, 2014