Healthcare-Associated Infections _ ______________________________________________________________
PRACTICAL STEPS IN FOLLOWING GUIDELINES TO PREVENT VENTILATOR-ASSOCIATED PNEUMONIA
Elevation of the Head of the Bed Include the intervention on nursing flow sheets and discuss at multidisciplinary rounds. Encourage respiratory therapy staff to notify nursing staff if the head of the bed is not elevated or empower respiratory therapy staff to place the bed in this position with help of nursing staff. Include the intervention on order sets for initiation and weaning of mechanical
ventilation, delivery of tube feedings, and provision of oral care. Sedative Interruptions and Assessment of Readiness to Extubate
Implement a protocol to lighten sedation daily at an appropriate time to assess for neurologic readiness to extubate. Include precautions to prevent self-extubation, such as monitoring and vigilance, during the trial. Include a sedative interruption strategy in the overall plan to wean the patient from the ventilator; add the strategy to the weaning protocol, if available. Assess compliance each day on multidisciplinary rounds. Consider implementation of a sedation scale, such as the Richmond Agitation Sedation Scale (RASS) scale, to avoid oversedation. Prophylaxis of Peptic Ulcer Disease Include intervention as part of the intensive care unit admission order set and ventilation order set. Make application of prophylaxis the default value on the form. Include intervention as an item for discussion on daily multidisciplinary rounds. Empower pharmacy staff to review orders for patients in the intensive care unit to ensure that some form of prophylaxis is in place at all times for patients. Prophylaxis of Deep Venous Thrombosis Include intervention as part of the intensive care unit admission order set and ventilation order set. Make application of prophylaxis the default value on the form. Include intervention as an item for discussion on daily multidisciplinary rounds. Empower pharmacy staff to review orders for patients in the intensive care unit to ensure that some form of prophylaxis is in place at all times for patients. Source: [201] Table 13
In one survey, guideline-recommended antibiotics were used 9% of the time for healthcare-associated pneumonia compared with 78% of the time for community-associated pneumonia [243]. This lack of adherence was not due to unfamiliarity or disagreement with the guidelines; 71% of the survey respon- dents said they were aware of the guidelines, and 79% said they agreed with and practiced according to them. It is reasonable to expect that strategies used to enhance adherence to guidelines in the community-acquired pneumonia setting would also be effective in the setting of hospital-acquired and ventilator- associated pneumonia. Such strategies include feedback on performance, reminder systems, standardized order sets, and education emphasizing outcomes and cost-effectiveness.
bloodstream infections increased significantly compared with 2019, largely as a result of the COVID-19 pandemic [6]. The analysis showed that national standard infection ratios for central-line-associated bloodstream infections initially declined in the first quarter of 2020 compared with the first quarter of 2019, but then rose by 27.9%, 46.4%, and 47.0% in the second, third, and fourth quarters of the year, respectively [6]. While acknowledging that 2020 was an unprecedented time for hospitals, the authors of the analysis emphasized the continued need for regular review of HAI surveillance data to identify gaps in prevention [6]. Risk Factors There are several types of intravascular catheters, and the risk of intravascular device-related bloodstream infections varies according to type. These catheters include:
INTRAVASCULAR DEVICE-RELATED BLOODSTREAM INFECTIONS
Bloodstream infections, such as septicemia and bacteremia, can develop from other types of HAIs or infections at other sites in the body, but about 24% are caused by intravascular devices, primarily central venous catheters [146]. It has been estimated that 5.3 infections occur per 1,000 catheter-days in the ICU [30; 42; 244]. The number of infections reported to NHSN has increased substantially, with 113,604 reported in 2018–2021, compared with 78,896 reported in 2015–2017, perhaps in part a consequence of improved surveillance [146]. These infections are also the most costly, with a mean cost of more than $50,000 per infection [245]. As stated, data from the NHSN indicated that rates of central-line-associated
• Peripheral venous catheters • Peripheral arterial catheters • Midline catheters • Nontunneled central venous catheters • Pulmonary artery catheters • Pressure monitoring system catheters • Peripherally inserted central venous catheters • Tunneled central venous catheters • Totally implantable devices
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