Pnina Shitrit1,2, Michal Meirson3, Gad Mendelson4, Michal Chowers1,2. 1. Infectious Diseases Unit, Meir Medical Center, Kfar Saba, Israel. 2. Sackler Medical School, Tel Aviv University, Ramat Aviv, Israel. 3. Chronic Ventilation Department, Natania, Israel. 4. Dorot Geriatric Center, Natania, Israel.
Abstract
OBJECTIVES: To evaluate the effectiveness of a modified bundle of preventative measures to decrease ventilator-associated pneumonia (VAP) in chronically ventilated long-term care facility (LTCF) residents. DESIGN: Cohort before-and-after study. SETTING: Geriatric hospital ward. PARTICIPANTS: LTCF residents on long-term ventilation. INTERVENTION: The modified bundle included hand hygiene before patient care, elevation of the head of the bed to more than 30° for individuals who are supine, chlorhexidine oral care at the beginning of each nursing shift, keeping tracheostomy cannula balloon pressure at 20 to 30 cm H2 O, and measuring nasogastric food remnants before every meal for individuals fed through a nasogastric tube. MEASUREMENTS: Number of VAP episodes was determined prospectively, and rates were calculated as episodes per 1,000 ventilation days. RESULTS: VAP rate decreased from 5.97 before the intervention to 2.34 after the intervention (P < .001). The use of broad-spectrum antibiotics decreased from 1,788 defined daily doses before the intervention to 1,093 after (P = .04). CONCLUSION: A modified bundle successfully decreased VAP rates in chronically ventilated elderly LTCF residents.
OBJECTIVES: To evaluate the effectiveness of a modified bundle of preventative measures to decrease ventilator-associated pneumonia (VAP) in chronically ventilated long-term care facility (LTCF) residents. DESIGN: Cohort before-and-after study. SETTING: Geriatric hospital ward. PARTICIPANTS: LTCF residents on long-term ventilation. INTERVENTION: The modified bundle included hand hygiene before patient care, elevation of the head of the bed to more than 30° for individuals who are supine, chlorhexidine oral care at the beginning of each nursing shift, keeping tracheostomy cannula balloon pressure at 20 to 30 cm H2 O, and measuring nasogastric food remnants before every meal for individuals fed through a nasogastric tube. MEASUREMENTS: Number of VAP episodes was determined prospectively, and rates were calculated as episodes per 1,000 ventilation days. RESULTS: VAP rate decreased from 5.97 before the intervention to 2.34 after the intervention (P < .001). The use of broad-spectrum antibiotics decreased from 1,788 defined daily doses before the intervention to 1,093 after (P = .04). CONCLUSION: A modified bundle successfully decreased VAP rates in chronically ventilated elderly LTCF residents.
Authors: Javier de Miguel-Díez; Ana López-de-Andrés; Valentín Hernández-Barrera; Isabel Jiménez-Trujillo; Manuel Méndez-Bailón; José M de Miguel-Yanes; Benito Del Rio-Lopez; Rodrigo Jiménez-García Journal: Medicine (Baltimore) Date: 2017-07 Impact factor: 1.889