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.
There are several main dimensions most frequently used to measure hospitals performance via clinical efficiency ( Clinical quality , evidence -based practices , health improvement and outcomes for individual and patients)
Patient safety goals effective january 1, 2016Hisham Aldabagh
Includes the patient safety goals which must be achieved during the year 2016, focusing on patient identification, proper patient medication, protection patient against infection, and strict per operative patient safety procedures
There are several main dimensions most frequently used to measure hospitals performance via clinical efficiency ( Clinical quality , evidence -based practices , health improvement and outcomes for individual and patients)
Patient safety goals effective january 1, 2016Hisham Aldabagh
Includes the patient safety goals which must be achieved during the year 2016, focusing on patient identification, proper patient medication, protection patient against infection, and strict per operative patient safety procedures
These indicators included: Falls, Falls with Injury, Nursing Care Hours per Patient Day, Skill Mix, Pressure Ulcer Prevalence, and Hospital-Acquired Pressure Ulcer Prevalence.
International Patient Safety Goals (IPSG) help accredited organizations address specific areas of concern in some of the most problematic areas of patient safety.
International-Patient-Safety-GoalsGoal 1: Identify patients correctly
Goal 2: Improve effective communication
Goal 3: Improve the safety of high-alert medications
Goal 4: Ensure safe surgery
Goal 5: Reduce the risk of health care-associated infections
Goal 6: Reduce the risk of patient harm resulting from falls
Creating a culture of continuous improvement requires having an AIM or knowing exactly what the organization is striving for.
This means the entire organization should understand the concept of excellence and continually look for ways to do things better and more efficiently, resulting in higher levels of effectiveness.
When everyone understands the aim of excellence, there’s a synergy to achieve that objective. Excellence doesn’t just happen; it’s intentional!
To achieve excellence, you need a systematic approach to improvement initiatives that result in positive change for the organization.
These indicators included: Falls, Falls with Injury, Nursing Care Hours per Patient Day, Skill Mix, Pressure Ulcer Prevalence, and Hospital-Acquired Pressure Ulcer Prevalence.
International Patient Safety Goals (IPSG) help accredited organizations address specific areas of concern in some of the most problematic areas of patient safety.
International-Patient-Safety-GoalsGoal 1: Identify patients correctly
Goal 2: Improve effective communication
Goal 3: Improve the safety of high-alert medications
Goal 4: Ensure safe surgery
Goal 5: Reduce the risk of health care-associated infections
Goal 6: Reduce the risk of patient harm resulting from falls
Creating a culture of continuous improvement requires having an AIM or knowing exactly what the organization is striving for.
This means the entire organization should understand the concept of excellence and continually look for ways to do things better and more efficiently, resulting in higher levels of effectiveness.
When everyone understands the aim of excellence, there’s a synergy to achieve that objective. Excellence doesn’t just happen; it’s intentional!
To achieve excellence, you need a systematic approach to improvement initiatives that result in positive change for the organization.
I DON'T need ultrasound monitoring on the ICUAdrian Wong
Taking the con side for this debate at the International Fluid Academy Day - Antwerp, Belgium.
Hopefully it provides some of the limitations of US on the ICU - focussing mostly on lack of governance and system
2018 Effect of Bag-Mask Ventilation vs Endotracheal Intubation During Cardiop...Robert Cole
Bag-mask ventilation (BMV) is a less complex technique than endotracheal
intubation (ETI) for airway management during the advanced cardiac life support phase of
cardiopulmonary resuscitation of patients with out-of-hospital cardiorespiratory arrest.
It has been reported as superior in terms of survival.
IOSR Journal of Mathematics(IOSR-JM) is an open access international journal that provides rapid publication (within a month) of articles in all areas of mathemetics and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications in mathematics. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
Assessment of the Implementation of Ventilator-associated Pneumonia Preventiv...IOSR Journals
Background: Pneumonia associated with mechanical ventilation (VAP) is one of the important
causes of nosocomial infections in pediatric intensive care units (PICU). VAP is the leading cause of morbidity
and mortality in PICUs. Aim: To assess the compliance to ventilator bundle components: elevation of the head
of bed >30, sedation interruption, spontaneous breathing trial, peptic ulcer prophylaxis and its effect on the
prevention of VAP. Subjects and Methods: A case control study at PICU of Abo EL Reish El Moneira Hospital,
including all mechanically ventilated patients admitted over a period of one year. The study tested the effect of
implementation of this bundle as regard the rate of VAP in both group, compliance to bundle and most affecting
component of it. Results: There was decrease incidence of VAP after implementation of the bundle, from (50%)
to (14%). Development of VAP was mostly affected by being in supine position, long duration of mechanical
ventilation and presence of pump failure. (p<0.05) The compliance to bundle components was statistically
significant, p= 0.001. Conclusion: VAP rate decreased after implementation of this bundle. Elevation of the
head of bed was the most compliant component of bundle in the PICU.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
NVBDCP.pptx Nation vector borne disease control program
VAP bundle compliance in ICU - Clinical Audit
1. VAP bundle compliance in ICU
Authors
A. Al-Harthy , A. F. Mady , H. Al-Hanafy , W. Al-Etreby , M. Asim Rana
Department of Intensive Care Medicine,
King Saud Medical City, Riyadh, Kingdom of Saudi Arabia.
Corresponding Author
Waleed Tharwat Hashim Al-Etreby
Kingdom of Saudi Arabia, Riyadh, P.O. Box 331140 ZIP code 11373 Al-Shemaisi
Anesth_71@yahoo.com
Lead Consultant
Abdul Rahman Mishal Al-Harthy
King Saud Medical City, Critical Care Department
Riyadh, Kingdom of Saudi Arabia
The Online Journal of Clinical Audits. 2014; Vol 6(2).
Published June 2014.
To subscribe to The Online Journal of Clinical Audits go to:
http://www.clinicalaudits.com/index.php/ojca/user/register
Article submission and authors instructions:
http://www.clinicalaudits.com/index.php/ojca/about/submissions
2. ISSN 2042-4779 ClinicalAudits.com
Abstract: Healthcare associated infection is a major concern worldwide, and ventilator associated
pneumonia (VAP) is the leading cause of mortality among them, VAP is also associated with increased
length of stay in ICU, and increased cost of treatment. Authorities all over the world have issued
guidelines and recommendations for the prevention of VAP in an effort to decrease its incidence.
Aims – To measure the compliance of healthcare providers in ICU with VAP bundle.
Methods – Concurrent snapshot review of the medical files of 88 adults ventilated patients took place,
during April 2014, for evidence of compliance with components of VAP bundle, namely: Hand hygiene,
mouth wash, elevation of head of bed (HOB), sedation vacation, non-routine changing of the ventilator
tubing, and the use of Endotracheal tube (ETT) with subglottic suction port.
Results – compliance with mouth wash and non-routine tubing change was 100%, while compliance with
hand hygiene was 87.5%, compliance with the elevation of HOB was 95.2%, compliance with sedation
vacation was 65.5%, no patients were intubated with ETT with subglottic suction port, so the compliance
was 0%
Conclusions – Awareness and education are required for the VAP bundle, every effort must be made to
minimize load of work on physicians and nurses, periodic preventive maintenance needs to be more
effective, and administration of the ICU will be addressed to provide ETT with subglottic suction ports.
Introduction
Healthcare-associated infection (HAI) is a major patient safety concern all over the
world 1
. The leading cause of death among (HAI) is ventilator associated pneumonia
(VAP), exceeding deaths due to central line infections, severe sepsis, and respiratory
tract infections in non-intubated patients 2
. With mortality rates ranging from 15% to
70% depending on the patient population 1
. And approximately 60% of deaths among
patients with hospital-acquired pneumonia 3
. Studies have also shown higher hospital
mortality rates of ventilated patients who develop VAP (about 46%) compared to
mortality rates of 32% of ventilated patients who do not develop VAP 4
. VAP is not only
associated with high mortality rates, but accounts also to increasing the length of stay
in ICU by an average of 4 to 9 days 3
. And consequently increasing directly
hospitalization costs to up to $40,000 per patient 5
. As well as increasing the duration of
mechanical ventilation, and making it more difficult to wean the patient from the
ventilator 6
.
Because of the seriousness of VAP and its morbid effect on patients’ outcome, many
authorities around the globe, like The Center for Disease Control (CDC), Joint
Commission, and the Leapfrog Group, have identified VAP rates as a measure of the
quality of care provided by an institution 7,8
. Several organizations have recommended
approaches, interventions, and evidence-based guidelines to address that issue 9
. And
many hospitals worldwide implemented a group of patient care practices, to be carried
out by the care team to standardize treatment, named the ventilator bundle or the VAP
bundle 10
. Including King Saud Medical City, Riyadh, KSA. Where this audit was carried
out.
3. ISSN 2042-4779 ClinicalAudits.com
Aims
To measure the compliance of the care providers with the elements of the VAP bundle.
Audit Standards (table 1)
1- Intubated patients should be positioned with their upper body elevated (semi-
recumbent or sitting) for as much of the time as possible, unless contraindicated
like spine injury.
2- Oral antiseptics (for example, chlorhexidine) should be included as part of an
oral hygiene regimen for all patients who are intubated, unless contraindicated
due to oro-pharyngeal trauma.
3- Hand hygiene, in accordance with national hand hygiene guidelines, should be
part of the routine clinical care of mechanically ventilated patients, without
exception.
4- The ventilator circuit should be changed only if soiled or damaged, not on a
routine basis.
5- Sedation reviewed, and if appropriate stopped daily, and the patient is assessed
for weaning and extubation, unless contraindicated due to difficulty of ventilation,
refractory hypoxia, or HFO.
6- Use of subglottic secretion drainage ETT in patients likely to be ventilated for
more than 48 hours.
Table 1: Audit standards and criteria.
Evidence of quality of care or service
(criterion)
Standard
(% compliance)
Exception(s) Definitions and
instructions for data
collection
1 Elevation of head of bed 30 – 45 degrees 100% Spine injury All ventilated adult
patients in ICU
2 Oral hygiene with chlorhexidine 100% Oro-pharyngeal trauma All ventilated adult
patients in ICU
3 Hand Hygiene 100% NONE All ventilated adult
patients in ICU
4 Circuit change only when needed 100% NONE All ventilated adult
patients in ICU
5 Sedation review and vacation 100% HFO, high ICP, difficult
to ventilate
All ventilated adult
patients in ICU
6 Subglottic suction ETT 100% Not available All ventilated adult
patients in ICU
Methods
The study was carried out at King Saud Medical City (KSMC), Riyadh, Saudi Arabia.
KSMC has a 120 bed state of the art ICU, making it one of the largest ICUs in the
middle east, accepting both medical and surgical cases.
During the month of April 2014, 88 mechanically ventilated adult patients were included
in the study.
Concurrent snap shot data were collected from the patients’ medical records, in a
YES/NO tick box form, concerning the six audit standards stated above. Percentage of
compliance with each standard was calculated separately, by dividing the number of
patients who meet the standard, by the number of patients to whom the standard
applies minus exceptions, multiplied by 100.
4. ISSN 2042-4779 ClinicalAudits.com
Results (table 2, figure 1)
1. Compliance with hand hygiene was observed in 77 cases out of 88 without
exceptions, with a percentage of 87.5%
2. Compliance with mouth wash with chlorhexidine was 100%, no patients were
excluded.
3. Compliance with elevation of head of bed was 81 out of 85 patients, with a
percentage of 95.2%, and 3 patients with unstable spine fracture were excluded.
4. Compliance with sedation vacation was documented in 57 patients out of 87,
with a percentage of 65.5%, while one patient on high frequency oscillation was
excluded.
5. Compliance with non-routine changing of the ventilator tubing was 100% without
exceptions.
6. Compliance with the use of subglottic suction ETT was 0%
Table 2: Summary of results.
Criteria Exception Compliance Percentage
Hand Hygiene zero 77/88 87.5 %
Mouthwash zero 88/88 100 %
HOB elevation 3 81/85 95.2 %
Sedation vacation 1 57/87 65.5 %
Changing tubing zero 88/88 100 %
Subglottic suction 88 0/88 0 %
Figure 1: Summary of results.
1- Hand hygiene, 2- Mouth wash, 3- HOB, 4- Sedation vacation, 5- change of tubes, 6- subglottic suction tube
5. ISSN 2042-4779 ClinicalAudits.com
Discussion
Mouthwash with chlorhexidine for intubated patients is a part of the daily nursing care in
our ICU, and all patients audited received that intervention, resulting in a compliance
percentage of 100%.
It is also the routine practice of respiratory therapists in the ICU to change tubing only if
they become soiled with secretions or damaged, resulting in a 100% compliance.
Compliance with hand hygiene was 87.5 %, noncompliance was observed in eleven
patients. Out of those eleven episodes of non-compliance, five cases were related to
emergency situations, like sudden desaturation or accidental extubation. Non-
compliance was observed among physicians, either ICU or out of ICU physicians.
Sedation vacation and assessment of readiness of extubation had the lowest
compliance percentage of about 66%, 87 patients were included and one patient on
HFO was excluded.
As for the use of ETT with subglottic suction port, all of the patients were excluded,
resulting in a compliance percentage of zero%
Conclusions
Compliance with the nursing elements of VAP bundle (mouth wash, hand hygiene, and
non-routine changing of the ventilator tubing) is up to standards, while the
inconsistencies were observed from the physicians side. In part due to unawareness
and lack of education about the elements of the bundle, especially between physicians
from outside the ICU, and in part due to the concentration on resuscitation by ICU
physicians in emergency situations, on the expense of policies and recommendations.
The overload of work (be it paper work, or critically ill patients handled by the same
person) make it impossible sometimes for the ICU physician to consider holding
sedation for an intubated patient and start a trial of weaning, which requires his/her
undivided attention and concentration.
Compliance with the standard of elevation of the head of bed, that was breached four
times, was the result of a malfunctioning bed once, and forgetting to return the patient
to semi-sitting position after care three times, which could also be attributed to the
overload of work on the bedside nurse, with many responsibilities and tasks to be
performed.
The zero compliance with the standard of using ETT with subglottic suction port was
simply due to its unavailability in our institution.
Recommendations
• Education, awareness, and enlightening are a must for the successful
implementation of any advocated intervention or practice. A campaign of
awareness of the VAP bundle is required to educate healthcare providers, about
its importance. Different methods can be used like: posters, reminder (pocket)
cards, lectures, group discussions, one-on-one talks …etc.
6. ISSN 2042-4779 ClinicalAudits.com
• Decreasing the load of work on the physician as well as the nurse is
recommended, so that the best care can be provided. Minimizing paper work is a
method, perhaps also recruitment of more personnel.
• Proper maintenance of all ICU equipment, and periodic checking. If a bed is not
functioning, it should not be available for patient admission.
• Administration of the ICU will be addressed to provide the ETT with subglottic
suction port.
References
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U.S. Hospitals. Public Health Reports 2007; 122: 160-166.
2. Move Your Dot™: Measuring, Evaluating, and Reducing Hospital Mortality Rates (Part 1). IHI
Innovation Series white paper. Boston: Institute for Healthcare Improvement; 2003.
3. Kollef MH, Shorr A, Tabak YP, Gupta V, Liu LZ, Johannes RS. Epidemiology and outcomes of health-
care-associated pneumonia: results from a large US database of culture-positive pneumonia. . Chest.
2005; 128(6): 3854-3862.
4. Luna CM, Blanzaco D, Niederman MS, Matarucco W, Baredes NC, Desmery P. Resolution of
ventilator associated pneumonia: prospective evaluation of the Clinical Pulmonary Infection Score as an
early clinical predictor of outcome. Crit Care Med 2003; 31: 676-82.
5. Warren DK, Shukla SJ, Olsen MA. Outcome and attributable cost of ventilatorassociated pneumonia
among intensive care unit patients in a suburban medical center. Crit Care Med 2003; 31(5): 1312-1317.
6. Rubenfeld GD, Caldwell E, Peabody E. Incidence and outcomes of acute lung injury. N Engl J Med
2005; 353: 1685-93.
7. Berwick DM, Calkins DR, McCannon CJ, Hackbarth AD. The 100,000 lives campaign: setting a goal
and a deadline for improving health care quality. jama 2006; 295(3): 324-327.
8. Jha AK,Orav EJ, Ridgway AB, Zheng J, EpsteinAM. Does the Leapfrog program help identify high-
quality hospitals?. Jt Comm J Qual Patient Saf. 2008; 34(6): 318-325.
9. Ricart M, Lorente C, Diaz E, Kollef MH, Rello J. Abstract: Nursing Adherence with Evidence-Based
Guidelines for Preventing Ventilator-Associated Pneumonia. Critical Care Medicine 2003; 31: 2693-2696.
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bundle to prevent ventilator-associated pneumonia.. Am J Crit Care. 2007; 16(1): 20-27.