Skip to main content
×
×
Home

Strategies to Prevent Ventilator-Associated Pneumonia in Acute Care Hospitals: 2014 Update

  • Michael Klompas (a1) (a2), Richard Branson (a3), Eric C. Eichenwald (a4), Linda R. Greene (a5), Michael D. Howell (a6), Grace Lee (a1) (a7), Shelley S. Magill (a8), Lisa L. Maragakis (a9), Gregory P. Priebe (a2) (a7) (a10), Kathleen Speck (a11), Deborah S. Yokoe (a2) and Sean M. Berenholtz (a11) (a12) (a13)...
Abstract

Previously published guidelines are available that provide comprehensive recommendations for detecting and preventing healthcare-associated infections (HAIs). The intent of this document is to highlight practical recommendations in a concise format to assist acute care hospitals in implementing and prioritizing strategies to prevent ventilator-associated pneumonia (VAP) and other ventilator-associated events (VAEs) and to improve outcomes for mechanically ventilated adults, children, and neonates. This document updates "Strategies to Prevent Ventilator-Associated Pneumonia in Acute Care Hospitals," published in 2008. This expert guidance document is sponsored by the Society for Healthcare Epidemiology of America (SHEA) and is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America (IDSA), the American Hospital Association (AHA), the Association for Professionals in Infection Control and Epidemiology (APIC), and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise. The list of endorsing and supporting organizations is presented in the introduction to the 2014 updates.

Copyright
Corresponding author
Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, 133 Brookline Avenue, 6th Floor, Boston, MA 02215 (mklompas@partners.org).
References
Hide All
1. Coffin SE, Klompas M, Classen D, et al. Strategies to prevent ventilator-associated pneumonia in acute care hospitals. Infect Control Hosp Epidemiol 2008;29(suppl 1):S31S40.
2. Yokoe DS, Andersen DJ, Berenholtz SM, et al. Introduction to “A Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals: 2014 Updates.” Infect Control Hosp Epidemiol 2014;35(5):455459.
3. Dudeck MA, Horan TC, Peterson KD, et al. National Healthcare Safety Network (NHSN) report, data summary for 2010, device-associated module. Am J Infect Control 2011;39(10):798816.
4. Klompas M. Eight initiatives that misleadingly lower ventilator-associated pneumonia rates. Am J Infect Control 2012;40(5):408410.
5. Vincent JL, Rello J, Marshall J, et al. International study of the prevalence and outcomes of infection in intensive care units. JAMA 2009;302(21):23232329.
6. Magill SS, Hellinger W, Cohen J, et al. Prevalence of healthcare-associated infections in acute care hospitals in Jacksonville, Florida. Infect Control Hosp Epidemiol 2012;33(3):283291.
7. Thomas BW, Maxwell RA, Dart BW, et al. Errors in administrative-reported ventilator-associated pneumonia rates: are never events really so? Am Surg 2011;77(8):9981002.
8. Skrupky LP, McConnell K, Dallas J, Kollef MH. A comparison of ventilator-associated pneumonia rates as identified according to the National Healthcare Safety Network and American College of Chest Physicians criteria. Crit Care Med 2012;40(1):281284.
9. Novosel TJ, Hodge LA, Weireter LJ, et al. Ventilator-associated pneumonia: depends on your definition. Am Surg 2012;78(8):851854.
10. Klompas M, Khan Y, Kleinman K, et al. Multicenter evaluation of a novel surveillance paradigm for complications of mechanical ventilation. PLoS ONE 2011;6(3):e18062.
11. Klompas M, Magill S, Robicsek A, et al. Objective surveillance definitions for ventilator-associated pneumonia. Crit Care Med 2012;40(12):31543161.
12. Hayashi Y, Morisawa K, Klompas M, et al. Toward improved surveillance: the impact of ventilator-associated complications on length of stay and antibiotic use in patients in intensive care units. Clin Infect Dis 2013;56(4):471477.
13. Prospero E, Illuminati D, Marigliano A, et al. Learning from Galileo: ventilator-associated pneumonia surveillance. Am J Respir Crit Care Med 2012;186(12):13081309.
14. Muscedere J, Sinuff T, Heyland D, et al. The clinical impact and preventability of ventilator-associated conditions in critically ill mechanically ventilated patients. Chest 2013;144(5):14531460.
15. Klein Klouwenberg PM, van Mourik MS, Ong DS, 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):947955.
16. Klompas M, Kleinman K, Murphy MV. Descriptive epidemiology and attributable morbidity of ventilator-associated events. Infect Control Hosp Epidemiol 2014;35(5):502510.
17. Nguile-Makao M, Zahar JR, Francais A, et al. Attributable mortality of ventilator-associated pneumonia: respective impact of main characteristics at ICU admission and VAP onset using conditional logistic regression and multi-state models. Intensive Care Med 2010;36(5):781789.
18. Bekaert M, Timsit JF, Vansteelandt S, et al. Attributable mortality of ventilator associated pneumonia: a reappraisal using causal analysis. Am J Respir Crit Care Med 2011;184(10):11331139.
19. Melsen WG, Rovers MM, Koeman M, Bonten MJ. Estimating the attributable mortality of ventilator-associated pneumonia from randomized prevention studies. Crit Care Med 2011;39(12):27362742.
20. Melsen WG, Rovers MM, Groenwold RH, et al. Attributable mortality of ventilator-associated pneumonia: a meta-analysis of individual patient data from randomised prevention studies. Lancet Infect Dis 2013;13(8):665671.
21. Safdar N, Dezfulian C, Collard HR, Saint S. Clinical and economic consequences of ventilator-associated pneumonia: a systematic review. Crit Care Med 2005;33(10):21842193.
22. Kirtland SH, Corley DE, Winterbauer RH, et al. The diagnosis of ventilator-associated pneumonia: a comparison of histologic, microbiologic, and clinical criteria. Chest 1997;112(2):445457.
23. Klompas M. Does this patient have ventilator-associated pneumonia? JAMA 2007;297(14):15831593.
24. Wunderink RG, Woldenberg LS, Zeiss J, Day CM, Ciemins J, Lacher DA. The radiologic diagnosis of autopsy-proven ventilator-associated pneumonia. Chest 1992;101(2):458463.
25. Tejerina E, Esteban A, Fernandez-Segoviano P, et al. Accuracy of clinical definitions of ventilator-associated pneumonia: comparison with autopsy findings. J Crit Care 2010;25(1):6268.
26. Schurink CA, Van Nieuwenhoven CA, Jacobs JA, et al. Clinical pulmonary infection score for ventilator-associated pneumonia: accuracy and inter-observer variability. Intensive Care Med 2004;30(2):217224.
27. Klompas M. Interobserver variability in ventilator-associated pneumonia surveillance. Am J Infect Control 2010;38(3):237239.
28. Klein Klouwenberg PM, Ong DS, Bos LD, et al. Interobserver agreement of Centers for Disease Control and Prevention criteria for classifying infections in critically ill patients. Crit Care Med 2013;41(10):23732378.
29. Stevens JP, Kachniarz B, Wright SB, et al. When policy gets it right: variability in U.S. hospitals’ diagnosis of ventilator-associated pneumonia. Crit Care Med 2014;42(3):497503.
30. Sherman ER, Heydon KH, St. John KH, et al. Administrative data fail to accurately identify cases of healthcare-associated infection. Infect Control Hosp Epidemiol 2006;27(4):332337.
31. Stevenson KB, Khan Y, Dickman J, et al. Administrative coding data, compared with CDC/NHSN criteria, are poor indicators of health care–associated infections. Am J Infect Control 2008;36(3):155164.
32. Drees M, Hausman S, Rogers A, Freeman L, Frosch K, Wroten K. Underestimating the impact of ventilator-associated pneumonia by use of surveillance data. Infect Control Hosp Epidemiol 2010;31(6):650652.
33. Klompas M. The paradox of ventilator-associated pneumonia prevention measures. Crit Care 2009;13(5):315.
34. Bonten MJ. Ventilator-associated pneumonia: preventing the inevitable. Clin Infect Dis 2011;52(1):115121.
35. Klompas M, Platt R. Ventilator-associated pneumonia—the wrong quality measure for benchmarking. Ann Intern Med 2007;147(11):803805.
36. van Saene HK, Silvestri L, de la Cal MA, Baines P. The emperor’s new clothes: the fairy tale continues. J Crit Care 2009;24(1):149152.
37. Uckay I, Ahmed QA, Sax H, Pittet D. Ventilator-associated pneumonia as a quality indicator for patient safety? Clin Infect Dis 2008;46(4):557563.
38. Blot S, Lisboa T, Angles R, Rello J. Prevention of VAP: is zero rate possible? Clin Chest Med 2011;32(3):591599.
39. Magill SS, Klompas M, Balk R, et al. Developing a new, national approach to surveillance for ventilator-associated events. Crit Care Med 2013;41(11):24672475.
40. Klompas M, Kleinman K, Platt R. Development of an algorithm for surveillance of ventilator-associated pneumonia with electronic data and comparison of algorithm results with clinician diagnoses. Infect Control Hosp Epidemiol 2008;29(1):3137.
41. Klompas M, Kleinman K, Khan Y, et al. Rapid and reproducible surveillance for ventilator-associated pneumonia. Clin Infect Dis 2012;54:370377.
42. Dessap AM, Katsahian S, Roche-Campo F, et al. Ventilator-associated pneumonia during weaning from mechanical ventilation: role of fluid management. Chest. doi:10.1378/chest.13-2564. Electronically published March 20, 2014.
43. Centers for Disease Control and Prevention (CDC). Ventilator-Associated Event Protocol. Atlanta: CDC, 2014. http://www.cdc.gov/nhsn/acute-care-hospital/vae/index.html. Accessed March 25, 2014.
44. Klompas M. Ventilator-associated events surveillance: a patient safety opportunity. Curr Opin Crit Care 2013;19(5):424431.
45. Lewis SC, Li L, Murphy MV, Klompas M. Risk factors for ventilator-associated events: a case-control multivariable analysis. Crit Care Med. doi:10.1097/CCM.0000000000000338. Electronically published April 18, 2014.
46. Strom T, Martinussen T, Toft P. A protocol of no sedation for critically ill patients receiving mechanical ventilation: a randomised trial. Lancet 2010;375(9713):475480.
47. Ely EW, Baker AM, Dunagan DP, et al. Effect on the duration of mechanical ventilation of identifying patients capable of breathing spontaneously. N Engl J Med 1996;335(25):18641869.
48. Girard TD, Kress JP, Fuchs BD, et al. Efficacy and safety of a paired sedation and ventilator weaning protocol for mechanically ventilated patients in intensive care (Awakening and Breathing Controlled trial): a randomised controlled trial. Lancet 2008;371(9607):126134.
49. Schweickert WD, Pohlman MC, Pohlman AS, et al. Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. Lancet 2009;373(9678):18741882.
50. Muscedere J, Rewa O, McKechnie K, Jiang X, Laporta D, Heyland DK. Subglottic secretion drainage for the prevention of ventilator-associated pneumonia: a systematic review and meta-analysis. Crit Care Med 2011;39(8):19851991.
51. Determann RM, Royakkers A, Wolthuis EK, et al. Ventilation with lower tidal volumes as compared with conventional tidal volumes for patients without acute lung injury: a preventive randomized controlled trial. Crit Care 2010;14(1):R1.
52. Futier E, Constantin J-M, Paugam-Burtz C, et al. A trial of intraoperative low-tidal-volume ventilation in abdominal surgery. N Engl J Med 2013;369(5):428437.
53. Wiedemann HP, Wheeler AP, Bernard GR, et al. Comparison of two fluid-management strategies in acute lung injury. N Engl J Med 2006;354(24):25642575.
54. Hebert PC, Wells G, Blajchman MA, et al; Transfusion Requirements in Critical Care Investigators, Canadian Critical Care Trials Group. A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care. N Engl J Med 1999;340(6):409417.
55. Klompas M. Prevention of ventilator-associated pneumonia. Expert Rev Anti Infect Ther 2010;8(7):791800.
56. Bouadma L, Wolff M, Lucet JC. Ventilator-associated pneumonia and its prevention. Curr Opin Infect Dis 2012;25(4):395404.
57. Hess DR. Noninvasive positive-pressure ventilation and ventilator-associated pneumonia. Respir Care 2005;50(7):924929.
58. Burns KE, Adhikari NK, Keenan SP, Meade MO. Noninvasive positive pressure ventilation as a weaning strategy for intubated adults with respiratory failure. Cochrane Database Syst Rev 2010(8):CD004127.
59. Carron M, Freo U, BaHammam AS, et al. Complications of non-invasive ventilation techniques: a comprehensive qualitative review of randomized trials. Br J Anaesth 2013;110(6):896914.
60. Aboussouan LS, Ricaurte B. Noninvasive positive pressure ventilation: increasing use in acute care. Cleve Clin J Med 2010;77(5):307316.
61. Barr J, Fraser GL, Puntillo K, et al. Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. Crit Care Med 2013;41(1):263306.
62. Kress JP, Pohlman AS, O’Connor MF, Hall JB. Daily interruption of sedative infusions in critically ill patients undergoing mechanical ventilation. N Engl J Med 2000;342(20):14711477.
63. Schweickert WD, Gehlbach BK, Pohlman AS, Hall JB, Kress JP. Daily interruption of sedative infusions and complications of critical illness in mechanically ventilated patients. Crit Care Med 2004;32(6):12721276.
64. Mehta S, Burry L, Cook D, et al. Daily sedation interruption in mechanically ventilated critically ill patients cared for with a sedation protocol. JAMA 2012:308(19):19851992.
65. Kress JP, Hall JB. The changing landscape of ICU sedation. JAMA 2012;308(19):20302031.
66. Kollef MH, Shapiro SD, Silver P, et al. A randomized, controlled trial of protocol-directed versus physician-directed weaning from mechanical ventilation. Crit Care Med 1997;25(4):567574.
67. Marelich GP, Murin S, Battistella F, Inciardi J, Vierra T, Roby M. Protocol weaning of mechanical ventilation in medical and surgical patients by respiratory care practitioners and nurses: effect on weaning time and incidence of ventilator-associated pneumonia. Chest 2000;118(2):459467.
68. Lellouche F, Mancebo J, Jolliet P, et al. A multicenter randomized trial of computer-driven protocolized weaning from mechanical ventilation. Am J Respir Crit Care Med 2006;174(8):894900.
69. Esteban A, Frutos F, Tobin MJ, et al; Spanish Lung Failure Collaborative Group. A comparison of four methods of weaning patients from mechanical ventilation. N Engl J Med 1995;332(6):345350.
70. Hopkins RO, Spuhler VJ, Thomsen GE. Transforming ICU culture to facilitate early mobility. Crit Care Clin 2007;23(1):8196.
71. Morris PE, Goad A, Thompson C, et al. Early intensive care unit mobility therapy in the treatment of acute respiratory failure. Crit Care Med 2008;36(8):22382243.
72. Bailey P, Thomsen GE, Spuhler VJ, et al. Early activity is feasible and safe in respiratory failure patients. Crit Care Med 2007;35(1):139145.
73. Morris PE, Griffin L, Berry M, et al. Receiving early mobility during an intensive care unit admission is a predictor of improved outcomes in acute respiratory failure. Am J Med Sci 2011;341(5):373377.
74. Burtin C, Clerckx B, Robbeets C, et al. Early exercise in critically ill patients enhances short-term functional recovery. Crit Care Med 2009;37(9):24992505.
75. Needham DM, Korupolu R, Zanni JM, et al. Early physical medicine and rehabilitation for patients with acute respiratory failure: a quality improvement project. Arch Phys Med Rehabil 2010;91(4):536542.
76. Titsworth WL, Hester J, Correia T, et al. The effect of increased mobility on morbidity in the neurointensive care unit. J Neurosurg 2012;116(6):13791388.
77. Balas MC, Vasilevskis EE, Olsen KM, et al. Effectiveness and safety of the awakening and breathing coordination, delirium monitoring/management, and early exercise/mobility bundle. Crit Care Med 2014;42(5):10241036.
78. Lord RK, Mayhew CR, Korupolu R, et al. ICU early physical rehabilitation programs: financial modeling of cost savings. Crit Care Med 2013;41(3):717724.
79. Bouza E, Perez MJ, Munoz P, Rincon C, Barrio JM, Hortal J. Continuous aspiration of subglottic secretions in the prevention of ventilator-associated pneumonia in the postoperative period of major heart surgery. Chest 2008;134(5):938946.
80. Lacherade JC, De Jonghe B, Guezennec P, et al. Intermittent subglottic secretion drainage and ventilator-associated pneumonia: a multicenter trial. Am J Respir Crit Care Med 2010;182(7):910917.
81. Shorr AF, O’Malley PG. Continuous subglottic suctioning for the prevention of ventilator-associated pneumonia: potential economic implications. Chest 2001;119(1):228235.
82. Hallais C, Merle V, Guitard PG, et al. Is continuous subglottic suctioning cost-effective for the prevention of ventilator-associated pneumonia? Infect Control Hosp Epidemiol 2011;32(2):131135.
83. Frost SA, Azeem A, Alexandrou E, et al. Subglottic secretion drainage for preventing ventilator associated pneumonia: a meta-analysis. Aust Crit Care 2013;26(4):180188.
84. Drakulovic MB, Torres A, Bauer TT, Nicolas JM, Nogue S, Ferrer M. Supine body position as a risk factor for nosocomial pneumonia in mechanically ventilated patients: a randomised trial. Lancet 1999;354(9193):18511858.
85. van Nieuwenhoven CA, Vandenbroucke-Grauls C, van Tiel FH, et al. Feasibility and effects of the semirecumbent position to prevent ventilator-associated pneumonia: a randomized study. Crit Care Med 2006;34(2):396402.
86. Keeley L. Reducing the risk of ventilator-acquired pneumonia through head of bed elevation. Nurs Crit Care 2007;12(6):287294.
87. Alexiou VG, Ierodiakonou V, Dimopoulos G, Falagas ME. Impact of patient position on the incidence of ventilator-associated pneumonia: a meta-analysis of randomized controlled trials. J Crit Care 2009;24(4):515522.
88. Dreyfuss D, Djedaini K, Weber P, et al. Prospective study of nosocomial pneumonia and of patient and circuit colonization during mechanical ventilation with circuit changes every 48 hours versus no change. Am Rev Respir Dis 1991;143(4 pt 1):738743.
89. Kollef MH, Shapiro SD, Fraser VJ, et al. Mechanical ventilation with or without 7-day circuit changes: a randomized controlled trial. Ann Intern Med 1995;123(3):168174.
90. Long MN, Wickstrom G, Grimes A, Benton CF, Belcher B, Stamm AM. Prospective, randomized study of ventilator-associated pneumonia in patients with one versus three ventilator circuit changes per week. Infect Control Hosp Epidemiol 1996;17(1):1419.
91. Lorente L, Lecuona M, Galvan R, Ramos MJ, Mora ML, Sierra A. Periodically changing ventilator circuits is not necessary to prevent ventilator-associated pneumonia when a heat and moisture exchanger is used. Infect Control Hosp Epidemiol 2004;25(12):10771082.
92. Rutala WA, Weber DJ; Healthcare Infection Control Practices Advisory Committee. Guideline for Disinfection and Sterilization in Healthcare Facilities, 2008 . http://www.cdc.gov/hicpac/Disinfection_Sterilization/acknowledg.html. Accessed April 1, 2014.
93. Krueger WA, Lenhart FP, Neeser G, et al. Influence of combined intravenous and topical antibiotic prophylaxis on the incidence of infections, organ dysfunctions, and mortality in critically ill surgical patients: a prospective, stratified, randomized, double-blind, placebo-controlled clinical trial. Am J Respir Crit Care Med 2002;166(8):10291037.
94. de Jonge E, Schultz MJ, Spanjaard L, et al. Effects of selective decontamination of digestive tract on mortality and acquisition of resistant bacteria in intensive care: a randomised controlled trial. Lancet 2003;362(9389):10111016.
95. de Smet AM, Kluytmans JA, Cooper BS, et al. Decontamination of the digestive tract and oropharynx in ICU patients. N Engl J Med 2009;360(1):2031.
96. Liberati A, D’Amico R, Pifferi S, Torri V, Brazzi L, Parmelli E. Antibiotic prophylaxis to reduce respiratory tract infections and mortality in adults receiving intensive care. Cochrane Database Syst Rev 2009(4):CD000022.
97. de Smet AM, Kluytmans JA, Blok HE, et al. Selective digestive tract decontamination and selective oropharyngeal decontamination and antibiotic resistance in patients in intensive-care units: an open-label, clustered group-randomised, crossover study. Lancet Infect Dis 2011;11(5):372380.
98. Chan EY, Ruest A, Meade MO, Cook DJ. Oral decontamination for prevention of pneumonia in mechanically ventilated adults: systematic review and meta-analysis. BMJ 2007;334(7599):889.
99. Daneman N, Sarwar S, Fowler RA, Cuthbertson BH. Effect of selective decontamination on antimicrobial resistance in intensive care units: a systematic review and meta-analysis. Lancet Infect Dis 2013;13(4):328341.
100. van der Meer JW, Vandenbroucke-Grauls CM. Resistance to selective decontamination: the jury is still out. Lancet Infect Dis 2013;13(4):282283.
101. Chlebicki MP, Safdar N. Topical chlorhexidine for prevention of ventilator-associated pneumonia: a meta-analysis. Crit Care Med 2007;35(2):595602.
102. Pileggi C, Bianco A, Flotta D, Nobile CG, Pavia M. Prevention of ventilator-associated pneumonia, mortality and all intensive care unit acquired infections by topically applied antimicrobial or antiseptic agents: a meta-analysis of randomized controlled trials in intensive care units. Crit Care 2011;15(3):R155.
103. Labeau SO, Van de Vyver K, Brusselaers N, Vogelaers D, Blot SI. Prevention of ventilator-associated pneumonia with oral antiseptics: a systematic review and meta-analysis. Lancet Infect Dis 2011;11(11):845854.
104. Tantipong H, Morkchareonpong C, Jaiyindee S, Thamlikitkul V. Randomized controlled trial and meta-analysis of oral decontamination with 2% chlorhexidine solution for the prevention of ventilator-associated pneumonia. Infect Control Hosp Epidemiol 2008;29(2):131136.
105. Li J, Xie D, Li A, Yue J. Oral topical decontamination for preventing ventilator-associated pneumonia: a systematic review and meta-analysis of randomized controlled trials. J Hosp Infect 2013;84(4):283293.
106. Shi Z, Xie H, Wang P, et al. Oral hygiene care for critically ill patients to prevent ventilator-associated pneumonia. Cochrane Database Syst Rev 2013;8:CD008367.
107. Silvestri L, Weir I, Gregori D, et al. Effectiveness of oral chlorhexidine on nosocomial pneumonia, causative microorganisms and mortality in critically ill patients: a systematic review and meta-analysis. Minerva Anestesiol. Electronically published November 21, 2013.
108. Klompas M, Speck K, Howell MD, Greene LR, Berenholtz SM. Reappraisal of routine oral care with chlorhexidine gluconate for patients receiving mechanical ventilation: systematic review and meta-analysis. JAMA Intern Med 2014;174(5):751761.
109. DeRiso AJ 2nd, Ladowski JS, Dillon TA, Justice JW, Peterson AC. Chlorhexidine gluconate 0.12% oral rinse reduces the incidence of total nosocomial respiratory infection and nonprophylactic systemic antibiotic use in patients undergoing heart surgery. Chest 1996;109(6):15561561.
110. Segers P, Speekenbrink RG, Ubbink DT, van Ogtrop ML, de Mol BA. Prevention of nosocomial infection in cardiac surgery by decontamination of the nasopharynx and oropharynx with chlorhexidine gluconate: a randomized controlled trial. JAMA 2006;296(20):24602466.
111. Siempos II, Ntaidou TK, Falagas ME. Impact of the administration of probiotics on the incidence of ventilator-associated pneumonia: a meta-analysis of randomized controlled trials. Crit Care Med 2010;38(3):954962.
112. Liu KX, Zhu YG, Zhang J, et al. Probiotics’ effects on the incidence of nosocomial pneumonia in critically ill patients: a systematic review and meta-analysis. Crit Care 2012;16(3):R109.
113. Petrof EO, Dhaliwal R, Manzanares W, Johnstone J, Cook D, Heyland DK. Probiotics in the critically ill: a systematic review of the randomized trial evidence. Crit Care Med 2012;40(12):32903302.
114. Barraud D, Bollaert PE, Gibot S. Impact of the administration of probiotics on mortality in critically ill adult patients: a meta-analysis of randomized controlled trials. Chest 2013;143(3):646655.
115. Lherm T, Monet C, Nougiere B, et al. Seven cases of fungemia with Saccharomyces boulardii in critically ill patients. Intensive Care Med 2002;28(6):797801.
116. Munoz P, Bouza E, Cuenca-Estrella M, et al. Saccharomyces cerevisiae fungemia: an emerging infectious disease. Clin Infect Dis 2005;40(11):16251634.
117. Salminen MK, Rautelin H, Tynkkynen S, et al. Lactobacillus bacteremia, clinical significance, and patient outcome, with special focus on probiotic L. rhamnosus GG. Clin Infect Dis 2004;38(1):6269.
118. Cassone M, Serra P, Mondello F, et al. Outbreak of Saccharomyces cerevisiae subtype boulardii fungemia in patients neighboring those treated with a probiotic preparation of the organism. J Clin Microbiol 2003;41(11):53405343.
119. Graf C, Gavazzi G. Saccharomyces cerevisiae fungemia in an immunocompromised patient not treated with Saccharomyces boulardii preparation. J Infect 2007;54(3):310311.
120. Lorente L, Lecuona M, Jimenez A, Mora ML, Sierra A. Influence of an endotracheal tube with polyurethane cuff and subglottic secretion drainage on pneumonia. Am J Respir Crit Care Med 2007;176(11):10791083.
121. Poelaert J, Depuydt P, De Wolf A, Van de Velde S, Herck I, Blot S. Polyurethane cuffed endotracheal tubes to prevent early postoperative pneumonia after cardiac surgery: a pilot study. J Thorac Cardiovasc Surg 2008;135(4):771776.
122. Valencia M, Ferrer M, Farre R, et al. Automatic control of tracheal tube cuff pressure in ventilated patients in semirecumbent position: a randomized trial. Crit Care Med 2007;35(6):15431549.
123. Nseir S, Zerimech F, Fournier C, et al. Continuous control of tracheal cuff pressure and microaspiration of gastric contents in critically ill patients. Am J Respir Crit Care Med 2011;184(9):10411047.
124. Caruso P, Denari S, Ruiz SA, Demarzo SE, Deheinzelin D. Saline instillation before tracheal suctioning decreases the incidence of ventilator-associated pneumonia. Crit Care Med 2009;37(1):3238.
125. Yao LY, Chang CK, Maa SH, Wang C, Chen CC. Brushing teeth with purified water to reduce ventilator-associated pneumonia. J Nurs Res 2011;19(4):289297.
126. Alhazzani W, Smith O, Muscedere J, Medd J, Cook D. Toothbrushing for critically ill mechanically ventilated patients: a systematic review and meta-analysis of randomized trials evaluating ventilator-associated pneumonia. Crit Care Med 2013;41(2):646655.
127. Kollef MH, Afessa B, Anzueto A, et al. Silver-coated endotracheal tubes and incidence of ventilator-associated pneumonia: the NASCENT randomized trial. JAMA 2008;300(7):805813.
128. Delaney A, Gray H, Laupland KB, Zuege DJ. Kinetic bed therapy to prevent nosocomial pneumonia in mechanically ventilated patients: a systematic review and meta-analysis. Crit Care 2006;10(3):R70.
129. Sud S, Sud M, Friedrich JO, Adhikari NK. Effect of mechanical ventilation in the prone position on clinical outcomes in patients with acute hypoxemic respiratory failure: a systematic review and meta-analysis. Can Med Assoc J 2008;178(9):11531161.
130. Alsaghir AH, Martin CM. Effect of prone positioning in patients with acute respiratory distress syndrome: a meta-analysis. Crit Care Med 2008;36(2):603609.
131. Abroug F, Ouanes-Besbes L, Elatrous S, Brochard L. The effect of prone positioning in acute respiratory distress syndrome or acute lung injury: a meta-analysis. Areas of uncertainty and recommendations for research. Intensive Care Med 2008;34(6):10021011.
132. Kopterides P, Siempos II, Armaganidis A. Prone positioning in hypoxemic respiratory failure: meta-analysis of randomized controlled trials. J Crit Care 2009;24(1):89100.
133. Abroug F, Ouanes-Besbes L, Dachraoui F, Ouanes I, Brochard L. An updated study-level meta-analysis of randomised controlled trials on proning in ARDS and acute lung injury. Crit Care 2011;15(1):R6.
134. Guerin C, Reignier J, Richard JC, et al. Prone positioning in severe acute respiratory distress syndrome. N Engl J Med 2013;368(23):21592168.
135. Marik PE, Vasu T, Hirani A, Pachinburavan M. Stress ulcer prophylaxis in the new millennium: a systematic review and meta-analysis. Crit Care Med 2010;38(11):22222228.
136. Alhazzani W, Alenezi F, Jaeschke RZ, Moayyedi P, Cook DJ. Proton pump inhibitors versus histamine 2 receptor antagonists for stress ulcer prophylaxis in critically ill patients: a systematic review and meta-analysis. Crit Care Med 2013;41(3):693705.
137. Wang F, Wu Y, Bo L, et al. The timing of tracheotomy in critically ill patients undergoing mechanical ventilation: a systematic review and meta-analysis of randomized controlled trials. Chest 2011;140(6):14561465.
138. Reignier J, Mercier E, Le Gouge A, et al. Effect of not monitoring residual gastric volume on risk of ventilator-associated pneumonia in adults receiving mechanical ventilation and early enteral feeding: a randomized controlled trial. JAMA 2013;309(3):249256.
139. Casaer MP, Mesotten D, Hermans G, et al. Early versus late parenteral nutrition in critically ill adults. N Engl J Med 2011;365(6):506517.
140. Vonberg RP, Eckmanns T, Welte T, Gastmeier P. Impact of the suctioning system (open vs. closed) on the incidence of ventilation-associated pneumonia: meta-analysis of randomized controlled trials. Intensive Care Med 2006;32(9):13291335.
141. Jongerden IP, Rovers MM, Grypdonck MH, Bonten MJ. Open and closed endotracheal suction systems in mechanically ventilated intensive care patients: a meta-analysis. Crit Care Med 2007;35(1):260270.
142. Siempos II, Vardakas KZ, Falagas ME. Closed tracheal suction systems for prevention of ventilator-associated pneumonia. Br J Anaesth 2008;100(3):299306.
143. Jongerden IP, Buiting AG, Leverstein–van Hall MA, et al. Effect of open and closed endotracheal suctioning on cross-transmission with gram-negative bacteria: a prospective crossover study. Crit Care Med 2011;39(6):13131321.
144. Lorente L, Lecuona M, Jimenez A, Mora ML, Sierra A. Tracheal suction by closed system without daily change versus open system. Intensive Care Med 2006;32(4):538544.
145. Maggiore SM. Endotracheal suctioning, ventilator-associated pneumonia, and costs: open or closed issue? Intensive Care Med 2006;32(4):485487.
146. Dudeck MA, Horan T, Peterson KD, et al. National Healthcare Safety Network (NHSN) Report, Data Summary for 2011, Device-Associated Module. Atlanta: Centers for Disease Control and Prevention, 2013. http://www.cdc.gov/nhsn/PDFs/dataStat/NHSN-Report-2011-Data-Summary.pdf. Accessed April 1, 2014.
147. Bhandari V, Finer NN, Ehrenkranz RA, et al. Synchronized nasal intermittent positive-pressure ventilation and neonatal outcomes. Pediatrics 2009;124(2):517526.
148. Finer NN, Carlo WA, Walsh MC, et al. Early CPAP versus surfactant in extremely preterm infants. N Engl J Med 2010;362(21):19701979.
149. Bhandari V. Nasal intermittent positive pressure ventilation in the newborn: review of literature and evidence-based guidelines. J Perinatol 2010;30(8):505512.
150. Hamid MH, Malik MA, Masood J, Zia A, Ahmad TM. Ventilator-associated pneumonia in children. J Coll Physicians Surg Pak 2012;22(3):155158.
151. Ng E, Taddio A, Ohlsson A. Intravenous midazolam infusion for sedation of infants in the neonatal intensive care unit. Cochrane Database Syst Rev 2012;6:CD002052.
152. Veldman A, Trautschold T, Weiss K, Fischer D, Bauer K. Characteristics and outcome of unplanned extubation in ventilated preterm and term newborns on a neonatal intensive care unit. Paediatr Anaesth 2006;16(9):968973.
153. Samransamruajkit R, Jirapaiboonsuk S, Siritantiwat S, et al. Effect of frequency of ventilator circuit changes (3 vs 7 days) on the rate of ventilator-associated pneumonia in PICU. J Crit Care 2010;25(1):5661.
154. Hsieh TC, Hsia SH, Wu CT, Lin TY, Chang CC, Wong KS. Frequency of ventilator-associated pneumonia with 3-day versus 7-day ventilator circuit changes. Pediatr Neonatol 2010;51(1):3743.
155. Aly H, Badawy M, El-Kholy A, Nabil R, Mohamed A. Randomized, controlled trial on tracheal colonization of ventilated infants: can gravity prevent ventilator-associated pneumonia? Pediatrics 2008;122(4):770774.
156. Taylor JE, Hawley G, Flenady V, Woodgate PG. Tracheal suctioning without disconnection in intubated ventilated neonates. Cochrane Database Syst Rev 2011(12):CD003065.
157. van Veenendaal MB, Miedema M, de Jongh FH, van der Lee JH, Frerichs I, van Kaam AH. Effect of closed endotracheal suction in high-frequency ventilated premature infants measured with electrical impedance tomography. Intensive Care Med 2009;35(12):21302134.
158. Terrin G, Passariello A, De Curtis M, et al. Ranitidine is associated with infections, necrotizing enterocolitis, and fatal outcome in newborns. Pediatrics 2012;129(1):e40e45.
159. Guillet R, Stoll BJ, Cotten CM, et al. Association of H2-blocker therapy and higher incidence of necrotizing enterocolitis in very low birth weight infants. Pediatrics 2006;117(2):e137e142.
160. Kuppala VS, Meinzen-Derr J, Morrow AL, Schibler KR. Prolonged initial empirical antibiotic treatment is associated with adverse outcomes in premature infants. J Pediatr 2011;159(5):720725.
161. Alexander VN, Northrup V, Bizzarro MJ. Antibiotic exposure in the newborn intensive care unit and the risk of necrotizing enterocolitis. J Pediatr 2011;159(3):392397.
162. Shah P, Nathan E, Doherty D, Patole S. Prolonged exposure to antibiotics and its associations in extremely preterm neonates—the western Australian experience. J Matern Fetal Neonatal Med 2013;26(17):17101714.
163. Weintraub AS, Ferrara L, Deluca L, et al. Antenatal antibiotic exposure in preterm infants with necrotizing enterocolitis. J Perinatol 2012;32(9):705709.
164. Davis PG, Henderson-Smart DJ. Extubation from low-rate intermittent positive airways pressure versus extubation after a trial of endotracheal continuous positive airways pressure in intubated preterm infants. Cochrane Database Syst Rev 2001(4):CD001078.
165. Kaczmarek J, Kamlin CO, Morley CJ, Davis PG, Sant’anna GM. Variability of respiratory parameters and extubation readiness in ventilated neonates. Arch Dis Child Fetal Neonatal Ed 2013;98(1):F70F73.
166. Kamlin CO, Davis PG, Argus B, Mills B, Morley CJ. A trial of spontaneous breathing to determine the readiness for extubation in very low birth weight infants: a prospective evaluation. Arch Dis Child Fetal Neonatal Ed 2008;93(4):F305F306.
167. Rojas MA, Lozano JM, Rojas MX, et al. Prophylactic probiotics to prevent death and nosocomial infection in preterm infants. Pediatrics 2012;130(5):e1113e1120.
168. Manzoni P, Mostert M, Leonessa ML, et al. Oral supplementation with Lactobacillus casei subspecies rhamnosus prevents enteric colonization by Candida species in preterm neonates: a randomized study. Clin Infect Dis 2006;42(12):17351742.
169. De Groote MA, Frank DN, Dowell E, Glode MP, Pace NR. Lactobacillus rhamnosus GG bacteremia associated with probiotic use in a child with short gut syndrome. Pediatr Infect Dis J 2005;24(3):278280.
170. Kunz AN, Noel JM, Fairchok MP. Two cases of Lactobacillus bacteremia during probiotic treatment of short gut syndrome. J Pediatr Gastroenterol Nutr 2004;38(4):457458.
171. Land MH, Rouster-Stevens K, Woods CR, Cannon ML, Cnota J, Shetty AK. Lactobacillus sepsis associated with probiotic therapy. Pediatrics 2005;115(1):178181.
172. Foglia E, Meier MD, Elward A. Ventilator-associated pneumonia in neonatal and pediatric intensive care unit patients. Clin Microbiol Rev 2007;20(3):409425.
173. Bigham MT, Amato R, Bondurrant P, et al. Ventilator-associated pneumonia in the pediatric intensive care unit: characterizing the problem and implementing a sustainable solution. J Pediatr 2009;154(4):582e2587e2.
174. Taira BR, Fenton KE, Lee TK, et al. Ventilator-associated pneumonia in pediatric trauma patients. Pediatr Crit Care Med 2009;10(4):491494.
175. Gautam A, Ganu SS, Tegg OJ, Andresen DN, Wilkins BH, Schell DN. Ventilator-associated pneumonia in a tertiary paediatric intensive care unit: a 1-year prospective observational study. Crit Care Resusc 2012;14(4):283289.
176. Awasthi S, Tahazzul M, Ambast A, Govil YC, Jain A. Longer duration of mechanical ventilation was found to be associated with ventilator-associated pneumonia in children aged 1 month to 12 years in India. J Clin Epidemiol 2013;66(1):6266.
177. Liljemark WF, Bloomquist C. Human oral microbial ecology and dental caries and periodontal diseases. Crit Rev Oral Biol Med 1996;7(2):180198.
178. Kononen E. Development of oral bacterial flora in young children. Ann Med 2000;32(2):107112.
179. Javouhey E, Barats A, Richard N, Stamm D, Floret D. Non-invasive ventilation as primary ventilatory support for infants with severe bronchiolitis. Intensive Care Med 2008;34(9):16081614.
180. Yanez LJ, Yunge M, Emilfork M, et al. A prospective, randomized, controlled trial of noninvasive ventilation in pediatric acute respiratory failure. Pediatr Crit Care Med 2008;9(5):484489.
181. Ferguson LP, Walsh BK, Munhall D, Arnold JH. A spontaneous breathing trial with pressure support overestimates readiness for extubation in children. Pediatr Crit Care Med 2011;12(6):e330e335.
182. Randolph AG, Wypij D, Venkataraman ST, et al. Effect of mechanical ventilator weaning protocols on respiratory outcomes in infants and children: a randomized controlled trial. JAMA 2002;288(20):25612568.
183. Foronda FK, Troster EJ, Farias JA, et al. The impact of daily evaluation and spontaneous breathing test on the duration of pediatric mechanical ventilation: a randomized controlled trial. Crit Care Med 2011;39(11):25262533.
184. Newth CJ, Venkataraman S, Willson DF, et al. Weaning and extubation readiness in pediatric patients. Pediatr Crit Care Med 2009;10(1):111.
185. Lucas da Silva PS, de Carvalho WB. Unplanned extubation in pediatric critically ill patients: a systematic review and best practice recommendations. Pediatr Crit Care Med 2010;11(2):287294.
186. Curley MA, Schwalenstocker E, Deshpande JK, et al. Tailoring the Institute for Health Care Improvement 100,000 Lives Campaign to pediatric settings: the example of ventilator-associated pneumonia. Pediatr Clin North Am 2006;53(6):12311251.
187. American Dental Association. Your child’s growing smile. J Am Dent Assoc 2012;143(1):88.
188. Tsai HH, Lin FC, Chang SC. Intermittent suction of oral secretions before each positional change may reduce ventilator-associated pneumonia: a pilot study. Am J Med Sci 2008;336(5):397401.
189. Gopalareddy V, He Z, Soundar S, et al. Assessment of the prevalence of microaspiration by gastric pepsin in the airway of ventilated children. Acta Paediatr 2008;97(1):5560.
190. Weiss M, Dullenkopf A, Fischer JE, Keller C, Gerber AC. Prospective randomized controlled multi-centre trial of cuffed or uncuffed endotracheal tubes in small children. Br J Anaesth 2009;103(6):867873.
191. Kleinman ME, de Caen AR, Chameides L, et al. Part 10: pediatric basic and advanced life support: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Circulation 2010;122(16 suppl 2):S466S515.
192. Gupta K, Gupta VK, Jayashree M, Singhi S. Randomized controlled trial of interrupted versus continuous sedative infusions in ventilated children. Pediatr Crit Care Med 2012;13(2):131135.
193. Sebastian MR, Lodha R, Kapil A, Kabra SK. Oral mucosal decontamination with chlorhexidine for the prevention of ventilator-associated pneumonia in children—a randomized, controlled trial. Pediatr Crit Care Med 2012;13(5):e305e310.
194. Wan AK, Seow WK, Purdie DM, Bird PS, Walsh LJ, Tudehope DI. The effects of chlorhexidine gel on Streptococcus mutans infection in 10-month-old infants: a longitudinal, placebo-controlled, double-blind trial. Pediatr Dent 2003;25(3):215222.
195. Jacomo AD, Carmona F, Matsuno AK, Manso PH, Carlotti AP. Effect of oral hygiene with 0.12% chlorhexidine gluconate on the incidence of nosocomial pneumonia in children undergoing cardiac surgery. Infect Control Hosp Epidemiol 2011;32(6):591596.
196. Kusahara DM, Friedlander LT, Peterlini MA, Pedreira ML. Oral care and oropharyngeal and tracheal colonization by gram-negative pathogens in children. Nurs Crit Care 2012;17(3):115122.
197. Kusahara DM, Peterlini MA, Pedreira ML. Oral care with 0.12% chlorhexidine for the prevention of ventilator-associated pneumonia in critically ill children: randomised, controlled and double blind trial. Int J Nurs Stud 2012;49(11):13541363.
198. Pedreira ML, Kusahara DM, de Carvalho WB, Nunez SC, Peterlini MA. Oral care interventions and oropharyngeal colonization in children receiving mechanical ventilation. Am J Crit Care 2009;18(4):319328.
199. Yildizdas D, Yapicioglu H, Yilmaz HL. Occurrence of ventilator-associated pneumonia in mechanically ventilated pediatric intensive care patients during stress ulcer prophylaxis with sucralfate, ranitidine, and omeprazole. J Crit Care 2002;17(4):240245.
200. Lopriore E, Markhorst DG, Gemke RJ. Ventilator-associated pneumonia and upper airway colonisation with gram negative bacilli: the role of stress ulcer prophylaxis in children. Intensive Care Med 2002;28(6):763767.
201. Morrow BM, Mowzer R, Pitcher R, Argent AC. Investigation into the effect of closed-system suctioning on the frequency of pediatric ventilator-associated pneumonia in a developing country. Pediatr Crit Care Med 2012;13(1):e25e32.
202. Hatler CW, Mast D, Corderella J, et al. Using evidence and process improvement strategies to enhance healthcare outcomes for the critically ill: a pilot project. Am J Crit Care 2006;15(6):549555.
203. Pronovost PJ, Berenholtz SM, Needham DM. Translating evidence into practice: a model for large scale knowledge translation. BMJ 2008;337:a1714.
204. Krimsky WS, Mroz IB, McIlwaine JK, et al. A model for increasing patient safety in the intensive care unit: increasing the implementation rates of proven safety measures. Qual Saf Health Care 2009;18(1):7480.
205. Hawe CS, Ellis KS, Cairns CJ, Longmate A. Reduction of ventilator-associated pneumonia: active versus passive guideline implementation. Intensive Care Med 2009;35(7):11801186.
206. Rello J, Lode H, Cornaglia G, Masterton R. A European care bundle for prevention of ventilator-associated pneumonia. Intensive Care Med 2010;36(5):773780.
207. Berenholtz SM, Pham JC, Thompson DA, et al. Collaborative cohort study of an intervention to reduce ventilator-associated pneumonia in the intensive care unit. Infect Control Hosp Epidemiol 2011;32(4):305314.
208. Klompas M. Ventilator-associated pneumonia: is zero possible? Clin Infect Dis 2010;51(10):11231126.
209. Crunden E, Boyce C, Woodman H, Bray B. An evaluation of the impact of the ventilator care bundle. Nurs Crit Care 2005;10(5):242246.
210. Burger CD, Resar RK. “Ventilator bundle” approach to prevention of ventilator-associated pneumonia. Mayo Clin Proc 2006;81(6):849850.
211. Apisarnthanarak A, Pinitchai U, Thongphubeth K, et al. Effectiveness of an educational program to reduce ventilator-associated pneumonia in a tertiary care center in Thailand: a 4-year study. Clin Infect Dis 2007;45(6):704711.
212. Youngquist P, Carroll M, Farber M, et al. Implementing a ventilator bundle in a community hospital. Jt Comm J Qual Patient Saf 2007;33(4):219225.
213. Bloos F, Muller S, Harz A, et al. Effects of staff training on the care of mechanically ventilated patients: a prospective cohort study. Br J Anaesth 2009;103(2):232237.
214. Sinuff T, Muscedere J, Cook DJ, et al. Implementation of clinical practice guidelines for ventilator-associated pneumonia: a multicenter prospective study. Crit Care Med 2013;41(1):1523.
215. 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 pneumonia. Jt Comm J Qual Patient Saf 2005;31(5):243248.
216. Ellingson K, Haas JP, Aiello AE, et al. Strategies to prevent healthcare-associated infections through hand hygiene. Infect Control Hosp Epidemiol 35(8):937960 (in this issue).
217. Boles JM, Bion J, Connors A, et al. Weaning from mechanical ventilation. Eur Respir J 2007;29(5):10331056.
218. Aragon D, Sole ML. Implementing best practice strategies to prevent infection in the ICU. Crit Care Nurs Clin North Am 2006;18(4):441452.
219. Burns SM, Earven S, Fisher C, et al. Implementation of an institutional program to improve clinical and financial outcomes of mechanically ventilated patients: one-year outcomes and lessons learned. Crit Care Med 2003;31(12):27522763.
220. Brierley J, Highe L, Hines S, Dixon G. Reducing VAP by instituting a care bundle using improvement methodology in a UK paediatric intensive care unit. Eur J Pediatr 2012;171(2):323330.
221. Weireter LJ Jr, Collins JN, Britt RC, Reed SF, Novosel TJ, Britt LD. Impact of a monitored program of care on incidence of ventilator-associated pneumonia: results of a longterm performance-improvement project. J Am Coll Surg 2009;208(5):700704.
222. Johnson V, Mangram A, Mitchell C, Lorenzo M, Howard D, Dunn E. Is there a benefit to multidisciplinary rounds in an open trauma intensive care unit regarding ventilator-associated pneumonia? Am Surg 2009;75(12):11711174.
223. Heimes J, Braxton C, Nazir N, et al. Implementation and enforcement of ventilator-associated pneumonia prevention strategies in trauma patients. Surg Infect (Larchmt) 2011;12(2):99103.
224. Craven DE. Preventing ventilator-associated pneumonia in adults: sowing seeds of change. Chest 2006;130(1):251260.
225. Mangino JE, Peyrani P, Ford KD, et al. Development and implementation of a performance improvement project in adult intensive care units: overview of the Improving Medicine Through Pathway Assessment of Critical Therapy in Hospital-Acquired Pneumonia (IMPACT-HAP) study. Crit Care 2011;15(1):R38.
226. Scales DC, Dainty K, Hales B, et al. A multifaceted intervention for quality improvement in a network of intensive care units: a cluster randomized trial. JAMA 2011;305(4):363372.
227. Rello J, Afonso E, Lisboa T, et al. A care bundle approach for prevention of ventilator-associated pneumonia. Clin Microbiol Infect 2013;19(4):363369.
228. Grimshaw J, Eccles M, Thomas R, et al. Toward evidence-based quality improvement: evidence (and its limitations) of the effectiveness of guideline dissemination and implementation strategies 1966–1998. J Gen Intern Med 2006;21(suppl 2):S14S20.
229. Berenholtz S, Pronovost PJ. Barriers to translating evidence into practice. Curr Opin Crit Care 2003;9(4):321325.
230. Bouadma L, Mourvillier B, Deiler V, et al. Changes in knowledge, beliefs, and perceptions throughout a multifaceted behavioral program aimed at preventing ventilator-associated pneumonia. Intensive Care Med 2010;36(8):13411347.
231. Bassi GL, Ferrer M, Saucedo LM, Torres A. Do guidelines change outcomes in ventilator-associated pneumonia? Curr Opin Infect Dis 2010;23(2):171177.
232. Lyerla F. Design and implementation of a nursing clinical decision support system to promote guideline adherence. Comput Inform Nurs 2008;26(4):227233.
233. Sinuff T, Muscedere J, Cook D, Dodek P, Heyland D. Ventilator-associated pneumonia: improving outcomes through guideline implementation. J Crit Care 2008;23(1):118125.
234. Omrane R, Eid J, Perreault MM, et al. Impact of a protocol for prevention of ventilator-associated pneumonia. Ann Pharmacother 2007;41(9):13901396.
235. Zaydfudim V, Dossett LA, Starmer JM, et al. Implementation of a real-time compliance dashboard to help reduce SICU ventilator-associated pneumonia with the ventilator bundle. Arch Surg 2009;144(7):656662.
236. Salahuddin N, Zafar A, Sukhyani L, et al. Reducing ventilator-associated pneumonia rates through a staff education programme. J Hosp Infect 2004;57(3):223227.
237. Westwell S. Implementing a ventilator care bundle in an adult intensive care unit. Nurs Crit Care 2008;13(4):203207.
238. Pinto A, Burnett S, Benn J, et al. Improving reliability of clinical care practices for ventilated patients in the context of a patient safety improvement initiative. J Eval Clin Pract 2011;17(1):180187.
239. Guyatt GH, Oxman AD, Vist GE, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ 2008;336(7650):924926.
240. GRADE. Canadian Task Force on Preventive Health Care website. http://canadiantaskforce.ca/methods/grade/. Accessed December 31, 2013.
241. Rosenthal VD, Rodriguez-Calderon ME, Rodriguez-Ferrer M, et al. Findings of the International Nosocomial Infection Control Consortium (INICC), part II: impact of a multidimensional strategy to reduce ventilator-associated pneumonia in neonatal intensive care units in 10 developing countries. Infect Control Hosp Epidemiol 2012;33(7):704710.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Infection Control & Hospital Epidemiology
  • ISSN: 0899-823X
  • EISSN: 1559-6834
  • URL: /core/journals/infection-control-and-hospital-epidemiology
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 202 *
Loading metrics...

Abstract views

Total abstract views: 596 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 16th December 2017. This data will be updated every 24 hours.