How can ventilator-associated pneumonia be prevented in hospitals?

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Researchers from the John Hopkins Armstrong Institute of Patient Safety and Quality (MD, USA) have conducted a study demonstrateing how ventilator-associated infections can be reduced in hospitals.

There are hopes that the results from this study, recently published in Critical Care Medicine, will help prevent one of the deadliest hospital-acquired infections, ventilator-associated pneumonia.

In the United States approximately 800,000 hospital patients are treated with mechanical ventilation each year, stabilizing illnesses such as stroke or pneumonia. While a ventilator can improve a patient’s breathing it can also lead to ventilator-associated events such as blood clots, lung damage or ventilator-associated pneumonia.

Sean Berenholtz (John Hopkins University School of Medicine) explained: “These complications prolong the duration of mechanical ventilation, and they keep patients in the hospital longer. This, in turn, leads to higher complications, higher mortality, higher lengths of stay and higher costs. So decreasing these complications is a national priority and helps our patients recover sooner.”

For this reason researchers set to limit these complications. The study took place from October 2012 to March 2015 at 56 Intensive Care Units in 38 hospitals in Maryland and Pennsylvania. The team trained and coached quality improvement teams on the recommended interventions by the Society for Healthcare Epidemiology of America and the Society of Critical Care Medicine for patients on ventilators. This included performing oral care such as tooth brushing and the use of a chlorhexidine-based mouthwash, elevating the head of the patient’s bed, and reducing narcotics and sedatives to perform spontaneous awakening and breathing trials.

Hospitals were also trained on how to implement the Agency for Healthcare Research and Quality’s (AHRQ) Comprehensive Unit-based Safety Program, aimed at frontline healthcare staff members to prevent harm.

Over this study period researchers observed ventilator associated-events in Intensive Care Units decrease by nearly 38%, infection-related ventilator-associated complications decrease by more than 50% and possible and probable ventilator-associated pneumonia reduce by 78%.

Berenholtz commented: “This is the largest study to date to show that these complications of mechanical ventilation, or ventilator associated events, are also preventable.”

Sources: Nishi R, Ting Y, Kisha A, et al. Two-State Collaborative Study of a Multifaceted Intervention to Decrease Ventilator-Associated Events. Crit. Care Med. doi: 10.1097/CCM.0000000000002463 (2017); www.hopkinsmedicine.org/news/media/releases/johns_hopkins_study_shows_one_of_the_deadliest_hospital_acquired_infections_is_preventable

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