Hostname: page-component-cd9895bd7-8ctnn Total loading time: 0 Render date: 2024-12-28T05:11:10.607Z Has data issue: false hasContentIssue false
  • English
  • Français

“Bundle” Practices and Ventilator-Associated Events: Not Enough

Published online by Cambridge University Press:  19 September 2016

John C. O’Horo ,
Haitao Lan ,
Charat Thongprayoon ,
Louis Schenck ,
Adil Ahmed ,
Mikhail Dziadzko ,
Ognjen Gajic  and
Priya Sampathkumar
John C. O’Horo*
Affiliation:
Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota, United States Multidisciplinary Epidemiology and Translational Research in Intensive Care, Emergency and Perioperative Medicine (METRIC-EPM) Group, Mayo Clinic, Rochester, Minnesota, United States
Haitao Lan
Affiliation:
Multidisciplinary Epidemiology and Translational Research in Intensive Care, Emergency and Perioperative Medicine (METRIC-EPM) Group, Mayo Clinic, Rochester, Minnesota, United States Guang’anmen Hospital, China Academy of Chinese Medicine Sciences, Beijing, China
Charat Thongprayoon
Affiliation:
Multidisciplinary Epidemiology and Translational Research in Intensive Care, Emergency and Perioperative Medicine (METRIC-EPM) Group, Mayo Clinic, Rochester, Minnesota, United States
Louis Schenck
Affiliation:
Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, United States
Adil Ahmed
Affiliation:
North Central Texas Medical Foundation, Wichita Falls Family Practice Residency Program, Wichita Falls, Texas, United States
Mikhail Dziadzko
Affiliation:
Division of Critical Care, Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota, United States
Ognjen Gajic
Affiliation:
Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, United States
Priya Sampathkumar
Affiliation:
Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota, United States
*
Address correspondence to John C. O’Horo, MD, MPH, Assistant Professor of Medicine, Division of Infectious Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN 55905 (OHoro.John@mayo.edu).
Get access Rights & Permissions [Opens in a new window]

Abstract

OBJECTIVE

Ventilator-associated events (VAEs) are nosocomial events correlated with length of stay, costs, and mortality. Current ventilator bundle practices target the older definition of ventilator-associated pneumonia and have not been systematically evaluated for their impact on VAEs.

DESIGN

Retrospective cohort study.

SETTING

Tertiary medical center between January 2012 and August 2014.

PARTICIPANTS

All adult patients ventilated for at least 24 hours at our institution.

INTERVENTIONS

We conducted univariate analyses for compliance with each element; we focused on VAEs occurring within a 2-day window of failure to meet any ventilator bundle element. We used Cox proportional hazard models to assess the effect of stress ulcer prophylaxis, deep vein thrombosis (DVT) prophylaxis, oral care, and sedation breaks on VAEs. We adjusted models for gender, age, and Acute Physiology and Chronic Health Evaluation (APACHE) III scores.

RESULTS

Our cohort comprised 2,660 patients with 16,858 ventilator days and 77 VAEs. Adjusting for APACHE score and gender, only oral care was associated with a reduction in the risk of VAE (hazard ratio [HR], 0.44; 95% confidence interval [CI], 0.26–0.77). The DVT prophylaxis and sedation breaks did not show any significant impact on VAEs. Stress ulcer prophylaxis trended toward an increased risk of VAE (HR, 1.59; 95% CI, 1.00–2.56).

CONCLUSION

Although limited by a low baseline rate of VAEs, existing ventilator bundle practices do not appear to target VAEs well. Oral care is clearly important, but the impact of DVT prophylaxis, sedation breaks, and especially stress ulcer prophylaxis are questionable at best.

Infect Control Hosp Epidemiol 2016;1453–1457

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 37 , Issue 12 , December 2016 , pp. 1453 - 1457
Copyright
© 2016 by The Society for Healthcare Epidemiology of America. All rights reserved 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

a

Authors with equal contribution.

*

Authors’ names have been added since original publication. An erratum notice detailing this change was also published (DOI: 10.1017/ice.2017.132).

References

REFERENCES

1. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med 2005;171:388–416.CrossRefGoogle Scholar
2. Berenholtz, SM, Pham, JC, Thompson, DA, et al. Collaborative cohort study of an intervention to reduce ventilator-associated pneumonia in the intensive care unit. Infect Control Hosp Epidemiol 2011;32:305–314.CrossRefGoogle ScholarPubMed
3. Eom, JS, Lee, MS, Chun, HK, et al. The impact of a ventilator bundle on preventing ventilator-associated pneumonia: a multicenter study. Am J Infect Control 2014;42:34–37.CrossRefGoogle ScholarPubMed
4. Kollef, MH, Hamilton, CW, Ernst, FR. Economic impact of ventilator-associated pneumonia in a large matched cohort. Infect Control Hosp Epidemiol 2012;33:250–256.CrossRefGoogle Scholar
5. Safdar, N, Dezfulian, C, Collard, HR, Saint, S. Clinical and economic consequences of ventilator-associated pneumonia: a systematic review. Crit Care Med 2005;33:2184–2193.CrossRefGoogle ScholarPubMed
6. Warren, DK, Shukla, SJ, Olsen, MA, et al. Outcome and attributable cost of ventilator-associated pneumonia among intensive care unit patients in a suburban medical center. Crit Care Med 2003;31:1312–1317.CrossRefGoogle Scholar
7. Magill, SS, Klompas, M, Balk, R, et al. Developing a new, national approach to surveillance for ventilator-associated events. Am J Crit Care 2013;22:469–473.CrossRefGoogle ScholarPubMed
8. Klein Klouwenberg, PM, van Mourik, MS, Ong, DS, et al. Electronic implementation of a novel surveillance paradigm for ventilator-associated events: feasibility and validation. Am J Respir Crit Care Med 2014;189:947–955.CrossRefGoogle ScholarPubMed
9. McMullen, KM, Boyer, AF, Schoenberg, N, Babcock, HM, Micek, ST, Kollef, MH. Surveillance versus clinical adjudication: differences persist with new ventilator-associated event definition. Am J Infect Control 2015;43:589–591.CrossRefGoogle ScholarPubMed
10. Klompas, M, Kleinman, K, Khan, Y, et al. Rapid and reproducible surveillance for ventilator-associated pneumonia. Clin Infect Dis 2012;54:370–377.CrossRefGoogle ScholarPubMed
11. Bouadma, L, Sonneville, R, Garrouste-Orgeas, M, et al. Ventilator-associated events: prevalence, outcome, and relationship with ventilator-associated pneumonia. Crit Care Med 2015;43:1798–1806.CrossRefGoogle ScholarPubMed
12. Centers for Disease Control and Prevention. Device module: ventilator associated events. National Healthcare Safety Network (NHSN): NHSN Patient Safety Component Manual, 2016.Google Scholar
13. Herasevich, V, Pickering, BW, Dong, Y, Peters, SG, Gajic, O. Informatics infrastructure for syndrome surveillance, decision support, reporting, and modeling of critical illness. Mayo Clin Proc 2010;85:247–254.CrossRefGoogle ScholarPubMed
14. Lan, H, Thongprayoon, C, Ahmed, A, et al. Automating quality metrics in the era of electronic medical records: digital signatures for ventilator bundle compliance. Biomed Res Int 2015;2015:396508.CrossRefGoogle ScholarPubMed
15. Therneau, TM, Grambsch, PM. Modeling survival data: extending the Cox model Statistics for Biology and Health. New York: Springer; 2000;xiii:350 p.Google Scholar
16. Li, L, Ai, Z, Zheng, X, Jie, L. Can routine oral care with antiseptics prevent ventilator-associated pneumonia in patients receiving mechanical ventilation? An update meta-analysis from 17 randomized controlled trials. Int J Clin Exp Med 2015;8:1645–1657.Google ScholarPubMed
17. Klompas, M, Speck, K, Howell, MD, Greene, LR, Berenholtz, SM. Reappraisal of routine oral care with chlorhexidine gluconate for patients receiving mechanical ventilation: systematic review and meta-analysis. JAMA Intern Med 2014;174:751–761.CrossRefGoogle ScholarPubMed
18. Par, M, Badovinac, A, Plancak, D. Oral hygiene is an important factor for prevention of ventilator-associated pneumonia. Acta Clin Croat 2014;53:72–78.Google ScholarPubMed
19. Krag, M, Perner, A, Wetterslev, J, et al. Stress ulcer prophylaxis in the intensive care unit: an international survey of 97 units in 11 countries. Acta Anaesthesiol Scand 2015;59:576–585.CrossRefGoogle ScholarPubMed
20. Buendgens, L, Bruensing, J, Matthes, M, et al. Administration of proton pump inhibitors in critically ill medical patients is associated with increased risk of developing Clostridium difficile-associated diarrhea. J Crit Care 2014;29:696 e611–e695.CrossRefGoogle ScholarPubMed
21. Khorvash, F, Abbasi, S, Meidani, M, Dehdashti, F, Ataei, B. The comparison between proton pump inhibitors and sucralfate in incidence of ventilator associated pneumonia in critically ill patients. Adv Biomed Res 2014;3:52.Google ScholarPubMed
22. Mehta, S, Burry, L, Cook, D, et al. Daily sedation interruption in mechanically ventilated critically ill patients cared for with a sedation protocol: a randomized controlled trial. JAMA 2012;308:1985–1992.CrossRefGoogle ScholarPubMed
23. Sharpe, JP, Magnotti, LJ, Weinberg, JA, et al. Gender disparity in ventilator-associated pneumonia following trauma: identifying risk factors for mortality. J Trauma Acute Care Surg 2014;77:161–165.CrossRefGoogle ScholarPubMed
Supplementary material: File

O’Horo supplementary material

Appendix

Download O’Horo supplementary material(File)
File 17.2 KB