Ventilator-associerad pneumoni (VAP) är den vanligaste infektionen på intensivvårdsavdelningar. Det är en komplikation som orsakar stort lidande, ökad mortalitet och medför höga vårdkostnader. Det finns många evidensbaserade riktlinjer för att förhindra att VAP uppstår, där sjuksköterskan har en betydande roll. Flera studier har visat att det finns brister i sjuksköterskans kunskap att tillämpa de evidensbaserade riktlinjerna för att förhindra uppkomsten av VAP. Syftet med studien var att beskriva intensivvårdsjuksköterskors tillämpning av de evidensbaserade riktlinjerna för att förhindra uppkomsten av ventilatorassocierad pneumoni hos intensivvårdspatienter samt att jämföra tillämpningen av riktlinjer mellan subgrupper. En strukturerad enkät delades ut till alla intensivvårdsjuksköterskor (N=40) på en intensivvårdsavdelning i mellansverige, varav 30 besvarade enkäten. Resultatet visade att intensivvårdsjuksköterskorna tillämpar de evidensbaserade riktlinjerna i hög utsträckning utifrån självskattningar. Det framkom inga signifikanta skillnader mellan de med kort (0-5 år) och lång (>5 år) erfarenhet som intensivvårdsjuksköterska, vad gäller i vilken utsträckning de använder de evidensbaserade riktlinjerna för att förhindra uppkomsten av VAP. Kunskapen och tillämpningen av de evidensbaserade riktlinjerna kan anses vara god hos respondenterna i föreliggande studie utifrån självskattningar. I det närmaste alla respondenter hade fått utbildning/information om VAP vilket kan vara orsaken till det resultat som framkom. Många tidigare studier har visat att utbildning ökar tillämpningen av de evidensbaserade riktlinjerna. / Ventilator-associated pneumonia is the most common infection in the intensive care unit. It is a complication that causes major morbidity, increased mortality and growing healthcare costs. There are many evidence-based clinical practice guidelines in order to prevent that VAP arises, where the nurse has a significant role. Several studies have established that there is deficiencies in the nurse's knowledge to apply to the evidence-based guidelines in order to prevent the origin of VAP. The aim with the study was to describe intensive care unit nurses' application of the evidence-based guidelines in order to prevent the origin of VAP at intensive care patients and to compare the application of the evidence-based guidelines between subgroups. A structured questionnaire was distributed out to all intensive care nurses (N=40) on an intensive care unit in the middle of Sweden, of which 30 responded to the questionnaire. The result showed that the intensive care nurses apply to the evidence-based guidelines in a high extent on the basis of self-reports. There were no significant differences between they with short (0-5 year) and long (> 5 year) experience as an intensive care nurse, as regards in what extent they use the evidence-based guidelines in order to prevent the origin of VAP. The respondents knowledge and application of the evidence-based guidelines can be considered to be good in this study, on the basis of self-reports. Most of the respondents had got education/information about VAP, what can have caused the result that appeared. Many previous studies have shown that education increases the application of the evidence-based guidelines.

Intubated and mechanically ventilated patients are vulnerable to respiratory tract infections. In response, the Ontario government has recently mandated surveillance and reporting of ventilator-associated pneumonia (VAP). Serious respiratory infections, and the related costs of additional care can be reduced in part, through oral hygiene. However, the literature asserts that oral care is neglected in busy, high-tech settings. Despite these concerns, little research has examined how mouth care happens in the critical care unit. The purpose of this institutional ethnography (IE) was to explore the social organization of mouth care in one critical care unit in Ontario, Canada. As a reflexive and critical method of inquiry, IE focuses on features of everyday life that often go unnoticed. In paying special attention to texts, the ethnographer traces how institutional forces that arrive from outside the practice setting coordinate experiences and activities. Inquiry began in the field with day/night participant observation to better understand the particularities of nursing care for orally intubated patients. Other data sources included reflexive fieldnotes, stakeholder interviews, and transcripts as well as work documents and artifacts. Over time, the analysis shifted from the critical care unit to the larger social context of Ontario’s Critical Care Transformation Strategy. Analysis traced the discursive and translocal social relations that permeate nursing work. Findings revealed a disjuncture between the ideals of VAP prevention and the actualities of mouth care. Tensions and contradictions emerged as nurses described their location within an expansive accountability network: nursing duties now extend beyond oral care to a controversial project of epidemiological surveillance. Patient comfort and safety now rest upon a hidden nursing agenda to overcome limited time, training and tools in oral care. Nurses worried that the effectiveness of preventative oral care was inhibited by technical problems of application that remain uninvestigated and unresolved. As a counterpoint to assertions that oral care is neglected, this study demonstrates how nursing knowledge and agency is obscured. Because international infection-prevention guidelines increasingly endorse oral care, novel research investigating the practice problems nurses encounter is warranted.

Intubated and mechanically ventilated patients are vulnerable to respiratory tract infections. In response, the Ontario government has recently mandated surveillance and reporting of ventilator-associated pneumonia (VAP). Serious respiratory infections, and the related costs of additional care can be reduced in part, through oral hygiene. However, the literature asserts that oral care is neglected in busy, high-tech settings. Despite these concerns, little research has examined how mouth care happens in the critical care unit. The purpose of this institutional ethnography (IE) was to explore the social organization of mouth care in one critical care unit in Ontario, Canada. As a reflexive and critical method of inquiry, IE focuses on features of everyday life that often go unnoticed. In paying special attention to texts, the ethnographer traces how institutional forces that arrive from outside the practice setting coordinate experiences and activities. Inquiry began in the field with day/night participant observation to better understand the particularities of nursing care for orally intubated patients. Other data sources included reflexive fieldnotes, stakeholder interviews, and transcripts as well as work documents and artifacts. Over time, the analysis shifted from the critical care unit to the larger social context of Ontario’s Critical Care Transformation Strategy. Analysis traced the discursive and translocal social relations that permeate nursing work. Findings revealed a disjuncture between the ideals of VAP prevention and the actualities of mouth care. Tensions and contradictions emerged as nurses described their location within an expansive accountability network: nursing duties now extend beyond oral care to a controversial project of epidemiological surveillance. Patient comfort and safety now rest upon a hidden nursing agenda to overcome limited time, training and tools in oral care. Nurses worried that the effectiveness of preventative oral care was inhibited by technical problems of application that remain uninvestigated and unresolved. As a counterpoint to assertions that oral care is neglected, this study demonstrates how nursing knowledge and agency is obscured. Because international infection-prevention guidelines increasingly endorse oral care, novel research investigating the practice problems nurses encounter is warranted.

No description available.

Synopsis Ventilation-associated pneumonia (VAP) presents a severe complication in the care for the mechanically-ventilated patient and its importance rises with the increasing number of resistant microorganisms, which causes VAP. VAP increases morbidity and mortality of the patients, prolongs their hospitalization and leads to the increase of direct and indirect treatment expenses. Options of treatment are sometimes difficult, costly and inefficient, thereby the need to prevent the occurance of VAP by employing a set of preventive measures is needed. Employing and enforcing those measures can decrease the incidence of VAP and thus to improve prognosis of the critically-ill patients in the intesive care. The goal of the experimental part of this thesis was to audit the employment of these preventive measures in practice. A survey using questionnaires and observing the situation on KAR FNKV have shown, that some measures are performed correctly, while some present a space for improvement, some are performed incorrectly or not at all.

Orientador: June Barreiros Freire / Dissertação (mestrado profissional) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-25T18:22:01Z (GMT). No. of bitstreams: 1 Tomaleri_JoanPinton_M.pdf: 1325881 bytes, checksum: 6f4e87940073641943e02dce81bb73ee (MD5) Previous issue date: 2014 / Resumo: Trata-se de um estudo analítico dos óbitos relacionados a pneumonia associada a ventilação mecânica (PAV), ocorridos na Unidade de Terapia Intensiva Adulto do Hospital Estadual Sumaré, SP, de 2007 à 2012. O estudo retrospectivo dos prontuários contou com uma amostra de 56 casos com uma taxa de mortalidade devido a PAV de 6,77%, com média de idade de 50,9 anos, desvio padrão de 18,1 anos e mediana de 55,5 anos. A maioria dos pacientes foram admitidos na Unidade de Terapia Intensiva Adulto devido a fatores clínicos (44,6%) e neurológicos (37,5%). Em relação aos pacientes que evoluíram para óbito 84% apresentavam alguma comorbidade, prevalecendo Hipertensão arterial (57,1%), Diabetes mellitus (30,4%) e Cardiopatias (30,4%). Trinta e um casos (57,4%) que evoluíram para óbito por pneumonia associada a ventilação mecânica apresentaram etiologia definida. Pseudomonas aeruginosa foi a bactéria mais frequente, tendo sido identificada em nove casos (16%). Em nove pacientes (16%) foram identificados microrganismos multirresistentes, sendo que em três (5%) deles foi isolado Acinetobacter baumannii. Foi evidenciado em apenas 19 (33,9%) dos óbitos a adesão às boas práticas, mensuráveis individualmente, na prevenção à pneumonia associada a ventilação mecânica. O monitoramento e intervenções baseadas nas boas práticas para prevenção das infecções relacionadas à Assistência em Saúde, em especial à PAV, podem contribuir para evitar o surgimento de situações de risco, complicações clínicas e óbitos dos pacientes / Abstract: This is an analytical study of deaths related to ventilator-associated pneumonia (VAP), in adult intensive care unit (ICU) of Hospital Estadual Sumaré, SP, from 2007 to 2012. The retrospective study of medical records included a sample of 56 cases with a mortality rate due to VAP of 6.77%, with a mean age of 50.9 years, standard deviation of 18.1 years and a median of 55.5 years . Most patients were admitted to ICU Adult due to clinical factors (44.6%) and neurological (37.5%). As regards patients who died, 84% had a comorbidity, prevailing arterial hypertension (57.1%), diabetes mellitus (30.4%) and Cardiac (30.4%). Thirty-one cases (57.4%) who died of pneumonia associated with mechanical ventilation had definite etiology. Pseudomonas aeruginosa is the most common bacterium, has been identified in nine cases (16%). In nine patients (16%) multiresistant microorganisms were identified, of which three (5%) of Acinetobacter baumannii was isolated. Was found in only 19 (33.9%) of deaths adherence to best practices, measurable individually in preventing VAP. Was found in only 19 (33.9%) of deaths adherence to best practices, measurable individually in preventing VAP. The monitoring and interventions based on best practices for preventing infections related to health care, especially with VAP, may contribute to preventing the emergence of risk situations, clinical complications and deaths of patients / Mestrado / Política, Gestão e Planejamento / Mestre em Saúde Coletiva, Política e Gestão

La VC est nécessaire à la survie des patients les plus graves et impose le plus souvent sédation profonde et une mise au repos des muscles respiratoires. Si la VC est un traitement de référence en cas d'insuffisance respiratoire aigüe, elle peut cependant entraîner une altération des propriétés contractiles du diaphragme, principal muscle respiratoire, et promouvoir la survenue d'infections nosocomiales, pulmonaires en particulier. Dans ce travail, nous avons tout d'abord montré les effets délétères d'une VC de courte durée en acidose hypercapnique aigüe puis nous avons montré les effets protecteurs de l'acidose hypercapnique modérée et prolongée et du maintien de cycles ventilatoires spontanés sur la dysfonction diaphragmatique en comparaison à la VC. Deuxièmement, dans le cadre des effets délétères de la ventilation prolongée sur l'incidence des complications infectieuses pulmonaires nosocomiales, nous avons rapporté l'intérêt de la prise en compte des facteurs de risque de bactéries multi-résistantes dans le traitement des Pneumonie Acquise sous Ventilation Mécanique (PAVM) et avons ensuite montré l'apport de la surveillance de la colonisation trachéale dans le diagnostic et le traitement précoce de la PAVM. Finalement, nous présentons les perspectives d'interactions entre dysfonction diaphragmatique et sepsis, en particulier d'origine pulmonaire à travers nos projets de travaux expérimentaux et cliniques. / Mechanical ventilation (MV) is a life saving procedure for critically ill and often needs deep sedation and rest muscles. Although MV is a basic treatment for acute respiratory failure, it can alter diaphragmatic contractile properties (Ventilator Induced Diaphragmatic Dysfunction, VIDD) and can promote nosocomial infections, Ventilator Associated Pneumonia (VAP) in particular. In this thesis, we first showed the deleterious effects of acute hypercapnic acidosis and the protective effects of both moderate and prolonged hypercapnic acidosis and by maintaining spontaneous ventilation activity while initiating MV in a healthy piglet model. Second, we reported the potential impact of considering tracheal colonisation as a guide for an early diagnosis and adequate initial treatment of VAP. Finally, we present the potential interactions and futures animal and clinical studies suggesting the potential interaction between VIDD and VAP.

Ventilator associated pneumonia (VAP) is a nosocomial infection that is acquired in critically ill patients 48 hours or more after intubation. Many interventions have been studied to reduce or prevent patients from acquiring VAP. This integrated literature review examines empirical evidence related to suctioning techniques that reduce or prevent the acquisition of VAP. Oral and subglottic secretion suctioning were examined in depth. It is concluded that the intervention of oral and subglottic secretion suctioning was shown to reduce the incidence of VAP in adult patients.

Ventilator-associated pneumonia (VAP) has been attributed with lengthening patients' stay in the intensive care unit (ICU), is the leading cause of death among nosocomial infections, and leads to increased hospital cost. Various positional strategies in the prevention of VAP include head of bed (HOB) elevation, continuous lateral rotation therapy (CLRT), and kinetic bed therapy. However, poor compliance rates in critical care units have been reported. Mechanically ventilated patients develop nosocomial pneumonia at a rate 6 to 21 times greater than non-ventilated hospitalized patients. A HOB elevation of 30' to 45' and the turning of patients every two hours are two commonly accepted guidelines used to prevent respiratory compilations by facilitating the clearance of pulmonary secretions. Both HOB elevation and CLRT were explored as interventions that could be implemented to reduce the incidence of VAP. It is difficult to attribute reduced VAP rates to either modality alone. However, when HOB elevation and CLRT are utilized in concert with other modalities, clinically significant benefits become readily apparent. Implementation of both improves clinical outcomes. These modalities should not be considered as individual strategies to reduce VAP, but as part of a comprehensive approach to reduce the incidence of VAP and improve patient outcomes.

No description available.