2 results
Impact of Each Component of a Ventilator Bundle on Preventing Ventilator-Associated Pneumonia and Lower Respiratory Infection
- Rafaela Pinho, Luciana Tanure, Jussara Pessoa, Leonardo Santos, Braulio Couto, Carlos Starling
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 41 / Issue S1 / October 2020
- Published online by Cambridge University Press:
- 02 November 2020, pp. s259-s260
- Print publication:
- October 2020
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Background: Ventilator-associated lower respiratory infections (LRIs) and pneumonia (VAP) are important healthcare-associated infections and are among the leading causes of death worldwide. Prevention of these infections are often based on care bundles. We investigated the incidence of VAP+LRI and the preventive efficacy of each component of our ventilator bundle. Methods: Our ventilator bundle includes 6 components that are daily checked by an infection control practitioner. These 6 evidence-based practices were implemented in 3 ICUs from a general tertiary-care private hospital in Belo Horizonte City (Brazil): (1) daily oral care with chlorhexidine; (2) elevate the head of the bed to between 30 and 45; (3) avoid scheduled ventilator circuit change; (4) monitor cuff pressure; (5) use subglottic secretion drainage; and (6) daily sedation interruption and daily assessment of readiness to extubate. VAP and ventilator-LRI definitions were obtained from the CDC NHSN. The impact of adherence rate to items in the ventilator bundle (%) on the incidence rate of VAP+LRI was assessed using linear regression and scatterplot analyses. Results: Between January 2018 and April 2019, 1,888 ventilator days were observed in the 3 ICUs, with 42 VAP and LRI events, an overall incidence rate of 22.2 cases per 1,000 ventilator days. After September 2018, the infection control service started a campaign to increase the ventilator bundle compliance (Fig. 1). Adherence rates to all 6 bundle components increased between January–August 2018 and September 2018–April 2019 from 25% to 55% for daily oral care, from 34% to 79% for elevating the head of the bed, 28% to 86% for avoiding scheduled ventilator circuit change, from 32% to 83% for cuff pressure monitoring, from 32% to 83% for subglottic secretion drainage, and from 33% to 85% for daily sedation interruption. PAV and LRI incidence decreased from 41 to 16 in ICU A, from 22 to 14 in ICU B and from 24 to 18 in ICU C. The impact of each bundle component was identified by linear regression, calculating the percentage of PAV+LRI incidence rate that is explained by bundle item adherence (r2) and correlation coefficient (r): daily sedation interruption (r2 = 48%; r = 0.69; P = .004) (Fig. 2), cuff pressure monitorization (r2 = 0.3721; r = 0.61; P = .016), subglottic secretion drainage (r2 = 36%; r = 0.60; P = .017), avoidance of scheduled ventilator circuit change (r2 = 34%; r = 0.58; P = .023), daily oral care (r2 = 25%; r = 0.50; P = .050), and elevate the head of the bed (r2 = 25%; r = 0.48; P = .067). Conclusions: The impact of each bundle component on preventing PAV+LRI was identified by the study. An educational intervention performed by the infection control service increased the adherence to the ventilator bundle, and the PAV and LRI incidence decreased.
Funding: None
Disclosures: None
Hospital Infections by Stenotrophomonas maltophilia: Results in Five Years of Multicentric Study
- Luciana Tanure, Rafaela Pinho, Mayra de Oliveira, Daniela Ribeiro, Jose A. Ferreira, Braulio Couto, Carlos Starling
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 41 / Issue S1 / October 2020
- Published online by Cambridge University Press:
- 02 November 2020, pp. s250-s251
- Print publication:
- October 2020
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- Article
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Background:Stenotrophomonas maltophilia is an emerging pathogen responsible for high morbidity and mortality rates. Hospital infections caused by this bacteria, especially in intensive care centers, are concerning for the health system, given that the microorganism is multidrug resistant to most antimicrobials available. Objective: Therefore, the present study is built from an analysis of the variables related to nosocomial infections caused by S. maltophilia in hospitals in Brazil, to display points of major concern. Methods: We used the data collected by the Infection Prevention and Control Service to clarify the incidence rate of Stenotrophomonas maltophilia in Brazilian hospitals as well as the gross lethality of these infections and the profiles of infected patients. We collected and analyzed epidemiological data from 10 hospitals in Brazil for the period July 2014 to June 2019 according to the CDC NHSN protocol. Results: In 5 years, 93 Stenotrophomonas maltophilia infections were diagnosed in the hospitals analyzed. Overall, 61 occurred in men (66%) and 32 occurred in women (34%). Furthermore, 47 cases (51%) occurred in adult ICUs; 19 cases (20%) followed zascular surgery; 9 (10%) cases occurred in the neonatal ICU; 7 (8%) cases were from the medical clinic; and 11 (12%) were from other clinics. The incidence rate was 1.2 cases for 10,000 hospitalizations, ranging from 0.0 to 2.8 (Fig. 1). Patients’ ages ranged from 0 to 90 years, with a mean of 55 years (SD, 26 years) and a median of 64 years. Time between admission and diagnosis of infection was 1 to 102 days, with a mean of 24 days (SD, 21 days) and a median of 17 days. The gross lethality for S. maltophilia infection was 43 of 93 (46%) (95% CI, 35.8%–56.9%). The frequencies of specific infections were as follows (Fig. 2): pneumonia, 26 (28%); tracheobronchitism, 22 (24%); primary bloodstream infection, 18 (19%); skin and soft-tissue infection, 13 (14%); local infection, 7 (8%); vascular access infection, 3 (3%); urinary tract infection, 2 (2%); gastrointestinal infection, 1 (1%); and eye, nose, throat, and mouth infections, 1 (1%). Conclusions:Stenotrophomonas maltophilia infection is a rare and highly lethal event that usually occurs after 2 weeks of hospitalization. The most affected region is the respiratory tract, with a higher incidence in patients aged >60 years or in the ICU. Early and accurate investigations of multiresistant microorganisms in a hospital setting are needed to reduce patient morbidity and mortality.
Funding: None
Disclosures: None