22 Matching Annotations
  1. Oct 2023
  2. www.ncbi.nlm.nih.gov www.ncbi.nlm.nih.gov
    The Impact of Care Bundles on Ventilator-Associated Pneumonia (VAP) Prevention in Adult ICUs:A Systematic Review
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    1. mawise4882 02 Oct 2023
      ombined with adequate ETT cuff pressure and subglotticsuctioning, without forgetting the hand hygiene and aseptic suctioning technique. ICUsshould adopt basic practices that prevent or decrease VAP rates, and as a result, mortality,duration of mechanical ventilation, length of stay, and healthcare costs. Moreover, thestrategies should be multifaceted and supported by a long-term education program byensuring compliance in the care bundle

      • Combining proper endotracheal tube (ETT) cuff pressure and subglottic suctioning, along with essential hand hygiene and aseptic suctioning technique.

      • Emphasizing the importance of ICUs adopting fundamental VAP prevention practices to reduce mortality, mechanical ventilation duration, hospital stays, and healthcare costs.

      • Highlighting the need for multifaceted strategies supported by ongoing education programs to ensure compliance with care bundles for sustained VAP reduction.

    2. mawise4882 02 Oct 2023
      In particular, differences in study quality areindicative of great differences in studies design, since seven studies had a high level ofquality, 20 had a moderate level, and 11 a low level

      Most studies were at the moderate and low level, which should be kept in mind. They maybe should have did the same of each level.

    3. mawise4882 02 Oct 2023
      hand hygiene and aseptic suctioning technique are of the most basictechniques and that they were taken for granted, along with all the other interventionsfor VAP prevention in the included studie

      We always need to refer back to the basics in nursing. Hand washing is key to prevent the spread of infections!

    4. mawise4882 02 Oct 2023
      endotracheal tube is one of the major predisposingfactors for VAP development, as pathogens enter the trachea either by micro aspirationaround the ETT cuff or by the biofilm formed in the inner side of the ETT

      Extubation can predispose patients to VAP. New pathogens can be introduced to the lungs in their vulnerable state.

    5. mawise4882 02 Oct 2023
      Oralcare remains an important tool for dental plaque removal and the promotion of a normalmicrobial community inside the oral cavity, thus preventing the growth of microorganismsin the trachea and the creation of VAP

      Oral Care is so important not only for VAP but many different conditions! Nurses especially need to perform oral care on intubated patients because they are unable too!

    6. mawise4882 02 Oct 2023
      Worldwide, scientists’ aimto decrease VAP incidence in order: first, to improve ventilated patients’ outcomes, andthereafter to decrease mortality, hospital length of stay and healthcare expenditures. VAPdiagnostic criteria, methods of respiratory sampling, interventions in VAP bundles andstudy designs varies, at a great extent, among the ICUs worldwide [ 24 ]. Nevertheless, VAPcare bundles combined with a focused education program, which could lead to increasedcompliance, have proved their efficacy in VAP reduction

      It is great that the VAP care bundles have good research to back the these interventions. EBP is the best way to ensure the best patient care.

    7. mawise4882 02 Oct 2023
      VAP diagnostic criteriadiffer among ICUs but usually require factors such as fever, leukocytosis, progressiveinfiltrate on chest X-ray, positive cultures from respiratory secretions and reduction in gasexchange

      VAP requires continued diagnostic testing and assessment in order to prevent further complications!

    8. mawise4882 02 Oct 2023
      Education program included self-learning packets, presenta-tions, discussions, knowledge questionnaires, posters, checklists, videos, reminder signs inpatients’ rooms, nursing and medical champions, stimulation scenarios and feedback meet-ings. Thirty-two studies measured the compliance to ventilator bundles and/or educationprogram, and in all of them there was a significant increase in VAP bundle adherence afterthe education program

      In 32 studies, compliance with ventilator bundles and/or the education program was measured. In all of them, there was a significant increase in adherence to VAP prevention protocols after the education program. Thats why as nurses we should stress education and continued learning always!

    10. mawise4882 02 Oct 2023
      Head-of-Bed elevation, with a range of 30◦ to 45◦, wasimplemented by all the reviewed studies, except one [32]. The second most widely usedintervention was oral hygiene using chlorhexidine 0.12%. Only one study [3] used sodiumbicarbonate and another one [33] sponges and mouthwashes, albeit without a particularchange in VAP reduction. Six studies did not adopt the measure of oral care
      • Head-of-Bed elevation (30° to 45°) was widely adopted in all studies except one.
      • The second most common intervention was oral hygiene with chlorhexidine 0.12%.
      • Some studies used alternatives like sodium bicarbonate and sponges/mouthwashes, but these didn't significantly reduce VAP.
      • Six studies didn't include oral care in their VAP prevention measures.
    11. mawise4882 02 Oct 2023
      Thestudied populations were critically ill ventilated patients admitted to general, medical,surgical, neurosurgical, trauma, and cardiovascular ICUs. Most of the included studieswere performed in general ICUs and fifteen of them were multicente

      Maybe they could have included patients that have been on long term ventilation as well? or even on different ages and sexes?

    12. mawise4882 02 Oct 2023
      The total sample size rangedfrom 43 intubated patients [20 ] to 171,237 intubated patients

      The vast size of data makes this study more reliable and decreases the chance of the data being bias or skewed.

    13. mawise4882 02 Oct 2023
      After completing the checklist,all studies were classified as low risk, moderate risk, serious risk, critical risk, or “noinformatio

      This checklist ensured that the results were not inaccurate nor bias.

    14. mawise4882 02 Oct 2023
      roughly presenting all the combined interventions and calculating the pre andpost intervention VAP rate; (e) compare with the individual intervention’s implementa-tion for VAP prevention; and (f) be published after the implementation of “IHI VentilatorBundle”. Additi

      The study aims to provide an overview of combined interventions for VAP prevention, analyze VAP rates before and after their implementation, compare their effectiveness with individual interventions, and ensure that the publication of findings occurs after the implementation of the "IHI Ventilator Bundle."

    15. mawise4882 02 Oct 2023
      As VAP is oneof the most common preventable lung infections in critically ill intubated patients, it isimperative to determine the most efficient preventive measures for VAP reduction

      VAP as a common preventable lung infection: Highlights that Ventilator-Associated Pneumonia is a prevalent infection that occurs in critically ill patients who are intubated and emphasizes the importance of preventing it.

      Imperative to determine efficient preventive measures: Emphasizes the urgent need to identify and implement effective strategies to reduce the incidence of VAP in this vulnerable patient population.

    16. mawise4882 02 Oct 2023
      a result, there has been a variation in the included interventions of VAP bundles amongICUs and until now there is no common bundle which can be agreed to be implemented bythe communities worldwide [10].In the last two decades, a major problem has been the increasing rates of occurrence ofcommunity-associated methicillin resistant Staphylococcus aureus (CA-MRSA) and hospital-associated MRSA (HA-MRSA). Apart from that, the communities have faced several viraloutbreaks, such as SARS-1, SARS-2, and MERS

      • Increasing rates of CA-MRSA and HA-MRSA: Highlights the rising prevalence of methicillin-resistant Staphylococcus aureus infections in both community and hospital settings, which pose significant challenges for healthcare.

      • Viral outbreaks like SARS-1, SARS-2, and MERS: Refers to severe respiratory syndromes caused by viruses, including Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS), and the more recent COVID-19 pandemic (SARS-CoV-2).

      • Increased rates of ventilated patients: Indicates that the combination of MRSA infections and viral outbreaks, along with an aging population, has resulted in a higher number of patients requiring mechanical ventilation.

    17. mawise4882 02 Oct 2023
      (3) peptic ulcer disease (PUD) prophylaxis and (4) deep venus thrombosis (DVT)prophylaxis [ 9 ]. In 2010, IHI added a fifth intervention: (5) daily oral care with chlorhexi-dine. In 2016, the Intensive Care Society proposed a bundle called “Recommended bundleof Interventions for the prevention of VAP”, including elevation of head of bed, daily seda-tion vacation and assessment of readiness to extubate, use of subglottic secretion drainage,avoidance of scheduled ventilator circuit changes, oral hygiene without chlorhexidine andPUD prophylaxis (only for high-risk patients), without mentioning DVT prophylaxis
      • Elevation of the head of the bed (HOB) to 30°–45°: Raising the head of the bed to prevent aspiration in ventilated patients.
      • Daily "sedation vacation" and readiness assessment for extubation: Temporary reduction of sedation to assess if the patient is ready to have the breathing tube removed.
      • Peptic ulcer disease (PUD) prophylaxis: Preventing peptic ulcers, often due to stress or medications.
      • Deep venous thrombosis (DVT) prophylaxis: Preventing dangerous blood clots in deep veins.
      • Daily oral care with chlorhexidine: Maintaining oral hygiene with an antiseptic.

      These are all super important interventions not only for VAP but other preventable conditions!

    18. mawise4882 02 Oct 2023
      Bundle is a set of individual components, combined to make a set of quality indicators for aspecific system, procedure, or treatment [8]. These interventions must be all implementedtogether to achieve significantly better results

      A "bundle" is a collection of individual components that are combined to form a set of quality indicators for a specific system, procedure, or treatment.It's important to note that these interventions within the bundle must all be implemented together in a coordinated manner to achieve significantly improved results. Bundles I feel are beneficial for patients and staff to ensure the best care.

    19. mawise4882 02 Oct 2023
      (VAP) is one of the main types of infection in criticallyill mechanically ventilated patients, leading to increased mortality, morbidity, hospital stay,economic and psychological costs for patients and their families

      A critical infection commonly observed in mechanically ventilated patients in intensive care units. It has a profound impact, including increased mortality rates, elevated morbidity, prolonged hospital stays, substantial economic burdens, and psychological distress for both patients and their families.

      The prevention and management of VAP are crucial in improving patient outcomes and reducing the associated burdens.

    20. mawise4882 02 Oct 2023
      he “IHI Ventilator Bundle” combined with adequate endotracheal tube cuff pressure and subglotticsuctioning. Multifaced techniques can lead to VAP reduction at a great exten

      The "IHI Ventilator Bundle," when combined with proper management of endotracheal tube cuff pressure and subglottic suctioning, can significantly contribute to the reduction of (VAP). Employing a variety of techniques in a coordinated manner can greatly enhance the effectiveness of VAP prevention efforts.

    21. mawise4882 02 Oct 2023
      The most common interventions monitored in the care bundles were sedation andweaning protocols, semi-recumbent positioning, oral and hand hygiene, peptic ulcer disease anddeep venus thrombosis prophylaxis, subglottic suctioning, and cuff pressure control

      Sedation and weaning protocols: These are strategies for managing a patient's level of sedation and the process of gradually removing mechanical ventilation.

      Semi-recumbent positioning: This refers to the practice of elevating the patient's upper body at a specific angle, often to prevent complications such as aspiration pneumonia or pressure ulcers.

      Oral and hand hygiene: This involves maintaining cleanliness of a patient's mouth and hands, which is essential for preventing infections.

      Peptic ulcer disease prophylaxis: This refers to measures taken to prevent the development of peptic ulcers, which can be caused by factors like stress and certain medications.

      Deep venous thrombosis prophylaxis: Measures taken to prevent the formation of blood clots in the deep veins, which can be life-threatening if they travel to the lungs.

      Subglottic suctioning: A procedure used to remove secretions from below the vocal cords, often employed in patients on mechanical ventilation to prevent pneumonia.

      Cuff pressure control: Refers to the management of the pressure inside the cuff of an endotracheal tube to prevent complications like aspiration or tracheal damage.

    22. mawise4882 02 Oct 2023
      Ventilator-associated pneumonia (VAP) remains a common risk in mechanically ventilatedpatients. Different care bundles have been proposed to succeed VAP reduction

      VAP care bundles were created to help reduce the incident of VAP. Nurses should implement these bundles into everyday care for patient that are on mechanical ventilation. These care bundles are important in reducing morbidity and mortality rates.

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    ncbi.nlm.nih.gov/pmc/articles/PMC9952750/pdf/antibiotics-12-00227.pdf