Application of a ventilator associated pneumonia prevention guideline and outcomes: A quasi-experimental study.

OBJECTIVE: Ventilator associated pneumonia is the most frequent health-care-associated infection in Intensive Care Units, causing increased antibiotic consumption and resistance, length of stay, plus multiple health and economic costs. The aim of the study was to assess whether a customised guideline implementation would improve ventilator-associated pneumonia incidence and associated intensive care outcomes. DESIGN: This was a quasi-experimental, before-after study consisting of pre-intervention, intervention and post-intervention periods. SETTING: Three intensive care units at a well-known Portuguese hospital centre. INTERVENTION: A set of eight recommendations was implemented after a guideline adaptation process. PATIENTS: Adult patients admitted to the intensive care units over the study periods, aged 18 years or older and under invasive ventilation through an endotracheal tube or tracheostomy cannula. MEASUREMENTS AND MAIN RESULTS: Data related to patient characterisation, guideline compliance and health outcomes were analysed. From a population of 1970 patients, a study sample of 828 was studied. Compliance with the recommendations was high. We identified a significant reduction in the incidence of ventilator-associated pneumonia in two of the units (p = 0.020 and p = 0.001) and a reduction in duration of invasive ventilation, intensive care unit length of stay and mortality in all the three units. We found associations between some recommendations and the implementation of the set of recommendations and intensive care unit length of stay, duration of invasive ventilation and mortality. CONCLUSION: The implementation of an evidence-based, locally customised guideline may improve ventilator associated pneumonia incidence and several outcomes.

Intubation-associated pneumonia: An integrative review.

OBJECTIVE: This article aims to characterise intubation-associated pneumonia regarding its diagnosis, causes, risk factors, consequences and incidence. RESEARCH METHODOLOGY: Integrative literature review using database Pubmed and B-on and webpages of organisations dedicated to this area of study. SETTING: The research took place between May and July 2015. After selection of the articles, according to established criteria, their quality was assessed and 17 documents were included. RESULTS: Evidence has demonstrated that intubation associated pneumonia has a multifactorial aetiology and one of its main causes is micro-aspiration of gastric and oropharynx contents. Risk factors can be internal or external. The diagnostic criteria are based on clinical, radiological and microbiological data, established by several organisations, including the European Centres for Disease Control and Prevention, which are, however, still not accurate. In recent years, there has been a downward trend in the incidence in Europe. Nevertheless, it continues to have significant economic impact, as well as affecting health and human lives. CONCLUSIONS: Several European countries are committed to addressing this phenomenon through infection control and microbial resistance programmes; however there is a much to be done in order to minimise its effects. The lack of consensus in the literature regarding diagnosis criteria, risk factors and incidence rates is a limitation of this study.