Prevention of ventilator-associated pneumonia: Use of the care bundle approach

Alcan, A.O. et al. American Journal of Infection Control. Published online: 4 July 2016

Highlights

  • Ventilator-associated pneumonia is one of the most common nosocomial infections for critical care patients.
  • This study investigates the effect of using the care bundle on ventilator-associated pneumonia rates.
  • Implementation of the care bundle through nurse education is effective at reducing the rate of ventilator-associated pneumonia.

Image shows colour enhanced scanning electron micrograph of a colony of Streptococcus pneumoniae

Background: The ventilator-associated pneumonia (VAP) care bundle consists of evidence-based practices to improve the outcomes of patients receiving mechanical ventilatory therapy. This study aimed to investigate the implementation of the care bundle on VAP rates in this quasiexperimental study.

Methods: The protocol of this study consisted of 3 phases. In the initial phase, observations were made to determine the VAP care bundle adherence of intensive care unit (ICU) nurses. In the second phase, education was provided to ICU nurses on the subject of the VAP care bundle. For the third phase, the effect of VAP care bundle adherence on the VAP rates after education was investigated.

Results: The nurses’ VAP care bundle adherence improved after education from 10.8% (n = 152) to 89.8% (n = 1,324) and showed statistically significant improvement (P = .0001 and P < .05). In this study, the VAP rates were determined as 15.91/103 ventilator-days before education and 8.50/103 ventilator days after education. It was found that the VAP rates after the education period were significantly lower than the VAP rates before education.

Conclusion: VAP care bundle implementation with education prepared according to evidence-based guidelines decreased VAP rates. Thus, implementation of the VAP care bundle on mechanically ventilated patients care is recommended.

Read the abstract here

US hospitals make progress against healthcare associated infections

McCarthy, M. BMJ 2016;352:i1352

US hospitals have made progress in preventing healthcare associated infections, but such infections remain common and are often caused by difficult to treat, antibiotic resistant organisms, a study by the Centers for Disease Control and Prevention (CDC) has found.

Researchers compared the number of infections reported in 2014 with a predicted number of infections based on historical baselines established over several years for central line associated bloodstream infections, surgical site infections, catheter associated urinary tract infections, and Clostridium difficile infections. The study was reported in the CDC’s Morbidity and Mortality Weekly Report and led by Lindsey M Weiner, of the Division of Healthcare Quality Promotion at the CDC’s National Center for Emerging and Zoonotic Infectious Diseases.

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Image source: NIAID

Image shows scanning electron micrograph of Staphylococcus aureus bacteria (gold) outside a white blood cell (blue).

About 4000 acute care hospitals, 501 long term acute care hospitals, and 1135 inpatient rehabilitation facilities in all 50 states, the District of Columbia, and Puerto Rico reported infections to the CDC’s National Healthcare Safety Network.

The researchers found that short term acute care hospitals had seen a 50% decline in central line associated bloodstream infections from 2008 to 2014 and a 17% decline in surgical site infections over the same period, but no change was found in the incidence of catheter associated urinary tract infections from a 2009 baseline.

In long term acute care hospitals, central line associated bloodstream infections fell by 9%, while catheter associated urinary tract infections fell by 11%. Inpatient rehabilitation facilities saw a 14% reduction in catheter associated urinary tract infections from baseline.

Hospital onset C difficile infections actually increased by 4% during 2013-14, meaning that these infections decreased by only 8% from the baseline established in 2011.

Read the full article here

Red the original report here

A multifaceted prevention program to reduce infection after cesarean section: Interventions assessed using an intensive postdischarge surveillance system

American Journal of Infection Control: August 1, 2015 Volume 43, Issue 8, Pages 805–809

Background
We assessed the effects of the components of a multifaceted and evidence-based caesarean-section surgical site infection (SSI) prevention program on the SSI rate after cesarean section using a postdischarge surveillance (PDS) system.

Methods
Multiple prevention interventions were serially implemented. SSI case finding was undertaken through active inpatient surveillance and intensive PDS using a standardized form at the 6-week postdischarge visit. SSI diagnosis was made using the Centers for Disease Control and Prevention standardized criteria. All cesarean deliveries between July 2007 and December 2012 were included. Changes in SSI rate were analyzed using segmented regression analysis.

Results
Nine thousand four hundred forty-two cesarean sections were assessed during the study period. PDS forms were completed for 7,985 women (85%). SSI was detected in 451 cases (5.6%): 91% were superficial, 9% were deep/organ-space infections. The SSI rate decreased incrementally from 8.2% at baseline to 4.1%; significant decreases were observed after optimizing antibiotic prophylaxis timing, using a surgical safety checklist, and enhancing prenatal education to discourage prehospital self-removal of hair. Nonelective surgeries or those undertaken after >12 hours of rupture of membranes had a significantly higher rate compared with those without either risk factor (6.3% vs 3.2%; P < .001).

Conclusions
A multifaceted SSI prevention strategy, with periodic feedback of data, led to a significant reduction in SSI rates after cesarean section.

via A multifaceted prevention program to reduce infection after cesarean section: Interventions assessed using an intensive postdischarge surveillance system – American Journal of Infection Control.