...infection control and hospital epidemiology march 2014, vol. 35, no. 3 original article Ventilator-Associated Pneumonia: Overdiagnosis and Treatment Are Common in Medical and Surgical Intensive Care Units Veronique Nussenblatt, MD, MHS;1 Edina Avdic, PharmD, MBA;2 Sean Berenholtz, MD, MHS;3,4 Elizabeth Daugherty, MD, MPH;5 Eric Hadhazy, MS;1 Pamela A. Lipsett, MD, MHPE;3,4 Lisa L. Maragakis, MD, MPH;1 Trish M. Perl, MD, MSc;1 Kathleen Speck, MPH;3 Sandra M. Swoboda, RN, MS;3 Wendy Ziai, MD;3,6 Sara E. Cosgrove, MD, MS1 objective. Diagnosing ventilator-associated pneumonia (VAP) is difficult, and misdiagnosis can lead to unnecessary and prolonged antibiotic treatment. We sought to quantify and characterize unjustified antimicrobial use for VAP and identify risk factors for continuation of antibiotics in patients without VAP after 3 days. methods. Patients suspected of having VAP were identified in 6 adult intensive care units (ICUs) over 1 year. A multidisciplinary adjudication committee determined whether the ICU team’s VAP diagnosis and therapy were justified, using clinical, microbiologic, and radiographic data at diagnosis and on day 3. Outcomes included the proportion of VAP events misdiagnosed as and treated for VAP on days 1 and 3 and risk factors for the continuation of antibiotics in patients without VAP after day 3. results. Two hundred thirty-one events were identified as possible VAP by the ICUs. On day 1, 135 (58.4%) of them were determined to not have VAP...
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......................................................................................…...8 Data collection ……………………………………..………….……………………………8 Statistics and data analysis …………………………………………………………….…...9 Expected results …………………………………………………………………………………..9 References cited………………………………………………………………………………….10 Appendix A………………………………………………………………………………………13 Appendix B………………………………………………………………………………………14 Appendix C………………………………………………………………………………………15 Appendix D………………………………………………………………………………………16 Ventilator associated pneumonia and chlorhexidine use in the traumatic brain injured patient Ventilator associated pneumonia (VAP), is defined as, a nosocomial pneumonia that develops more than 48 hours following endotrachial intubation and mechanical ventilation, and is a common and serious intensive care unit (ICU) complication. VAP causes noteworthy morbidity, mortality, amplified hospital costs, and increased utilization of healthcare resources, prolonged time for ventilator support, as well as lengthened ICU and hospital stay (Caruso, 2009). Antibiotics (ATBs) have traditionally been used to treat VAP, but the occurrence of resistance...
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...Ventilator associated pneumonia (VAP) is a pneumonia occurring approximately 48 hours after a patient is intubated and placed on a mechanical ventilator. VAP is of major concern as it is directly caused by the use of a medical device. This pneumonia occurs when secretions from the oropharyngeal area move into the lungs (VAP, 2006). VAP accounts for 6 of every 10 deaths attributed to healthcare-associated infections (Doyle, Fletcher, Carter, Blunt, & Young, 2011). VAP extends the time a patient is in the intensive care unit by approximately a week and increases cost by $10000 per episode (Doyle et al., 2011). BioMed Central, a peer research group, performed a quantitative research study on VAP and the PneuX System addresses issues surrounding the prevention of VAP. This device incorporates and proprietary endotracheal tube and tracheal cuff seal monitor which is not used with traditional endotracheal intubation. When selecting the sample study, each patient was over the age of 18 years and intubation was required within their plan of care. PneuX System was implemented only of patients expected to be intubated over 24 hours (Doyle et al., 2011). For all patients included in the study, the PneuX System was used and intubation time was at least 48 hours. All patients intubated using the PneuX System were included in study results. First to review VAP and the role the PneuX system plays in VAP prevention. Often when placed on a ventilator a patient is sedated. Bacteria...
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...Prevention of Ventilator-Associated Pneumonia Prevention of Ventilator-Associated Pneumonia Ventilator-Associated Pneumonia (VAP) is the most common nosocomial infection in Critical Care units. VAP is linked with high mortality rates, increased hospital stays, longer mechanical ventilation and increased costs to hospitals and patients (Rosa, Hernandez, Carillo, Fernandez, & Valles, 2012). Patients who have an endotracheal tube (ETT) with mechanical ventilation are more likely to develop VAP. These patients have a poor cough reflex due to a decreased level of consciousness and diminished movement of the respiratory tract mucocila, leading to the inability to clear secretions. These contaminated secretions will then sit on top of the ETT cuff and eventually leak down and invade the lungs. Also aiding as a reservoir for microbes is a biofilm that can form on the ETT and enter the lungs causing infection (Mietto, Pinciroli, Patel, & Berra, 2013). Nurses are responsible for applying pharmacological and non-pharmacological measures to help prevent VAP which poses a very difficult challenge. Nurses must research and incorporate the use of evidence-based practice into their daily care of patients on mechanical ventilation (Sedwick, Lance-Smith, & Nardi, 2012). This paper will look closely at the evidence-based research and protocols implemented which best prevent ventilator-associated pneumonia. To help prevent further complications and improve outcomes in patients...
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...Australasian Medical Journal [AMJ 2012, 5, 2, 135-140] Outcome of ventilator-associated pneumonia: Impact of antibiotic therapy and other factors Noyal Mariya Joseph1, Sujatha Sistla1, Tarun Kumar Dutta2, Ashok Shankar Badhe3, Desdemona Rasitha1, Subhash Chandra Parija1 1. Department of Microbiology, 2. Department of Medicine, 3. Department of Anaesthesiology and Critical Care Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry - 605006, India RESEARCH Please cite this paper as: Joseph NM, Sistla S, Dutta TK, Badhe AS, Rasitha D, Parija SC. Outcome of ventilatorassociated pneumonia: impact of appropriate therapy and other factors. AMJ 2012, 5, 2, 135-140. http//dx.doi.org/10.4066/AMJ.2012.1004. Corresponding Author: Dr. Noyal Mariya Joseph, Assistant Professor, Department of Microbiology, Mahatma Gandhi Medical College and Research Institute, Pillaiyarkuppam, Pondicherry – 607 402 (India) Email: noyaljoseph@yahoo.com Please use these fonts and font sizes only. Abstract inappropriate therapy (defined as lack of coverage of one or all the significant VAP pathogens) were at significantly high risk for death (Relative risk, 2.00; 95% confidence interval, 1.14 to 3.52; P 0.0008). A delay of > 2 days in administering the first dose of appropriate antibiotic therapy significantly prolonged the duration of ventilation (P < 0.0001). Infection by multi-drug resistant pathogens, polymicrobial infection and time of onset of VAP did not...
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...Ventilator-Associated Pneumonia In general, Healthcare acquired infections are caused by a viral, bacterial, or fungal pathogen that is not present at the time of admission to a hospital or other healthcare setting. These infections can result in an extended stay for patients, mortality, and increased healthcare costs. They can also occur in pediatric and adult patients of either sex, but are more common in critically ill patients. Healthcare acquired infections are a huge concern in the medical field, because they can be associated with medical equipment and involve any system of the body. The most common HAI’s are pneumonia, bloodstream, and urinary tract infections (Custodio, 2015). Ventilator-associated pneumonia or VAP is pneumonia that occurs longer than forty-eight hours after a patient has been intubated and receiving mechanical ventilation. This illness is the second most common hospital acquired infection in critically ill patients. Around eighty-six percent of healthcare acquired pneumonias are due to mechanical ventilation. Every year in the United...
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...Hospital Acquired Infections (HAI) are a concerning complication during hospital stays. In 2011, it was estimated that out of 722,000 calculated HAI’s, 157,500 were caused by Pneumonia (CDC.gov, 2015). Ventilator Associated Pneumonia (VAP), a sub-category of Pneumonia, is a worldwide, challenging complication in the Intensive Care Unit (ICU) setting of many hospitals. VAP often leads to not only increased mortality rates, but also an increase in comorbidity, and healthcare costs in the affected population. It has been estimated that VAP As of 2013, Ventilator Associated Pneumonia has been renamed under the umbrella term Ventilator Associated Events (VAE), making it difficult to find statistics that specifically represent VAP incidences and...
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...duration of stay , is estimated as estimated as 1 to 4 days for urinary tract infections, 7 to 8.2 days for surgical site infections, 7 to 21 days for bloodstream infections, and 6.8 to 30 days for pneumonia. The estimated mortalities associated with nosocomial bloodstream infections and pneumonia are 23.8% to 50% and 14.8% to 71% (overall), or 16.3% to 35% and 6.8% to 30% (attributable), respectively. The estimated average costs of...
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...improved patient care. One element of the core measures is pneumonia. The performance measures for patients diagnosed with pneumonia were developed in a collaborative effort including the Joint Commission (TJC), the Centers for Medicare and Medicaid Services (CMS), the Infectious Disease Society of America (IDSA), the American Thoracic Society (ATS), the American College of Emergency Physicians (ACEP), and the Centers for Disease Control and Prevention (CDC) (The Joint Commission, 2014). The core measures for pneumonia stipulate the timely collection of blood cultures and administration of appropriate antibiotics (RN.com, 2013). It also focuses on the 30-day readmission rate (Agency for Healthcare Research and Quality, 2013). According to the Medicare Payment Advisory Commission in 2007, pneumonia was one of the seven conditions that account for nearly 30% of potentially preventable readmissions within 15 days of hospital discharge (Agency for Healthcare Research and Quality, 2013). Healthcare organizations report their performance as a percentage of compliance to TJC and CMS, which then effects both accreditation and reimbursement (RN.com, 2013). The increasing emphasis on quality of care, patient safety, and clinical care outcomes has resulted in impressive advances in patient care. For example, PeaceHealth/St. Joseph Hospital in Bellingham Washington was able to reduce complications and mortality associated with severe sepsis and septic shock by increasing compliance...
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...care agency specializing in the care of medically fragile children must develop a QI plan that best suits them by choosing data collection tools that based on potential improvement areas that they plan to tackle. The paper will discuss potential improvements, data needed to monitor for improvement in performance areas, data collection tools used, comparing and contrasting the tools and measurements as well as its importance in healthcare. Potential Areas for Improvement for Nurses Just for Kids There are many different areas that have the potential for improvement for Nurse Just for Kids but only two areas have been in need of quality improvement efforts the most. The two areas are back injuries and ventilator associated pneumonia. Two of the five clients that are being serviced from the home care agency has seen an increase in back injuries that are seen from their employees. The second area in need of improvement is in the area of ventilator associated pneumonia which there has been two pediatric clients with hospitalization due to pneumonia in the same month in 2011. This is a significant amount considering how small the company is in general and the amount of pediatric clients that is being serviced currently. Making changes in these areas will help Nurses Just for Kids in providing quality care. Data needed to monitor improvement in performance areas “Measurement is central to the concept of quality improvement; it provides a means to define what hospitals actually...
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...promotes quality health outcomes for the patients, families, communities, and the health care system. Nurses and other healthcare personnel are able to use the skills learned through evidence based research to decrease a patient’s length of stay, decreases morbidity and mortality, and healthcare cost. Nursing research is a scientific process that validates and refines existing knowledge and generates new knowledge that directly and indirectly influences nursing practice (Burns & Grove, 2011). Extensive research is needed to develop sound empirical knowledge for synthesis into the best research evidence needed for practice. This research evidence might be synthesized to develop guidelines, standards, protocols, or policies to direct the implementation of a variety of nursing interventions (Burns & Grove, 2011). One example of nursing research that has improved patient outcomes is through the use of VAP (ventilator associated pneumonia) bundles in an intensive care unit setting for patients that are intubated for more than twenty four hours. VAP is pneumonia that occurs in a patient who was intubated and ventilated at the time of or within 48 hours before the onset of event (Centers for Disease Control and Prevention, n.d.) The Institute of Health Improvement (IHI) developed a ventilator bundle that incorporates several strategies to prevent morbidity associated with being on a ventilator. These strategies included: elevation head of bed to 30-45 degrees (prevents aspiration), daily...
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...Pneumonia is a very common lung infection that is a collection of pus and other fluids in the lung air sacs. Pneumonia is caused by many kinds of microorganisms called germs. The most common type of getting pneumonia is bacteria. When an organism is identified it is usually the bacteria Streptococcus pneumonia. Pneumonia is a common illness affecting approximately 450 million people a year and occurring in all parts of the world. It is a major cause of death among all age groups, resulting in 1.4 million deaths in the U.S. in 2010. There were 56,832 deaths due to pneumonia and influenza in 2013, which combined were the eighth leading cause of death in the U.S. While the age‐adjusted death rate for pneumonia and influenza increased 9 percent from 2012 to 2013, it has decreased an average of 3.8 percent per year since 1999. Pneumonia is endogenous, exogenous, as well as nosocomial. Usual reservoirs for this pathogen are water, soil, agriculture plants, animals, and humans. The bacteria can be entered in the body by you touching or inhaling the bacteria in the air from somebody who already has pneumonia. In order for the bacteria to exit your body it ejected from the mouse and nose from your lungs. The means of transmission is when someone coughs or sneezes and when this happens...
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...AFT Task 4: Periodic Performance Review Accreditation Audit Case Introduction The accreditation process is designed to assist healthcare establishment to identify and enhance the patient’s safety and the quality of service delivery. This paper presents a review of the readiness Nightingale Community Hospital for accreditation audit. The paper comprises of a periodic performance review of the establishment. The review has focus of several priority areas. These areas include; assessment and care; quality improvement; patient safety, and staffing effectiveness. Trend within the hospital indicates the Nightingale has made significant progress towards fulfilling the standards of the Joint Review Commission. However, the trends in staffing effectiveness are limiting the organization’s compliance. Periodic Performance Review (PPR) The PPR is based on data collected in the Joint Commission Survey. The survey utilized the priority focus methodology to evaluate the compliance of Nightingale Community Hospital. The priority focus process is a methodology that makes use of data to establish priority areas for reviewing compliance. This process has utilized of both external and internal data to evaluate the compliance of Nightingale Community Hospital. This methodology identified several priority areas. These include; assessment and care services; quality improvement activities, and patient safety. This paper evaluates Nightingale’s compliance in these three priority areas. Compliance...
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...possessed nosocomial infections as in any real hospitals where patients seek admission for treatment. According to Center for Disease Control and prevention (CDC), and Pennsylvania Department of Health (PADOH), a healthcare associated infection (HAI) which is also known as nosocomial infection is an infection that a person gets while staying as a patient in a hospital or other health care facility (PADOH, 2008). Hence, it is clearly understood that patients always acquired nosocomial infections during the process of receiving health care services from health professionals in any hospital or healthcare setting. PADOH has also confirmed that HAIs are the primary contributors of most sicknesses and mortalities in the world. For example, in American hospitals alone, HAIs account for about 1.7 million infections causing 99,000 deaths each year. Therefore, based on the analysis of Good Health Hospital records, research had shown that a great number of recent nosocomial infections that had happened before were identified. Among the different kinds of nosocomial infections verified, few infection type have been listed as followed: 1. Surgical site infection (SSI). 2. Urinary tract infection (UTI). 3. Gastrointestinal infection (GI). 4. Blood stream infection (BSI). 5. Pneumonia infection (PNEU). 6. Lower respiratory tract(LRI)’ 7. Skin and soft tissue (SST). 8. Eye Ear Nose and Throat (EENT). 9. Cardiovascular system(CVS)....
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...consistency, we will use HAIs when referring to nosocomial infections, please refer to the definition section for further understanding of the terms) More than half of all the incidents occurred within the intensive care unit. HAIs can be associated with the devices used in medical procedures, such as central line-associated...
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