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THE NON-PHARMACALOGICAL BUNDLE TO PREVENT INFECTIONS ASSOCIATED WITH ENDOTRACHEAL TUBES AND VENTILATORS.
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2. Key recommendations include conducting an airway evaluation, preparing basic airway equipment, having a pre-planned intubation strategy with non-invasive options, considering awake versus induced intubation, and careful planning for extubation with criteria for awake versus induced extubation.
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1) Using noninvasive sampling with semiquantitative cultures rather than invasive sampling with quantitative cultures to diagnose VAP.
2) If invasive quantitative cultures are performed for a patient with suspected VAP and results are below the diagnostic threshold, antibiotics should be withheld rather than continued.
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1) Pulse oximetry should be routinely recorded along with vital signs to assess oxygenation. Arterial blood gases are still the gold standard but have limitations.
2) Oxygen is a drug that requires prescription documenting flow rate, delivery device, oxygen saturation targets, and criteria for deterioration or improvement.
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- VAP is pneumonia that develops in intubated patients and accounts for most ICU infections. It occurs in 10-20% of mechanically ventilated patients and has a high mortality rate.
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This document provides guidelines for the diagnosis and treatment of hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) in adults. Some of the key recommendations include:
1) Using noninvasive sampling with semiquantitative cultures rather than invasive sampling with quantitative cultures to diagnose VAP.
2) If invasive quantitative cultures are performed for a patient with suspected VAP and results are below the diagnostic threshold, antibiotics should be withheld rather than continued.
3) For patients with suspected HAP (non-VAP), treatment should be guided by microbiologic studies of respiratory samples rather than being empirically treated.
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This study evaluated a technique called minimal invasive surfactant therapy (MIST) which involves administering surfactant through a narrow bore catheter inserted into the trachea of preterm infants on continuous positive airway pressure (CPAP). The study found MIST was successfully applied in two hospitals with no significant complications. Infants receiving MIST at 25-28 weeks gestation had sustained reductions in oxygen requirements and decreased need for intubation compared to historical controls. The study concluded MIST is a promising technique for improving outcomes for preterm infants on CPAP but that a large randomized controlled trial is still needed.
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Healthcare Associated Infections (HAIs) are the fourth leading cause of death in the USA. About 1.8 million patients suffer annually from care-related infections. HAIs cause 99,000 deaths every year in the US alone, at a cost of $3.1 billion dollars in excess healthcare costs in acute care hospitals. Besides HAIs kill more people than AIDS, breast cancer and auto accidents combined.
It is estimated that 271 people died each day from healthcare-associated infections (HAIs) such as Methicillin-resistant Staphylococcus aureus (MRSA) infections. Which is equivalent to one airline crash per day.Frequency and management of respiratory incidents in invasive home ventilation
This study analyzed respiratory incidents in 17 patients receiving invasive home ventilation living in a nursing home attached to a weaning center over a 2-month period. The patients had been ventilated at home for an average of 490 days. During the study period, 8 of the 17 patients (47%) experienced a total of 95 respiratory incidents. The most common incidents were desaturation, dyspnea, and reduced general condition. The most common interventions by nursing staff were use of an Ambu bag and replacement of the tracheal cannula. While most incidents were managed by nursing staff, a doctor was called in 13% of cases. Respiratory incidents were common in long-term invasive home ventilation patients.
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This case study discusses the acquisition of the women's wear brand Tiara by Narnia Group from Berksdale Investments. Narnia Group is a well-established business group in India with a turnover of Rs. 600 crores and core businesses in men's wear and industrial lubricants. The case provides background information on Narnia's existing men's wear brands Best Formals and First Sports, which it acquired in 2006. It also discusses the company's consideration of acquiring Tiara to expand into the growing women's wear market.
Ventilator associated pneumonia in the icu
Ventilator-associated pneumonia (VAP) is pneumonia that develops 48-72 hours or more after endotracheal intubation. It is characterized by new infiltrates on chest imaging and signs of infection. Early onset VAP within 4 days is usually caused by antibiotic-sensitive bacteria, while late onset VAP after 4 days often involves multidrug-resistant organisms. Preventing VAP involves care bundles focusing on endotracheal tube maintenance and secretion removal, along with prudent antibiotic usage and limiting intubation time.
Ventilator associated pneumonia
Ventilator-associated pneumonia (VAP) is a common nosocomial infection that occurs in patients on mechanical ventilation. It can develop within the first 5 days of intubation or later after the 10th day. Risk factors include prolonged mechanical ventilation, comorbidities, and improper infection control practices. Common causative organisms include Streptococcus pneumoniae, Haemophilus influenzae, and methicillin-sensitive Staphylococcus aureus for early-onset VAP and Pseudomonas, MRSA, and drug-resistant Gram-negative rods for late-onset VAP. Diagnosis is based on clinical, microbiological, and radiological criteria though there is no gold standard. Treatment involves administering appropriate
Infection in ICU
This document discusses infection risks and prevention in the ICU setting. ICU patients are at high risk of infection due to their critical illness and invasive treatments like ventilation and catheters. Common ICU infections include urinary tract, bloodstream, skin and respiratory infections. Proper hand hygiene is the most important prevention method, though aseptic technique and limiting treatment invasiveness also help. Close monitoring and treatment of ICU infections is needed due to their risk of antibiotic resistance and mortality.
Ventilator Associated Pneumonia (VAP) or Hospital Acquired Pneumonia (HAP)
Ventilator Associated Pneumonia (VAP) or Hospital Acquired Pneumonia (HAP)Philippine Hospital Infection Contol Nurses Associaton (PHICNA) Inc.
This document discusses definitions, pathophysiology, risk factors, and prevention strategies for hospital-acquired infections (HAIs) like hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP). It focuses on prevention bundles, which group multiple interventions together to potentially increase their effectiveness by exploiting synergies. Effective bundle elements include proper hand hygiene, oral care with chlorhexidine, maintaining endotracheal tube cuff pressure, and early mobility. Bundles provide a practical way to enhance care and reduce infection rates.Safe Suctioning
The document discusses strategies for safe suctioning of patients to avoid potential cardiac hazards. It covers anatomy related to suctioning, a brief history of suctioning techniques, definitions, indications for suctioning, and various hazards associated with suctioning including patient anxiety, changes in intracranial pressure, trauma, infection, pneumothorax, and hypoxia. The objectives are to familiarize nursing staff with safe suctioning techniques and ways to reduce cardiac hazards through both theoretical and practical teaching.
Endo tracheal Suctioning
ET suctioning, definition, purpose, indication, complications, types, procedure of ET suctioning, post procedure care, documentation, caution
HAP/VAP 2016 ATS/IDSA Guidelines. Our Data available at: https://rdcu.be/Mx8E
Management of Adults With Hospital-acquired and
Ventilator-associated Pneumonia: 2016 Clinical Practice
Guidelines by the Infectious Diseases Society of America
and the American Thoracic Society.
To see our study results on HCAP and HAP, VISIT https://link.springer.com/article/10.1007/s00408-018-0117-7
Et tube suctioning ppt
Endotracheal suctioning involves mechanically aspirating pulmonary secretions from patients with an artificial airway. It is done to maintain a clear airway, improve oxygenation, stimulate coughing, and prevent infections. Signs that suctioning is needed include abnormal breath sounds, increased pressures during ventilation, inability to cough effectively, or deteriorating blood gases. Risks include hypoxemia, infection, and trauma, so nurses assess patients' tolerance of the procedure and position them comfortably before carefully performing suctioning with sterile technique.
Proverbs!!
This document presents and explains the meanings of several common English proverbs and sayings. It defines what a proverb is and provides examples like "The best things in life are free" meaning valuable things like love and friendship cannot be bought. It also explains proverbs including "A stitch in time saves nine" about minor repairs now preventing major problems later, and "Still waters run deep" referring to people who appear calm but have depth. The document aims to convey the underlying meanings and lessons of well-known proverbial expressions.
Suctioning Procedure
The document outlines the steps for performing oropharyngeal and nasopharyngeal suctioning procedures. Key steps include assessing the need for suctioning based on signs and symptoms, positioning the client comfortably, applying proper hand hygiene and using aseptic technique, setting the appropriate suction pressure, lubricating and inserting the catheter into the nose or mouth, and encouraging coughing to clear secretions. The procedure aims to clear secretions and promote oxygenation while preventing trauma and transmission of microorganisms.
Nosocomial infection & control
Nosocomial infections (Hospital acquired infections): sources, microorganisms, mode of transmission, diagnosis and prevention. Hospital Infection Control Committee
Time management ppt
The document discusses time management (TM) and how to manage time effectively. It defines TM as allocating the right time to the right activities. TM is needed to save time, reduce stress, function effectively, increase work output, and have more control over responsibilities. Effective TM involves planning, setting goals and deadlines, prioritizing activities, delegating work, and spending the right amount of time on tasks. The process of TM starts with costing your time, making activity logs, setting goals, planning, prioritizing, and scheduling.
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Ventilator Associated Pneumonia (VAP) or Hospital Acquired Pneumonia (HAP)
Ventilator Associated Pneumonia (VAP) or Hospital Acquired Pneumonia (HAP)
HAP/VAP 2016 ATS/IDSA Guidelines. Our Data available at: https://rdcu.be/Mx8E
HAP/VAP 2016 ATS/IDSA Guidelines. Our Data available at: https://rdcu.be/Mx8E
Similar to A stitch in time saves nine
Mechanical Ventilation
This document discusses various aspects of mechanical ventilation and weaning patients off ventilators. It addresses the problems associated with prolonged intubation versus premature extubation. It emphasizes the nurse's responsibility to monitor patients' readiness for weaning and to gradually decrease mechanical support. The document also discusses definitions of weaning success and ensuring patients are weaned at the appropriate time.
Ventilator Associated Pneumonia Management.pptx
Ventilator-associated pneumonia (VAP) is a common hospital-acquired infection that prolongs mechanical ventilation and ICU stays. It has a high mortality rate of 20-50%. Risk factors include prolonged mechanical ventilation, supine positioning, and use of sedatives. Diagnosis is difficult due to non-specific signs. New tools like LUPPIS aim to aid early diagnosis. Prevention strategies recommended by guidelines include early mobility, oral care, subglottic secretion drainage, and selective decontamination in some settings.
Bundles to prevent ventilator associated pneumonia
This document discusses ventilator-associated pneumonia (VAP), which is a common nosocomial infection in critically ill patients that leads to poor outcomes. It reviews guidelines for preventing VAP, including using orotracheal intubation, limiting circuit changes, and closed suctioning systems. It also describes the Ventilator Bundle, a set of evidence-based practices including elevating the head of the bed, daily sedation vacations, and DVT and stress ulcer prophylaxis that have been shown to reduce VAP rates more than individual measures. While effective, the bundle may not include all strategies recommended in guidelines, so modifying it or creating a specific VAP bundle is suggested.
Bundlestopreventventilator associatedpneumonia-140724021616-phpapp02
This document discusses ventilator-associated pneumonia (VAP), which is a common nosocomial infection in critically ill patients that leads to poor outcomes. It reviews guidelines for preventing VAP, including using orotracheal intubation, limiting circuit changes, and closed suctioning systems. It also describes the Ventilator Bundle, a set of evidence-based practices including elevating the head of the bed, daily sedation vacations, and DVT and stress ulcer prophylaxis that have been shown to reduce VAP rates more than individual measures. While effective, the bundle may not include all strategies recommended in guidelines, so modifying it or creating a specific VAP bundle is suggested.
approaching infection outbreak in picu
An infection control nurse informed the PICU consultant that two patients have been found to have MDR Acinetobacter infections. This may constitute an Acinetobacter outbreak. The consultant should confirm it is an outbreak by investigating patients and the environment, calculating the attack rate, and comparing it to the background rate. If confirmed, treatment and prevention measures should be implemented, including isolation, cohorting, strict sterilization and disinfection procedures.
Weaning, extubation and decannulation
1. The document discusses discontinuation of ventilatory support and weaning from mechanical ventilation in critically ill patients. It focuses on challenges in determining the optimal time for withdrawal of ventilation support and strategies to improve weaning outcomes.
2. Weaning from mechanical ventilation is a complex process that requires evaluation of respiratory, cardiac, muscular and cognitive factors. Approximately 20-30% of patients who are deemed ready for weaning trials will fail the initial spontaneous breathing test and require resumed mechanical ventilation.
3. The document reviews various approaches and considerations for evaluating patient readiness, managing weaning, and preventing extubation failure. It emphasizes the need for further research to identify high risk patients and improve weaning techniques.
SSET .pptx
This study aims to compare the effectiveness of standard endotracheal tubes versus continuous subglottic suctioning endotracheal tubes in preventing ventilator-associated pneumonia in mechanically ventilated patients. A prospective randomized study will be conducted assigning patients requiring over 48 hours of ventilation to either tube. Outcomes such as incidence of VAP, bacterial isolates, length of stay, mortality, and cost will be compared between the two tube types. Results may help guide best practices for reducing VAP and improving patient outcomes.
Vap bundle compliance in icu
This study aimed to measure compliance with ventilator-associated pneumonia (VAP) bundle components in an intensive care unit (ICU) in Saudi Arabia. An audit of 88 mechanically ventilated patients found high compliance (87.5-100%) with hand hygiene, mouth care, and avoiding routine ventilator tubing changes. Compliance was lower for head-of-bed elevation (95.2%) and daily sedation vacations (65.5%). No patients received endotracheal tubes with subglottic suction ports due to unavailability. The authors recommend increasing education, minimizing provider workload, improving equipment maintenance, and ensuring access to recommended ventilation equipment.
Tracheostomy overview
This document discusses tracheostomy, including its history, indications, effects, techniques for insertion, care, and cautions. It provides guidance on timing of tracheostomy for prolonged ventilation cases. Key points include:
- Tracheostomy decreases anatomical dead space and work of breathing compared to endotracheal intubation.
- The TracMan study found no difference in mortality between early (1-4 days) and late (10+ days) tracheostomy for prolonged ventilation, though early tracheostomy resulted in less days of sedation.
- Percutaneous tracheostomy is usually performed under bronchoscopic guidance using commercial kits involving guidewire dilation of the tracheal stoma.
- Trache
prevention of complication in CCU
This document discusses various complications that can occur during or as a result of critical care unit (CCU) treatment and care. It outlines common complications such as ventilator-associated pneumonia, bloodstream infections, delirium, weakness, pressure ulcers, and kidney or liver failure. It provides details on prevention and treatment strategies for each complication, with a focus on minimizing the risks through careful monitoring, following best practices and bundles of care, and considering patients' long-term prognosis and quality of life beyond their acute illness.
lecture CAUTI monitoring and prevention.ppt
Healthcare-associated infections affect millions of hospital patients each year, causing prolonged hospital stays, increased costs, and preventable deaths. Urinary tract infections are the most common type of healthcare-associated infection, with catheter-associated UTIs accounting for the majority. Inserting and leaving urinary catheters in place when not medically necessary can increase infection risks. Proper training of staff, following guidelines for catheter insertion and maintenance, and removing catheters as soon as possible can help reduce unnecessary catheter use and prevent catheter-associated UTIs.
Summer final defense presentation_FINAL_3-30-16
This document summarizes a DNP project that evaluated the implementation of a sedation vacation protocol in a medical intensive care unit (MICU). The purpose was to determine if the protocol reduced pneumonia incidence, intubation duration, and ICU length of stay. A literature review found support for daily sedation vacations, spontaneous breathing trials, and ventilator bundle care. Chart reviews of 33 patients in 2014 found the protocol was ordered for all patients but only documented for 67% of patients. Results were inconclusive on outcomes. Barriers to full protocol compliance were identified.
MANAGEMENT OF DIFFICULT AIRWAY
This document discusses the prevalence and management of difficult airways. It notes that difficult intubation occurs in about 1 in 2,000-3,000 routine cases, while cannot intubate cannot ventilate situations arise in about 1 in 5,000-10,000 cases. Key steps in managing a difficult airway include preparing alternate airway devices, having a plan for awake intubation versus general anesthesia, and being prepared for emergency surgical access if needed. The document provides guidance on evaluating the airway, contents for a difficult airway cart, algorithms for management, and follow up care considerations.
Guia das 2015
The document presents updated 2015 guidelines from the Difficult Airway Society for managing unanticipated difficult intubation in adults. Key points of the guidelines include:
1) Emphasis is placed on assessment, preparation, positioning, preoxygenation, maintaining oxygenation, and minimizing trauma from interventions.
2) If tracheal intubation fails, supraglottic airway devices are recommended to provide oxygenation while considering next steps.
3) When both tracheal intubation and supraglottic airway insertion fail, waking the patient is the default option, but cricothyroidotomy should be performed if face mask oxygenation is impossible due to muscle relaxation.
Acetazolamida
This randomized clinical trial investigated whether acetazolamide reduces the duration of mechanical ventilation among patients with chronic obstructive pulmonary disease (COPD) and metabolic alkalosis. The study assigned 382 COPD patients receiving invasive mechanical ventilation to receive either acetazolamide or placebo. The primary outcome was duration of invasive mechanical ventilation. While acetazolamide significantly reduced serum bicarbonate levels and days of metabolic alkalosis, it did not result in a statistically significant reduction in the duration of mechanical ventilation compared to placebo, though the difference was clinically important. Secondary outcomes like weaning time and respiratory parameters also did not differ significantly between groups.
Oxygénation Nasale Humidifiée à Haut Débit - Optiflow aux urgences COMUN 2018
Oxygénation Nasale Humidifiée à Haut Débit - Optiflow aux urgences COMUN 2018Nicolas Peschanski, MD, PhD
Quelle est la place de l'Optiflow aux urgences ?
Où en est-on des études cliniques ?
Peut-on traiter les patients des urgences comme ceux de réanimation avec l'oxygénation haut-débit ?
De nouvelles perspectives avec l'Optiflow ?VENTILATOR ACQUIRED PNEUMONIUA.pptx
Ventilator-acquired pneumonia (VAP) is a type of hospital-acquired pneumonia that occurs in critically ill patients on mechanical ventilation. It is caused by pathogenic bacteria spreading from the oropharynx to the lungs. Risk factors include prolonged ventilation, comorbidities, and supine positioning. Diagnosis involves assessing symptoms, chest imaging, and microbiological testing of respiratory samples. Treatment involves timely administration of broad-spectrum antibiotics, with later de-escalation based on culture results. Prevention focuses on minimizing ventilation time, proper positioning, oral care, and ventilator bundles.
VAP Prevention.pptx
This document discusses strategies for preventing ventilator-associated pneumonia (VAP) in intensive care units. It recommends oral care with chlorhexidine, use of subglottic suctioning, maintaining endotracheal tube cuff pressure between 20-30 cm H2O, and using silver-coated endotracheal tubes. It finds that heat and moisture exchangers and heated humidifiers are equally effective for humidification and do not differ in preventing VAP. Selective decontamination is not recommended due to antibiotic overuse concerns.
Integrative Project
Chlorhexidine mouthwash reduces the risk of ventilator-associated pneumonia (VAP) compared to standard oral care without chlorhexidine. The document discusses implementing the use of 0.12% chlorhexidine mouthwash every 4 hours for mechanically ventilated patients based on evidence from systematic reviews and randomized control trials showing chlorhexidine significantly reduces the occurrence of VAP. Barriers to implementation include resistance from nurses who must add it to daily care and questions about costs. Education of medical staff on the importance and proper use of chlorhexidine mouthwash is proposed to support adoption of this evidence-based practice change.
Prevention of pneunmonia in icu
This document discusses strategies for preventing pneumonia in the ICU. It begins by defining hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP), noting they are common ICU infections associated with high mortality. Risk factors and pathways for pneumonia are described. Strategies with probable effectiveness discussed include hand hygiene, vaccinations, isolation of resistant organisms, nutritional support like early enteral feeding, stress ulcer prophylaxis, and semi-recumbent positioning. Unproven strategies under investigation are also outlined. The document stresses bundles of interventions work better than individual measures to reduce ICU-acquired pneumonia.
Similar to A stitch in time saves nine (20)
Bundles to prevent ventilator associated pneumonia
Bundles to prevent ventilator associated pneumonia
Bundlestopreventventilator associatedpneumonia-140724021616-phpapp02
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A stitch in time saves nine
- 1. “ A STITCH IN TIME SAVES NINE” ALI SHAMSEDDINE, BS, RT AUBMC
- 6. How to Handle VAP? Prevention
- 9. Strategies aimed at prevention of VAP Kollef (1999)
Editor's Notes
- Since mechanically ventilated patients cannot be fed orally, their salivary secretions decrease, and self-cleansing of the oral cavity is markedly reduced. As a result, oral cavity hygiene worsens, and the number of bacteria increases excessively, leading to bacterial colonization of the oropharynx.
- Methods : Patients more than 18 years old receiving mechanical ventilation for more than 48 hours in a medical intensive care unit at a university-affiliated medical center were studied in 2 consecutive 24-month periods. Patients in the group studied before the intervention (n = 779) had no oral assessments, no suctioning of the subglottic space, no tooth brushing, and suctioning of secretions in the oral cavity as needed. The group studied during the intervention (n = 759) included patients treated under a protocol whereby the oral cavity was assessed, deep suctioning was done every 6 hours, oral tissue cleansing was done every 4 hours or as needed, and tooth brushing was done twice daily. Results: Compliance with protocol components exceeded 80%. The rate of ventilator-associated pneumonia was 12.0 per 1000 ventilator days before the intervention and decreased to 8.0 per 1000 ventilator days during the intervention ( P = .06). Duration of mechanical ventilation and length of stay in the intensive care unit differed significantly between groups, as did mortality.
- Prospective, randomized, single-blind, controlled study conducted in 54 centers in North America. A total of 9417 adult patients (18 years) were screened between 2002 and 2006. A total of 2003 patients expected to require mechanical ventilation for 24 hours or longer were randomized. Patients were assigned to undergo intubation with 1 of 2 high volume, low-pressure endotracheal tubes, similar except for a silver coating on the experimental tube.