https://scholars.lib.ntu.edu.tw/handle/123456789/493448
標題: | Efficacy of ventilator-associated pneumonia care bundle for prevention of ventilator-associated pneumonia in the surgical intensive care units of a medical center | 作者: | Lim K.-P. SHUENN-WEN KUO Ko W.-J. WANG-HUEI SHENG Chang Y.-Y. Hong M.-C. Sun C.-C. YEE-CHUN CHEN SHAN-CHWEN CHANG |
公開日期: | 2015 | 出版社: | Elsevier Ltd | 卷: | 48 | 期: | 3 | 起(迄)頁: | 316-321 | 來源出版物: | Journal of Microbiology, Immunology and Infection | 摘要: | Background: Ventilator-associated pneumonia (VAP) is one of the most serious treatment-related infections resulting in high mortalities and costs. Our hospital has implemented bundle care in the intensive care units (ICUs) with special focus on VAP prevention. This is a retrospective study to evaluate its efficacy. Methods: We implemented a six-item VAP care bundle modified from that of the Institute for Healthcare Improvement at five surgical ICUs (SICUs) in the National Taiwan University Hospital. A multidisciplinary teamwork was involved in this bundle care. This study analyses the SICU utilization, ventilator utilization, and VAP incidence between January 2006 and March 2013 to assess the impact of VAP bundle in a clinical setting. Results: A total of 28,454 SICU patients were analyzed in this study and patients under the age of 18 were excluded (n = 1329); eventually, 27,125 patients were enrolled, with 12,913 patients from the pre-VAP bundle phase and 14,212 from the post-VAP bundle phase. Patients from the post-VAP phase tended to be older (p = 0.024) and with shorter SICU stay (p = 0.006), and disease severity scores (Therapeutic Intervention Scoring System, Glasgow Coma Scale, and Acute Physiology and Chronic Health Evaluation II score) were lower in the post-VAP bundle phase (p < 0.001), except the Injury Severity Score (p = 0.729). In response to VAP bundle interventions, no difference in SICU utilization (p = 0.982) between the pre-VAP and post-VAP bundle phases was noted, whereas the ventilator utilization was significantly decreased, from 1148.5 ventilator days to 956.1 ventilator days (p < 0.001) monthly; the VAP density had remarkably decreased from 3.3 to 1.4 cases per 1000 ventilator days (p < 0.001). Conclusion: Implementation of VAP bundle care decreases the incidence of VAP at SICU. Multidisciplinary teamwork, education, and a comprehensive checklist to improve health-care workers' compliance are the keys to success. ? 2013, Taiwan Society of Microbiology. |
URI: | https://www.scopus.com/inward/record.uri?eid=2-s2.0-84929502611&doi=10.1016%2fj.jmii.2013.09.007&partnerID=40&md5=e85ee8e0df33a8eec5e3ec59da60d900 https://scholars.lib.ntu.edu.tw/handle/123456789/493448 |
ISSN: | 1684-1182 | DOI: | 10.1016/j.jmii.2013.09.007 | SDG/關鍵字: | adult; age; aged; APACHE; Article; artificial ventilation; care bundle; clinical effectiveness; disease severity; disease severity assessment; female; Glasgow coma scale; health care utilization; human; injury scale; intensive care unit; length of stay; major clinical study; male; mechanical ventilator; outcome assessment; retrospective study; surgical intensive care unit; teamwork; Therapeutic Intervention Scoring System; ventilator associated pneumonia; adolescent; care bundle; epidemiology; health services research; incidence; infection control; intensive care; middle aged; Pneumonia, Ventilator-Associated; procedures; Taiwan; treatment outcome; university hospital; young adult; Adolescent; Adult; Aged; Critical Care; Female; Health Services Research; Hospitals, University; Humans; Incidence; Infection Control; Male; Middle Aged; Patient Care Bundles; Pneumonia, Ventilator-Associated; Retrospective Studies; Taiwan; Treatment Outcome; Young Adult |
顯示於: | 醫學系 |
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