کد مقاله کد نشریه سال انتشار مقاله انگلیسی نسخه تمام متن
5566248 1563448 2017 7 صفحه PDF دانلود رایگان
عنوان انگلیسی مقاله ISI
Impact and feasibility of an emergency department-based ventilator-associated pneumonia bundle for patients intubated in an academic emergency department
ترجمه فارسی عنوان
تأثیر و امکان استفاده از یک صندوق پنومونی وابسته به بخش اورژانس برای بیمارانی که در بخش اورژانس دانشگاهی وارد شده اند
موضوعات مرتبط
علوم زیستی و بیوفناوری ایمنی شناسی و میکروب شناسی میکروب شناسی
چکیده انگلیسی


- Ventilator-associated pneumonia prevention is standard care in the intensive care unit, but not yet in the emergency department.
- Ventilator-associated pneumonia occurs frequently in emergency department intubated patients who may remain in the emergency department for many hours.
- Starting ventilator-associated pneumonia prevention in the emergency department results in decreased overall and early ventilator-associated pneumonia for these patients.
- High rates of compliance with an emergency department-based ventilator-associated pneumonia bundle can be achieved.
- Bundle compliance is improved with a registered nurse (RN) champion.

BackgroundVentilator-associated pneumonia (VAP) has been linked to emergency department (ED) intubation and length of stay (LOS). We assessed VAP prevalence in ED intubated patients, feasibility of ED VAP prevention, and effect on VAP rates.MethodsThis was a quality improvement initiative using a pre/post design. Phase 1 (PRE1) comprised patients before intensive care unit (ICU) bundle deployment. Phase 2 (PRE2) occurred after ICU but before ED deployment. Phase 3 (POST) included patients received VAP prevention starting at ED intubation. Log-rank test for equality and Cox regression using a Breslow method for ties were performed. Bundle compliance was reported as percentages. Number needed to treat (NNT) was calculated by ventilator day.ResultsPRE1, PRE2, and POST groups were composed of 195, 192, and 153 patients, respectively, with VAP rates of 22 (11.3%), 11 (5.7%), and 6 (3.9%). Log-rank test showed significant reduction in VAP (χ2 = 9.16, P = .0103). The Cox regression hazard ratio was 1.38 for the Clinical Pulmonary Infection Score (P = .001), and the hazard ratio was 0.26 for the VAP bundle (P = .005). Bundle compliance >50% for head-of-bed elevation, oral care, subglottic suctioning, and titrated sedation improved significantly with introduction of a registered nurse champion. NNT varied from 7 to 11.ConclusionsVAP was common for ED intubated patients. ED-based VAP prevention is feasible. We demonstrate significant reduction in VAP rates, which should be replicated in a multicenter study.

ناشر
Database: Elsevier - ScienceDirect (ساینس دایرکت)
Journal: American Journal of Infection Control - Volume 45, Issue 2, 1 February 2017, Pages 151-157
نویسندگان
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