Application of an Automatic Medical Information System to Implement Bundle Care for the Prevention of Ventilator-Associated Pneumonia
Abstract
:1. Introduction
2. Methods
2.1. Study Design
2.2. Setting and Subjects
2.3. Data Sources
2.4. Intervention
2.5. Oral Hygiene Group
2.6. Prevention Ventilator-Associated Pneumonia Care Bundle Group
2.7. Data Analysis
2.8. Ethics Considerations
3. Results
3.1. Patient Characteristics
3.2. The Incidence of Ventilator-Associated Pneumonia
3.3. The Difference between Ventilator-Associated Pneumonia Cases and Non-Ventilator-Associated Pneumonia Cases
3.4. Logistic Regression for Predicting Ventilator-Associated Pneumonia
4. Discussion
5. Conclusions
Relevance to Clinical Practice
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
- Hua, F.; Xie, H.; Worthington, H.V.; Furness, S.; Zhang, Q.; Li, C. Oral hygiene care for critically ill patients to prevent ventilator-associated pneumonia. Cochrane Database Syst. Rev. 2016, 10, CD008367. [Google Scholar] [CrossRef] [PubMed]
- Spalding, M.C.; Cripps, M.W.; Minshall, C.T. Ventilator-associated pneumonia: New definitions. Crit. Care Clin. 2017, 33, 277–292. [Google Scholar] [CrossRef] [PubMed]
- Eldesuky Ali, H.; Rayan, A.; Ibrahim, T. Root cause analysis of ventilator-associated pneumonia and the effect of analysis of expanded ventilator bundle of care. Ain-Shams J. Anesthesiol. 2016, 9, 170–177. [Google Scholar] [CrossRef]
- Chen, Y.; Mao, E.Q.; Yang, Y.J.; Zhao, S.Y.; Zhu, C.; Wang, X.F.; Jing, F.; Sheng, H.Q.; Yang, Z.T.; Chen, E.Z. Prospective observational study to compare oral topical metronidazole versus 0.2% chlorhexidine gluconate to prevent nosocomial pneumonia. Am. J. Infect. Control 2016, 44, 1116–1122. [Google Scholar] [CrossRef] [PubMed]
- Zhang, T.T.; Tang, S.S.; Fu, L.J. The effectiveness of different concentrations of chlorhexidine for prevention of ventilator-associated pneumonia: A meta-analysis. J. Clin. Nurs. 2014, 23, 1461–1475. [Google Scholar] [CrossRef] [PubMed]
- Nicolosi, L.N.; del Carmen Rubio, M.; Martinez, C.D.; González, N.N.; Cruz, M.E. Effect of oral hygiene and 0.12% chlorhexidine gluconate oral rinse in preventing ventilator-associated pneumonia after cardiovascular surgery. Respir. Care 2014, 59, 504–509. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Institute for Healthcare Improvement Ventilator-associated Pneumonia. Available online: http://www.ihi.org/Topics/VAP/Pages/default.aspx (accessed on 25 December 2019).
- Klompas, M.; Branson, R.; Eichenwald, E.C.; Greene, L.R.; Howell, M.D.; Lee, G.; Magill, S.S.; Maragakis, L.L.; Priebe, G.P.; Speck, K.; et al. Strategies to prevent ventilator-associated pneumonia in acute care hospitals: 2014 update. Infect. Control Hosp. Epidemiol. 2014, 35, 915–936. [Google Scholar] [CrossRef] [PubMed]
- Al-Mousa, H.H.; Omar, A.A.; Rosenthal, V.D.; Salama, M.F.; Aly, N.Y.; El-Dossoky Noweir, M.; Rebello, F.M.; Narciso, D.M.; Sayed, A.F.; Kurian, A.; et al. Impact of the International Nosocomial Infection Control Consortium (INICC) multidimensional approach on rates of ventilator-associated pneumonia in intensive care units of two hospitals in Kuwait. J. Infect. Prev. 2018, 19, 168–176. [Google Scholar] [CrossRef] [PubMed]
- Goel, V.; Gupta, S.; Bisht, D.; Sharma, R. Bundle of care approach to reduce ventilator-associated pneumonia in the intensive care unit in a tertiary care teaching hospital in North India. Lung India Off. Organ Indian Chest Soc. 2019, 36, 177–178. [Google Scholar]
- Khan, R.; Al-Dorzi, H.M.; Al-Attas, K.; Ahmed, F.W.; Marini, A.M.; Mundekkadan, S.; Balkhy, H.H.; Tannous, J.; Almesnad, A.; Mannion, D.; et al. The impact of implementing multifaceted interventions on the prevention of ventilator-associated pneumonia. Am. J. Infect. Control 2016, 44, 320–326. [Google Scholar] [CrossRef] [PubMed]
- Ochoa-Hein, E.; Choi, S.J.; Gómez-Santillán, J.A.; Oyervides-Alvarado, J.A.; Galindo-Fraga, A.; Rivero-Sigarroa, E.; Hernández-Gilsoul, T.; Domínguez-Cherit, J.G. Near-zero ventilator-associated pneumonia rates after implementation of a multimodal preventive strategy in a Mexican hospital. Am. J. Infect. Control 2019, 48, 446–447. [Google Scholar] [CrossRef] [PubMed]
- Taiwan Centers for Disease Control Care Bundle for Prevention of Ventilator-Associated Pneumonia and Catheter-Associated Urinary Tract Infections. Available online: https://www.cdc.gov.tw/File/Get/Bycf0K9KfHGlJXVz_EVFVA (accessed on 25 December 2019).
- Hsu, C.W.; Chen, Y.S. Ventilator-associated pneumonia prevention bundle care. J. Intern. Med. Taiwan 2017, 28, 18–23. [Google Scholar]
Variables | Total (N = 1475) Mean ± SD/n (%) | Oral Hygiene (n = 779) Mean ± SD/n (%) | Care Bundle (n = 696) Mean ± SD/n (%) | χ2/t/Z | p | |
---|---|---|---|---|---|---|
Age (Years) | 66.5 ± 14.0 | 66.8 ± 14.1 | 66.2 ± 14.0 | 0.744 | 0.457 a | |
Gender | 1.793 | 0.181 b | ||||
Male | 994 (67.4) | 537 (68.9) | 457 (65.7) | |||
Female | 481 (32.6) | 242 (31.1) | 239 (34.3) | |||
Diagnosis | 9.277 | 0.233 b | ||||
Cardiovascular | 959 (65.0) | 522 (67.0) | 437 (62.8) | |||
Lung disease | 186 (12.6) | 97 (12.5) | 89 (12.8) | |||
Kidney disease | 46 (3.1) | 23 (3.0) | 23 (3.3) | |||
Infectious | 123 (8.3) | 60 (7.7) | 63 (9.1) | |||
Gastrointestinal | 45 (3.1) | 22 (2.8) | 23 (3.3) | |||
Brain disease | 35 (2.4) | 21 (2.7) | 14 (2.0) | |||
Cancer | 30 (2.0) | 16 (2.1) | 14 (2.0) | |||
Others | 51 (3.5) | 18 (2.3) | 33 (4.7) | |||
Past disease history | 5.783 | 0.016 b | ||||
Yes | 1320 (89.5) | 683 (87.7) | 637 (91.5) | |||
No | 155 (10.5) | 96 (12.3) | 59 (8.5) | |||
Hypertension | 2.005 | 0.157 b | ||||
Yes | 866 (58.7) | 444 (57.0) | 422 (60.6) | |||
No | 609 (41.3) | 335 (43.0) | 274 (39.4) | |||
Diabetes | 0.881 | 0.348 b | ||||
Yes | 539 (36.5) | 276 (35.4) | 263 (37.8) | |||
No | 936 (63.5) | 503 (64.6) | 433 (62.2) | |||
Cardiovascular disease | 0.941 | 0.332 b | ||||
Yes | 648 (43.9) | 333 (42.7) | 315 (45.3) | |||
No | 827 (56.1) | 446 (57.3) | 381 (54.7) | |||
Lung disease | 1.947 | 0.163 b | ||||
Yes | 83 (5.6) | 50 (6.4) | 33 (4.7) | |||
No | 1392 (94.4) | 729 (93.6) | 663 (95.3) | |||
Infectious disease | 0.244 | 0.621 b | ||||
Yes | 29 (2.0) | 14 (1.8) | 15 (2.2) | |||
No | 1446 (98.0) | 765 (98.2) | 681 (97.8) | |||
Ventilator-days | 8.1 ± 13.3 | 7.9 ± 12.1 | 8.3 ± 14.5 | −0.551 | 0.581 c | |
Median (Q1, Q3) | 2.8 (1.0, 8.9) | 2.9 (1.0, 9.2) | 2.8 (1.0, 8.9) | |||
Intensive care unit days | 9.2 ± 10.7 | 9.3 ± 10.7 | 9.0 ± 10.7 | 0.508 | 0.611 c | |
Median (Q1, Q3) | 5.2 (3.0, 11.8) | 5.2 (3.0, 11.9) | 5.2 (3.0, 11.7) | |||
Hospital days | 27.7 ± 22.5 | 27.0 ± 20.8 | 28.4 ± 24.2 | −0.753 | 0.452 c | |
Median (Q1, Q3) | 20.9 (13.9, 35.9) | 20.9 (13.8, 36.8) | 21.2 (13.9, 35.0) |
Variables | Total (N = 1475) n (%) | Oral hygiene (n = 779) n (%) | Care bundle (n = 696) n (%) | χ2 | p |
---|---|---|---|---|---|
Ventilator-associated Pneumonia | 4.769 | 0.029 | |||
Yes | 32 (2.2) | 23 (3.0) | 9 (1.3) | ||
No | 1443 (97.8) | 756 (97.0) | 687 98.7) |
Variables | Ventilator Associated Pneumonia Cases (n = 32) Mean ± SD/n (%) | Non-Ventilator Associated Pneumonia Cases (n = 1443) Mean ± SD/n (%) | χ/t/Z | p | |
---|---|---|---|---|---|
Age (years) | 67.1 ± 15.3 | 66.5 ± 14.0 | 0.250 | 0.803 a | |
Gender | 0.299 | 0.584 b | |||
Male | 23 (71.9) | 971 (67.3) | |||
Female | 9 (28.1) | 472 (32.7) | |||
Diagnosis | 6.657 | 0.465 b | |||
Cardiovascular | 19 (59.4) | 940 (65.1) | |||
Lung disease | 8 (25.0) | 178 (12.3) | |||
Kidney disease | 0 (0.0) | 46 (3.2) | |||
Infectious | 3 (9.4) | 120 (8.3) | |||
Gastrointestinal | 1 (3.1) | 44 (3.0) | |||
Brain disease | 0 (0.0) | 35 (2.4) | |||
Cancer | 0 (0.0) | 30 (2.1) | |||
Others | 1 (3.1) | 50 (3.5) | |||
Past disease history | 0.138 | 0.710 b | |||
Yes | 28 (87.5) | 1292 (89.5) | |||
No | 4 (12.5) | 151 (10.5) | |||
Ventilator days | 26.8 ± 22.9 | 7.6 ± 12.7 | 7.047 | 0.000 c | |
Median (Q1, Q3) | 23.5 (10.6, 30.7) | 2.8 (1.0, 8.6) | |||
Intensive care unit days | 24.4 ± 15.9 | 8.9 ± 10.3 | 6.600 | 0.000 c | |
Median (Q1, Q3) | 22.4 (14.7, 30.5) | 5.2 (3.0, 11.1) | |||
Hospital days | 39.3 ± 29.1 | 27.4 ± 22.3 | 3.100 | 0.002 c | |
Median (Q1, Q3) | 33.2 (20.4, 42.5) | 20.9 (13.8, 35.0) | |||
Group | 4.769 | 0.029 b | |||
Oral hygiene | 23 (71.9) | 756 (52.4) | |||
care bundle | 9 (28.1) | 687 (47.6) |
Variables | Coeff (SE) | OR (95% CI) | p-Value |
---|---|---|---|
Groups (care bundle-oral hygiene) | −1.01 (0.42) | 0.367 (0.16–0.84) | 0.018 |
Ventilator days | 0.03 (0.01) | 1.03 (1.01–1.05) | 0.003 |
Intensive care unit days | 0.03 (0.01) | 1.03 (1.00–1.06) | 0.024 |
Constant | −4.29 (0.28) | 0.01 | 0.000 |
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. |
© 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Lee, H.-H.; Lin, L.-Y.; Yang, H.-F.; Tang, Y.-Y.; Wang, P.-H. Application of an Automatic Medical Information System to Implement Bundle Care for the Prevention of Ventilator-Associated Pneumonia. Int. J. Environ. Res. Public Health 2021, 18, 11128. https://doi.org/10.3390/ijerph182111128
Lee H-H, Lin L-Y, Yang H-F, Tang Y-Y, Wang P-H. Application of an Automatic Medical Information System to Implement Bundle Care for the Prevention of Ventilator-Associated Pneumonia. International Journal of Environmental Research and Public Health. 2021; 18(21):11128. https://doi.org/10.3390/ijerph182111128
Chicago/Turabian StyleLee, Hung-Hui, Li-Ying Lin, Hsiu-Fen Yang, Yu-Yi Tang, and Pei-Hern Wang. 2021. "Application of an Automatic Medical Information System to Implement Bundle Care for the Prevention of Ventilator-Associated Pneumonia" International Journal of Environmental Research and Public Health 18, no. 21: 11128. https://doi.org/10.3390/ijerph182111128