The Effect of Ventilator-Associated Pneumonia Prevention Bundles on Ventilator-Associated Event Rate in the Intensive Care Units of a Tertiary Care Hospital

Yıl 2023, Cilt: 20 Sayı: 3, 642 - 648, 31.12.2023

Gokhan Erdem , Dilek Ünal

https://doi.org/10.35440/hutfd.1370783

Öz

Background: It has been shown that the incidence of VAP decreases with compliance with ventilator-associated pneumonia (VAP) precautionary bundles. However, the effect of these bundles on the incidence of ventilator-related events (VIO) is still controversial. The aim of this study is to investigate the incidence of VIO and compliance with the VAP prevention bundle in a certain period in the in-tensive care units (ICU) of a training and research hospital.
Materials and Methods: This is a prospective observational case-control study investigating the inci-dence of VIO and compliance with VAP prevention bundles between April and June 2019 in ICUs of a tertiary education and research hospital. VAP prevention bundle created; The incidence of VIO was determined according to the 2013 United States Centers for Disease Control and Prevention (CDC) surveillance criteria. The effects of patient characteristics and distribution of patients in ICUs on the development of VIO were investigated.
Results: The study was completed with 98 patients. It was determined that the rate of compliance with VAP prevention bundles varied between 65% and 85% among ICUs. It has been shown with other important risk factors that every 10% decrease in compliance with the VAP prevention bundle increases the risk of developing VIO.
Conclusions: According to the 2013 CDC criteria, the incidence of VIO in the ICUs of our hospital is 20.4%. The risk of developing VIO increases with low compliance with the VAP prevention bundle, patient characteristics, and many factors arising from ICU treatments. Differences in ICUs in terms of compliance with VIP measure bundles show the necessity of training activities on the subject.

Bir Üçüncü Basamak Hastanenin Yoğun Bakım Ünitelerinde Ventilatör İlişkili Pnömoni Önleme Demetlerinin Ventilatör İlişkili Olay Oranlarına Etkisi

Öz

Amaç: Ventilatör ilişkili pnömoni (VİP) önlem demetlerine uyum ile VİP insidansının azaldığı gösterilmiştir. Ancak bu demetlerin Ventilatör ilişkili olay (VİO) insidansına olan etkisi hala tartışmalıdır. Bu çalışmanın amacı, bir eğitim araştırma hastanesinin yoğun bakım ünitelerinde (YBÜ) belirli bir dönemdeki VİO insidansı ve VİP önleme demetine uyumun araştırılmasıdır.
Materyal ve metod: Bu çalışma, üçüncü basamak bir eğitim ve araştırma hastanesinin YBÜ’ lerinde Nisan - Haziran 2019 arasında VİO insidansı ve VİP önleme demetlerine uyumun araştırıldığı prospektif gözlemsel bir vaka kontrol çalışmasıdır. VİP önleme demeti oluşturuldu; VİO insidansı ise 2013 Amerika Birleşik Devletleri Hastalık Kontrol ve Önleme Merkezi (CDC) sürveyans kriterlerine göre belirlendi. Hasta özelliklerinin ve YBÜ’ lerdeki hasta dağılımının ve VİO gelişimi üzerine etkileri araştırıldı.
Bulgular: Araştırma 98 hasta ile tamamlandı. VİP önleme demetlerine uyum oranının YBÜ’ ler arasında %65 ile %85 arasında değiştiği saptandı. VİP önleme demetine uyumdaki her %10 azalmanın VİO gelişme riskini artırdığı diğer önemli risk faktörleri ile gösterildi.
Sonuç: Hastanemiz YBÜ’ lerinde 2013 CDC kriterlerine göre VIO insidansı %20,4’tür. VIO gelişme riski, VİP önleme demetine düşük uyum, hasta özellikleri ve YBÜ tedavilerinden kaynaklanan birçok faktör ile artmaktadır. YBÜ’ lerinde VİP önlem demetlerine uyum bakımından farklılıklar konu ile ilgili eğitim faaliyetlerinin gerekliliğini göstermektedir.

Anahtar Kelimeler

Ventilatör ilişkili pnömoni, ventilatör ilişkili olay, önlem demeti, sürveyans

Kaynakça

• 1. Galal YS, Youssef MRL, Ibrahiem SK. Ventilator-associated pneumonia: Incidence, risk factors and outcome in paediat-ric intensive care units at cairo university hospital. J Clin Di-agnostic Res. 2016;10(6):SC06-SC08
• 2. Ding C, Zhang Y, Yang Z, Wang J, Jin A, Wang W, et al. Incidence, temporal trend and factors associated with ven-tilator-associated pneumonia in mainland China: A system-atic review and meta-analysis. BMC Infect Dis. 2017;17(1):1-10
• 3. Miller F. Ventilator-Associated Pneumonia. World Fed Soc Anaesthesiol. 2018;ATOTW 382(June):1-6
• 4. Wilkes AR. Heat and moisture exchangers and breathing system filters: Their use in anaesthesia and intensive care. Part 2 - Practical use, including problems, and their use with paediatric patients. Anaesthesia. 2011;66:40-51
• 5. Japoni A, Vazin A, Davarpanah MA, Ardakani MA, Alborzi A, Japoni S, et al. Ventilator-associated pneumonia in Iranian intensive care units. J Infect Dev Ctries. 2011;5(4):286-293
• 6. Kalanuria AA, Zai W, Mirski M. Ventilator-associated pneumonia in the ICU. Crit Care. 2014;18(2)
• 7. Klompas M, Branson R, Eichenwald EC, Greene LR, Howell MD, Lee G, et al. Strategies to prevent ventilator-associated pneumonia in acute care hospitals: 2014 update.[Reprint in Infect Control Hosp Epidemiol. 2014 Sep;35 Suppl 2:S133-54; PMID: 25376073]. Infect Control Hosp Epidemiol. 2014;35(8):915-936
• 8. Yokoe DS, Classen D. Introduction : Improving Patient Safe-ty Through Infection Control: A New Healthcare Imperative . Infect Control Hosp Epidemiol. 2008;29(S1):S3-S11
• 9. Resar R, Pronovost P, Haraden C, Simmonds T, Rainey T, Nolan T. Using a bundle approach to improve ventilator care processes and reduce ventilator-associated pneumo-nia. Jt Comm J Qual Patient Saf. 2005;31(5):243-248
• 10. Zaydfudim V, Dossett LA, Starmer JM, Arbogast PG, Feurer ID, Ray WA, et al. Implementation of a real-time compli-ance dashboard to help reduce SICU ventilator-associated pneumonia with the ventilator bundle. Arch Surg. 2009;144(7):656-661
• 11. Klompas M. Complications of mechanical ventilation - The CDC’s new surveillance paradigm. N Engl J Med. 2013;368(16):1472-1475
• 12. Spalding MC, Cripps MW, Minshall CT. Ventilator-Associated Pneumonia: New Definitions. Crit Care Clin. 2017;33(2):277-292
• 13. Ventilatör ile ilişkili olayda (VİO) yeni ulusal surveyans yaklaşımı. Türk Yoğun Bakım Derneği Yoğun Bakım Kılavu-zları. 2015
• 14. Ramirez-Estrada S, Peña-Lopez Y, Vieceli T, Rello J. Ventila-tor-associated events: From surveillance to optimizing ma-nagement. J Intensive Med. 2023;3(3):204-211
• 15. Cocoros NM, Klompas M. Ventilator-Associated Events and Their Prevention. Infect Dis Clin North Am. 2016;30(4):887-908
• 16. Klompas M, Branson R, Cawcutt K, Crist M, Eichenwald EC, Greene LR, et al. Strategies to prevent ventilator-associated pneumonia, ventilator-associated events, and nonventilator hospital-acquired pneumonia in acute-care hospitals: 2022 Update. Infect Control Hosp Epidemiol. 2022;43(6):687-713
• 17. Klompas M. Potential strategies to prevent ventilator-associated events. Am J Respir Crit Care Med. 2015;192(12):1420-1430
• 18. Klompas M, Khan Y, Kleinman K, Evans RS, Lloyd JF, Steven-son K, et al. Multicenter evaluation of a novel surveillance paradigm for complications of mechanical ventilation. PLoS One. 2011;6(3)
• 19. Klouwenberg PMCK, Van Mourik MSM, Ong DSY, Horn J, Schultz MJ, Cremer OL, et al. Electronic implementation of a novel surveillance paradigm for ventilator-associated events feasibility and validation. Am J Respir Crit Care Med. 2014;189(8):947-955
• 20. Muscedere J, Sinuff T, Heyland DK, Dodek PM, Keenan SP, Wood G, et al. The clinical impact and preventability of ven-tilator-associated conditions in critically ill patients who are mechanically ventilated. Chest. 2013;144(5):1453-1460
• 21. Stoeppel CM, Eriksson EA, Hawkins K, Eastman A, Wolf S, Minei J, et al. Applicability of the National Healthcare Sa-fety Network’s surveillance definition of ventilator-associated events in the surgical intensive care unit: A 1-year review. In: Journal of Trauma and Acute Care Surgery. Vol 77. Lippincott Williams and Wilkins; 2014:934-937
• 22. Chang H-C, Chen C-M, Kung S-C, Wang C-M, Liu W-L, Lai C-C. Discordance between Novel and Traditional Surveillance Paradigms of Ventilator-Associated Pneumonia. Infect Control Hosp Epidemiol. 2014;35(9):1195-1196
• 23. Nakahashi S, Lmai H, Imanaka H, Ohshimo S, Satou T, Shima M, et al. Ventilator - associated events: prevalence and mortality in Japan. J Thorac Dis. 2018;10(12):6942-6949