תירבעה הטיסרבינואה תיתליהק האופרו רוביצה תואירבל רפסה תיב Inna Apelbaum

Transcription

1 האוניברסיטה העברית בית הספר לבריאות הציבור ורפואה קהילתית Inna Apelbaum

2 6.2 Abstract Background: Ventilator-associated pneumonia (VAP) is the most common nosocomial infection in mechanically ventilated patients. VAP is associated with considerable morbidity, including prolonged ICU length of stay, prolonged mechanical ventilation, and increased costs of hospitalization 29 Design: Observational study for mechanically ventilated patients, who are older than 18 years old at Hadassah Medical Center. Methods: In this study, we implemented VAP bundle to decrease the rate of VAP infection. This is a pre- and post-intervention trial beginning in 2009 to decrease the rate of VAP in adult mechanically ventilated patients. The study was conducted at Hadassah Medical Center in Jerusalem, Israel. The study included all adult patients who were on mechanical ventilation during the survey. Results: Findings from the First Survey vs Second Survey: Those that had an Head Angle above 30 degrees were seen at a rate of 48% in the first survey as oppose to 52% in the second survey; a rate of 54% of Mouth Hygiene was seen in the first survey, while in the second survey it was 92% (p<0.01); a rate of 72% of Ventilation Tube Hygiene was seen in the first survey, while in the second survey it was 84% (p<0.01); a rate of 16% of Washing Hands among the Nurse Staff was seen in the first survey, while in the second survey it was 50% (p<0.01); and lastly, a rate of 6% of Washing Hands among the Ventilation Technicians was seen in the first survey, while in the second survey it was 23% (p<0.01). Conclusion: Educational initiatives provide another strategy for preventing nosocomial infections. 2

3 BIBLIOGRAPHY 1. Alexander JA, Hearld LR, Jiang HJ, Fraser I Increasing the relevance of research to health care managers: hospital CEO imperatives for improving quality and lowering costs. Health Care Manage Review, 32(2), Al-Tawfiq JA, Abed MS Decreasing ventilator-associated pneumonia in adult intensive care units using the Institute for Healthcare Improvement bundle. American Journal of Infection Control, 4: Arlene F, Tolentino-De los Reyes AF, Rupert SD, Shiao SY Evidence based practice: Use of the ventilator care bundle to prevent ventilator associated pneumonia. American Journal of Critical Care, 16: Blamoun J, Alfakir M, Rella ME, Wojcik JM, Solis RA, Anees Khan M, DeBari VA Efficacy of an expanded ventilator bundle for the reduction of ventilatorassociated pneumonia in the medical intensive care unit. American Journal of Infection Control, 37: Chan EY, Ruest A, Meade MO Cook DJ Oral decontamination for prevention of pneumonia in mechanically ventilated adults: systematic review and meta-analysis. BMJ, Apr 28; 334(7599): Coffin SE, Klompas M, Classen D, Arias KM, Podgorny K, Anderson DJ, Burstin H, Calfee DP, Dubberke ER, Fraser V, Gerding DN, Griffin FA, Gross P, Kaye KS, Lo E, Marschall J, Mermel LA, Nicolle L, Pegues DA, Perl TM, Saint S, Salgado CD, Weinstein RA, Wise R, Yokoe DS Strategies to Prevent Ventilator-Associated Pneumonia in Acute Care Hospitals. Infection control and hospital epidemiology, October, vol. 29: S31- S40 7. Craven DE, Connolly MG Jr, Lichtenberg DA, Primeau PJ, McCabe WR.1982 Contamination of mechanical ventilators with tubing changes every 24 or 48 hours. The New England Journal of Medicine, Jun 24; 306(25): Díaz LA, Llauradó M, Rello J, Restrepo MI Non-pharmacological prevention of ventilator-associated pneumonia. Arch Bronc, Apr; 46(4): DuBose JJ, Inaba K, Shiflett A, Trankiem C, Teixeira PGR, Salim A, Rhee P, Demetriades D, Belzberg H Measurable Outcomes of Quality Improvement in the Trauma Intensive Care Unit: The Impact of a Daily Quality Rounding Checklist. The Journal of TRAUMA Injury, Infection, and Critical Care, 64(1):

4 10. Efrati S, Deutsch I, Antonelli M, Hockey PM, Rozenblum R, Gurman GM, Ventilator-associated pneumonia: current status and future recommendations. The Journal of Clinical Monitoring and Computing, 24: Ewig S, Müller E, Hecker E Ventilator-associated pneumonia: approaching the Horizon. The European Respiratory Journal, 35: Gastmeier P, Geffers C Prevention of ventilator-associated pneumonia: analysis of studies published since Journal of Hospital Infection, Sep; 67(1): Grap MJ, Munro CL, Unoki T, Hamilton VA, Ward KR Ventilator-associated Pneumonia: The Potential Critical Role of Emergency Medicine in Prevention. The Journal of Emergency Medicine, Aug 6: Hutchins K, Karras G, Erwin J, Sullivan KL Ventilator-associated pneumonia and oral care: A successful quality improvement project. American Journal of Infection Control, 37: Institute for Healthcare Improvement: 5 Million Lives Campaign. Getting Started Kit: Prevent Ventilator-Associated Pneumonia How-to Guide Cambridge, MA. Available online: 16. Keeley L Reducing the Risk of Ventilator Acquired Pneumonia through Head of Bed Elevation. Nursing in Critical Care, 12(6), Kollef M SMART Approaches for Reducing Nosocomial Infections in the ICU. CHEST, 134(2), Marra AR, Cal RG, Silva CV, Caserta RA, Paes AT, Moura DF Jr, dos Santos OF, Edmond MB, Durão MS Successful prevention of ventilator-associated pneumonia in an intensive care setting. American Journal of Infection Control, 37: Mookherjee S, Vidyarthi AR, Ranji SR, Maselli J, Wachter RM, Baron RB Potential unintended consequences due to medicare's "no pay for errors rule"? A randomized controlled trial of an educational intervention with internal medicine residents. The Journal of General Internal Medicine, Oct; 25(10): Munro CL, Grap MJ, Jones DJ, McClish DK, Sessler CN Chlorhexidine, Toothbrushing, and Preventing Ventilator-Associated Pneumonia in Critically Ill Adults. American Journal of Critical Care, 18: Rea- Neto A,Youssef NCM, Tuche F, Brunkhorst F, Ranieri VM,Reinhart K, SAark Y Diagnosis of Ventilator- Associated Pneumonia: a Systematic Review of the Literature. Critical Care, 12(2), R56 4

5 22. Reinarz JA, Pierce AK, Mays BB, Sanford JP The Potential Role of Inhalation Therapy Equipment in Nosocomial Pulmonary Infection. Journal of Clinical Investigation, Vol. 44, No Rose L, Baldwin I, Crawford T The use of bed-dials to maintain recumbent positioning for critically ill mechanically ventilated patients (The RECUMBENT study): Multicentre before and after observational study. International Journal of Nursing Studies, May, Shreve J, Van Den Bos J, Gray T, Halford M, Rustagi K, Ziemkiewicz E The Economic Measurement of Medical Errors. Society of Actuaries, 6: Vincent JL, Sakr Y, Sprung CL, Ranieri VM, Reinhart K, Gerlach H, Moreno R, Carlet J, Le Gall JR, Payen D Sepsis in European Intensive Care Units: Results of the SOAP study. Critical care medicine, 34(2), Westwell S Implementing a Ventilator Care Bundle in an Adult Intensive Care Unit. Nursing in Critical Care, 13(4), Zaydfudim V, Dossett LA, Starmer JM, Arbogast PG, Feurer ID, Ray WA, May AK, Pinson CW Implementation of a Real-time Compliance Dashboard to Help Reduce SICU Ventilator-Associated Pneumonia With the Ventilator Bundle. Archives of Surgery, Jul, 144(7):