Kontakt 2020, 22(4):222-227 | DOI: 10.32725/kont.2020.046

Incidence of ventilator-associated pneumonia at ICU - the effect of preventive measures in nursing careNursing - Original article

Dimitris Jatagandzidis1, Markéta Kočí1,2, Renáta Zoubková1,2,*
1 University Hospital in Ostrava, Clinic of Anesthesiology/Critical Care, Ostrava, Czech Republic
2 University of Ostrava, Faculty of Medicine, Ostrava, Czech Republic

Introduction: Pneumonia in patients on mechanical ventilation is the most frequently observed infectious complication in intensive care patients. The primary objective of the presented work was to evaluate compliance with procedures intended for the prevention of ventilator-associated pneumonia (VAP) in clinical practice at the Intensive Care Unit, University Hospital Ostrava (ICU UHO). The secondary objectives were to evaluate the incidence of VAP and the effect of a checklist introduced for prevention of VAP.

Methods: The study group consisted of a total of 525 patients hospitalized at the ICU UHO between 2016 and 2017. The research was performed with analysis of data obtained from the introduced checklist of VAP. In patients who were mechanically ventilated and not admitted to the hospital with a primary diagnosis of pneumonia or already confirmed VAP.

Results: In the overall assessment, compliance with only 2 of the 4 evaluated preventive measures against the onset of VAP was recorded in 58.10%. At one of the observed ICU, the incidence of VAP decreased by more than 50% after the introduction of the checklist. The results confirmed a statistically significant difference in the relation between positioning the patient in a semirecumbent position, maintaining pressure in the obturation cuff of the endotracheal tube within the recommended range, and the need to reintubate and the incidence of VAP. No statistically significant difference was observed in the relation between the performance of subglottic suctioning and the incidence of VAP.

Conclusions: The results of the survey show that the implemented system of prevention and the newly elaborated checklist lead to a decreased incidence of VAP.

Keywords: Checklist; System of prevention; Ventilator-associated pneumonia

Received: June 19, 2020; Revised: October 12, 2020; Accepted: November 18, 2020; Prepublished online: December 3, 2020; Published: December 15, 2020  Show citation

ACS AIP APA ASA Harvard Chicago Chicago Notes IEEE ISO690 MLA NLM Turabian Vancouver
Jatagandzidis D, Kočí M, Zoubková R. Incidence of ventilator-associated pneumonia at ICU - the effect of preventive measures in nursing care. Kontakt. 2020;22(4):222-227. doi: 10.32725/kont.2020.046.
Share...
Download citation
  • BibTeX (.bib)
  • Bookends (.ris)
  • EasyBib (.ris)
  • EndNote (.enw)
  • EndNote 8 (.xml)
  • ISI WoS (.isi)
  • Medlars (.medlars)
  • Mendeley (.ris)
  • MODS (.xml)
  • Papers (.ris)
  • RefWorks (.txt)
  • RefManager (.ris)
  • RIS (.ris)
  • MS Word (.xml)
  • Zotero (.ris)
    • Open full article

    Attachments

    Download fileannex.pdf

    File size: 80.81 kB

    References

    1. Álvarez-Lerma F, Palomar-Martínez M, Sachez-García M, Matínez-Alonso M, Álvarez-Rodríguez J, Lorente L, et al. (2018). Prevention of Ventilator-Associated Pneumonia: The Multimodal Approach of the Spanish ICU "Pneumonia Zero" Program. Crit Care Med 46(2): 181-188. DOI: 10.1097/CCM.0000000000002736. Go to original source... Go to PubMed...
    2. Álvarez-Lerma F, Sánchez-García M, Lorente L, Gordo F, Añón JM, Älvarez J, et al. (2014). Guidelines for the prevention of ventilator-associated pneumonia and their implementation. The Spanish "Zero-VAP" bundle. Med Intensiva 38(4): 226-236. DOI: 10.1016/j.medin.2013.12.007. Go to original source... Go to PubMed...
    3. Blot SI, Poelaert J, Kollef M (2014). How to avoid microaspiration? A key element for the prevention of ventilator associated pneumonia in intubated ICU patients. BMC Infect Dis 14(1): 1-6. DOI: 10.1186/1471-2334-14-119. Go to original source... Go to PubMed...
    4. Bulamba F, Kintu A, Ayupo N, Kojjo Ch, Ssemogerere L, Wabule A, et al. (2017). Achieving the Recommended Endotracheal Tube Cuff Pressure: A Randomized Control Study Comparing Loss of Resistance Syringe to Pilot Balloon Palpation. Anesthesiol Res Pract 2017: 2032748. DOI: 10.1155/2017/2032748. Go to original source... Go to PubMed...
    5. Caserta RA, Marra AR, Durao MS, Silva CV, Pavao dos Santos PV, Suton de Sonta Neves H, et al. (2012). A program for sustained improvement in preventing ventilator associated pneumonia in an intensive care setting. BMC Infect Dis 12(234): 2-8. DOI: 10.1186/1471-2334-12-234. Go to original source... Go to PubMed...
    6. Coppadoro A, Bittner E, Berra L (2012). Novel preventive strategies for ventilator-associated pneumonia. Crit Care 16(2): 2-6. DOI: 10.1186/cc11225. Go to original source... Go to PubMed...
    7. Davidson C, Banham S, Elliott M, Kennedy D, Gelder C, Glossop A (2016). British Thoracic Society/Intensive Care Society Guideline for the ventilatory management of acute hypercapnic respiratory failure in adults. BMJ Open Respir Res 3(1). DOI: 10.1136/bmjresp-2016-000133. Go to original source... Go to PubMed...
    8. Dosher WB, Loomis EC, Richardson SL, Crowell JA, Waltman RD, Miller LD, et al. (2014). The Effect of a Nurse-Led Multidisciplinary Team on Ventilator-Associated Pneumonia Rates. Crit Care Res Pract 682621, 5 p. DOI: 10.1155/2014/682621. Go to original source... Go to PubMed...
    9. Dostál P (2015). Nozokomiální pneumonie ventilovaných nemocných - je skutečně nevyhnutelnou komplikací umělé plicní ventilace? Anest Itenziv Med 26(6): 317-318.
    10. El Azab SR, El Sayed AE, Abdelkarim M, Al Mutairi KB, Al Saqabi A, El Demerdash S (2013). Combination of ventilator care bundle and regular oral care with chlorhexidine was associated with reduction in ventilator associated pneumonia. Egypt J Anaesth 29(3): 273-277. DOI: 10.1016/j.egja.2013.03.001. Go to original source...
    11. Frost SA, Azeem A, Alexandrou E, Tam V, Murphy JK, Hunt L, et al. (2013). Subglottic secretion drainage for preventing ventilator-associated pneumonia: A meta-analysis. Aust Crit Care 26(4): 180-188. DOI: 10.1016/j.aucc.2013.03.003. Go to original source... Go to PubMed...
    12. Gadani H, Vyas A, Kar AK (2010). A study of ventilator-associated pneumonia: Incidence, outcome, risk factors and measures to be taken for prevention. Indian J Anaesth 54(6): 535-540. DOI: 10.4103/0019-5049.72643. Go to original source... Go to PubMed...
    13. Goel V, Gupta S, Goel T (2016). Ventilator-associated pneumonia: A review of the clinically relevant challenges in diagnosis and prevention. BJMP 9(2): 910-918.
    14. Gosseling R, Bott J, Johnson M, Dean E, Nava S, Norrenberg M, et al. (2007). Physiotherapy for adult patients with critical illness: recommendations of the European Respiratory Society and European Society of Intensive Care Medicine Task Force on Physiotherapy for Critically Ill Patients. Intensive Care Med 34(7): 1188-1199. DOI: 10.1007/s00134-008-1026-7. Go to original source... Go to PubMed...
    15. Guanche-Garcell H, Morales-Perez C, Rosenthal VD (2013). Effectiveness of a multidimensional approach for the prevention of ventilator-associated pneumonia in an adult intensive care unit in Cuba: Findings of the International Nosocomial Infection Control Consortium (INICC). J Infect Public Health 6(2): 98-107. DOI: 10.1016/j.jiph.2012.11.009. Go to original source... Go to PubMed...
    16. Kalanuria A, Zai W, Mirski M (2014). Ventilator-associated pneumonia in the ICU. Crit Care 18(2): 208. DOI: 10.1186/cc13775. Go to original source... Go to PubMed...
    17. Kalil AC, Metersky ML, Klompas M, Muscedere J, Sweeney DA, Palmer LB, et al. (2016). Management of Adults With Hospital-acquired and Ventilator-associated Pneumonia: 2016 Clinical Practice Guidelines by the Infectious Diseases Society of America and the American Thoracic Society. Clin Infect Dis 63(5): 61-111. DOI: 10.1093/cid/ciw353. Go to original source... Go to PubMed...
    18. Kolek V, Kašák V, Vašáková M (2014). Pneumologie. 2nd extended ed. Prague: Maxdorf. 645 p.
    19. Lacherade J, De Jonghe B, Guezennec P, Debbat K, Hayon J, Monset A, et al. (2010). Intermittent Subglottic Secretion Drainage and Ventilator-associated Pneumonia: A Multicenter Trial. Am J Respir Crit Care Med 182(7): 910-917. DOI: 10.1164/rccm.200906-0838OC. Go to original source... Go to PubMed...
    20. Lau ACW, So HM, Tang SL, Yeung A, Lam SM, Yan WW, et al. (2015). Prevention of ventilator-associated pneumonia. Hong Kong Med J 21(1): 61-68. DOI: 10.12809/hkmj144367. Go to original source... Go to PubMed...
    21. Lorente L, Lecuona M, Jiménez A, Lorenzo L, Roca I, Cabrera J, et al. (2014). Continuous endotracheal tube cuff pressure control system protects against ventilator- associated pneumonia. Crit Care 18(2): R77. DOI: 10.1186/cc13837. Go to original source... Go to PubMed...
    22. Lorente L, Lecuona M, Jimenéz A, Mora ML, Sierra A (2007). Influence of an endotracheal tube with polyurethane cuff and subglottic secretion drainage on pneumonia. Am J Respir Crit Care Med 176(11): 1079-1083. DOI: 10.1164/rccm.200705-761OC. Go to original source... Go to PubMed...
    23. Mietto C, Pinciroli R, Patel N, Berra L (2013). Ventilator Associated Pneumonia: Evolving Definitions and Preventive Strategies Discussion. Respir Care 58(6): 990-1007. DOI: 10.4187/respcare.02380. Go to original source... Go to PubMed...
    24. Mogyoródi B, Dunai E, Gál J, Zsolt I (2016). Ventilator-associated pneumonia and the importance of education of ICU nurses on prevention - Preliminary results. Interv Med Appl Sci 8(4): 147-151. DOI: 10.1556/1646.8.2016.4.9. Go to original source... Go to PubMed...
    25. Muscedere J, Rewa O, McKechnie K, Jiang X, Laporta D, Heylang DK (2011). Subglottic secretion drainage for the prevention of ventilator-associated pneumonia: A systematic review and meta-analysis. Crit Care Med 39(8): 1985-1981. DOI: 10.1097/CCM.0b013e318218a4d9. Go to original source... Go to PubMed...
    26. Oliveira J, Zagalo C, Cavaco-Silva P (2014). Prevention of ventilator-associated pneumonia. Rev Port Pneumol 20(3): 152-161. Go to original source... Go to PubMed...
    27. Sedwick MB, Lance-Smith M, Reeder SJ, Nardi J (2012). Using evidence-based practice to prevent ventilator-associated pneumonia. Crit Care Nurse 32(4): 41-51. DOI: 10.4037/ccn2012964. Go to original source... Go to PubMed...
    28. Streitová D, Zoubková R (2015). Septické stavy v intenzivní péči: Ošetřovatelská péče. Prague: Grada Publishing.185 p.
    29. Valencia M, Ferrer M, Farre R, Navajas D, Badia JR, Nicolas JM, et al. (2007). Automatic control of tracheal tube cuff pressure in ventilated patients in semirecumbent position: a randomized trial. Crit Care Med 35(6): 1543-9. DOI: 10.1097/01.CCM.0000266686.95843.7D. Go to original source... Go to PubMed...
    30. Wang L, Li X, Yang Z, Tang X, Yuan Q, Deng L, Sun X (2016). Semi-recumbent position versus supine position for the prevention of ventilator-associated pneumonia in adults requiring mechanical ventilation. Cochrane Database Syst Rev 2016(1): CD009946. DOI: 10.1002/14651858.CD009946. Go to original source...
    31. Wang R, Zhen X, Yang B, Guo X-Z, Zeng X, Deng C-Y (2015). Subglottic secretion drainage for preventing ventilator-associated pneumonia: A meta-analysis. Chin Nurs Res 2: 55-60. DOI: 10.1016/j.cnre.2015.03.001. Go to original source...
    32. Xie X, Nicolau I, McGregor M, Dendukuri N (2012). Subglottic Secretion Drainage Endotracheal Tubes for Prevention of Ventilator-Associated Pneumonia. Montreal (Canada): Technology Assessment Unit (TAU) of the McGill University Health Centre (MUHC). [online] [cit. 2020-01-22]. Available from: https://muhc.ca/sites/default/files/micro/m-TAU/muhc_tau_2011_56_ssd.pdf
    33. Zolfaghari PS, Wyncoll DLA (2011). The tracheal tube: gateway to ventilator-associated pneumonia. Crit Care 15(5): 1-8. DOI: 10.1186/cc10352. Go to original source... Go to PubMed...

    This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND 4.0), which permits non-comercial use, distribution, and reproduction in any medium, provided the original publication is properly cited. No use, distribution or reproduction is permitted which does not comply with these terms.


    Return to the content