Adherence to the mechanical ventilation-associated pneumonia prevention bundle in neonatal and pediatric ICU

Authors

DOI:

https://doi.org/10.33448/rsd-v12i12.44117

Keywords:

Intensive care unit, neonatal; Intensive care unit, pediatric; Pneumonia, ventilator-associated; Patient care team; Health education.

Abstract

Ventilator-associated pneumonia (VAP) in neonatal (NEO ICU) and pediatric (PED ICU) intensive care units represents one of the most common problems related to the use of invasive devices. There are a series of measures (bundles) that can contribute to reducing VAP rates. The objective was to evaluate professionals' adherence to the bundle after an educational intervention with the team. Regarding the methodology, it was an intervention study, using data from 31 patients admitted to the NEO ICU and PED undergoing invasive mechanical ventilation (IMV) from 2021 to 2022. VAP prevention measures were verified before and after an intervention educational session with the multidisciplinary team (comparison of 150 pre-intervention observations and another 150 post-intervention observations). The results found were as follows: pre-intervention adherence rates to the items headboard between 30 and 45º, circuit without dirt, circuit without condensation, oral hygiene and physiotherapy were 79.3%, 86%, 74.7%, 6 .7% and 96%, respectively. After the intervention, the same values for the same items were: 96.7% (p<0.001), 100% (p<0.001), 97.3% (p<0.001), 97.3% (p<0.001) and 99.1% (p=0.137), respectively. An increase in team adherence to VAP prevention items was observed from 62% (pre-intervention) to 98% after the educational intervention. The incidence rate of VAP in the NEO ICU and PED reduced from 12.8 per 1000 MV-day to 8.4 per 1000 MV-day in the post-intervention period (34.4%). It was concluded that there was a statistically significant increase in team adherence after educational measures on VAP prevention.

References

Aelami, M. H., Lotfi, M. & Zingg, W. (2014). Ventilator-associated pneumonia in neonates, infants and children. Antimicrob Resist Infect Control, 3(30), 1-10.

Agência Nacional de Vigilância Sanitária. (2005). Pediatria: prevenção e controle de infecção hospitalar. https://biblioteca.cofen.gov.br/wp-content/uploads/2015/01/Pediatria-prevencao-e-controle-de-infeccao-hospitalar.pdf

Agência Nacional de Vigilância Sanitária. (2017). Medidas de Prevenção de Infecção Relacionada à Assistência à Saúde. Série Segurança do Paciente e Qualidade em Serviços de Saúde. https://www.gov.br/anvisa/pt-br/centraisdeconteudo/publicacoes/servicosdesaude/publicacoes/caderno-4-medidas-de-prevencao-de-infeccao-relacionada-a-assistencia-a-saude.pdf/view

Agência Nacional de Vigilância Sanitária. (2022). Relatório dos estados: infecção relacionada à assistência à saúde. https://www.gov.br/anvisa/pt-br/assuntos/servicosdesaude/prevencao-e-controle-de-infeccao-e-resistencia-microbiana/copy_of_infeccao-relacionada-a-assistencia-a-saude

Agência Nacional de Vigilância Sanitária. (2023). Nota Técnica GVIMS/GGTES nº 03/2023: critérios diagnósticos das Infecções Relacionadas à Assistência à Saúde (IRAS): notificação nacional obrigatória para o ano de 2023. https://www.gov.br/anvisa/pt-br/centraisdeconteudo/publicacoes/servicosdesaude/notas-tecnicas/notas-tecnicas-vigentes/nota-tecnica-gvims-ggtes-dire3-anvisa-no-03-2023-criterios-diagnosticos-das-infeccoes-relacionadas-a-assistencia-a-saude-iras-de-notificacao-nacional-obrigatoria-para-o-ano-de-2023/view

Azab, S. F., Sherbiny, H. S., Saleh, S. H., Elsaeed, W. F, Elshafiey, M. M. & Siam, A. G. (2015). Reducing ventilator-associated pneumonia in neonatal intensive care unit using "VAP prevention Bundle": a cohort study. BMC Infect Dis, 15, 314.

De Cristofano, A., Peuchot, V., Canepari, A., Franco, V., Perez, A. & Eulmesekian, P. (2016). Implementation of a Ventilator-Associated Pneumonia Prevention Bundle in a Single PICU. Pediatr Crit Care Med, 17(5), 451-456.

Esteban, E., Ferrer, R., Urrea, M., Suarez, D., Rozas, L. & Balaguer, M. (2013). The impact of a quality improvement intervention to reduce nosocomial infections in a PICU. Pediatr Crit Care Med, 14(5), 525-532.

Gil, A. C. (2017). Como elaborar projetos de pesquisa. 6ed. Atlas.

Gokce, I. K., Kutman, H. G. K., Uras, N., Canpolat, F. E., Dursun, Y. & Oguz, S. S. (2018). Successful Implementation of a Bundle Strategy to Prevent Ventilator-Associated Pneumonia in a Neonatal Intensive Care Unit. J Trop Pediatr, 64(3), 183-188.

Gupta, A., Kapil, A., Kabra, S. K., Lodha, R., Sood, S. & Dhawan, B. (2014). Assessing the impact of an educational intervention on ventilator-associated pneumonia in a pediatric critical care unit. Am J Infect Control, 42(2), 111-115.

Haque, A., Riaz, Q. & Ali, S. A. (2017). Implementation of Ventilator Bundle in Pediatric Intensive Care Unit of a Developing Country. J Coll Physicians Surg Pak, 27(5), 316-318.

Hill, C. (2016). Nurse-led implementation of a ventilator-associated pneumonia care bundle in a children's critical care unit. Nurs Child Young People, 28(4), 23-27.

Hsu, H. E., Mathew, R., Wang, R., Broadwell, C., Horan, K. & Jin, R. (2020). Health Care-Associated Infections Among Critically Ill Children in the US, 2013-2018. The Journal of the American Medical Association Pediatr, 174(12), 1176-1183.

José, J. D., Lúcio, D. S., Perugini, M. R. E., Stipp, A. T., Silva, M. F. S. & Capobiango, J. D. (2015). Prevenção de pneumonia associada a ventilação mecânica em neonatologia. J Infect Control, 4(1), 20-24.

Kunzler, I. M., Omizzollo, S. & Shama, S. (2021). Avaliação do impacto de uma intervenção educacional em Pneumonia Associada à Ventilação Mecânica. Fisioter, 28(3), 252-260.

Peña-López, Y., Pujol, M., Campins, M., González-Antelo, A., Rodrigo, J. A. & Balcells, J. (2016). Implementing a care bundle approach reduces ventilator-associated pneumonia and delays ventilator-associated tracheobronchitis in children: diferences according to endotracheal or tracheostomy devices. Int J Infect Dis, 52, 43-48.

Perugini, M. R. E., Perugini, V. H., Figueira, F. D., Fontana, L. M. S., Diniz, J. J. & Santos, D. L. (2015). Impacto de um bundle nas taxas de pneumonia associada à ventilação mecânica (PAV) em uma unidade de terapia intensiva pediátrica em Londrina-PR. Semin Ciênc Biol Saúde, 36(1), 259-266.

Portoghese, I., Galletta, M., Battistelli, A., Saiani, L., Penna, M. P. & Allegrini, E. (2012). Change-related expectations and commitment to change of nurses: the role of leadership and communication. J Nurs Manag, 20(5), 582-591.

Rosenthal, V. D., Álvarez-Moreno, C., Villamil-Gómez, W., Singh, S., Ramachandran, B. & Navoa-Ng, J. A. (2012). Effectiveness of a multidimensional approach to reduce ventilator-associated pneumonia in pediatric intensive care units of 5 developing countries: International Nosocomial Infection Control Consortium findings. Am J Infect Control, 40(6), 497-501.

Rosenthal, V. D., Rodríguez-Calderón, M. E., Rodríguez-Ferrer, M., Singhal, T., Pawar, M. & Sobreyra-Oropeza, M. (2012). Findings of the International Nosocomial Infection Control Consortium (INICC), Part II: impact of a multidimensional strategy to reduce ventilator-associated pneumonia in neonatal intensive care units in 10 developing countries. Infect Control Hosp Epidemiol, 33(7), 704-710.

Silva, A. R. A. D., Silva, T. C. D., Bom, G. J. T., Vasconcelos, R. M. B. & Junior, R. S. (2018). Ventilator-associated pneumonia agents in Brazilian Neonatal Intensive Care Units: a systematic review. Braz J Infect Dis, 22(4), 338-344.

Silva, M. F. O., Silva, F. V. R., Mesquita, C. R. M., Figueiredo, P. T. S., Porto, S. S. & Campara, M. A. S. (2020). A adesão aos bundles reduz a prevalência de pneumonia associada a ventilação mecânica? Braz J of Develop, 6(1), 5334-5342.

Silva, S. G. D., Nascimento, E. R. P. D. & Salles, R. K. D. (2012). Bundle de prevenção da pneumonia associada à ventilação mecânica: uma construção coletiva. Texto Contexto Enferm, 21(4), 837-844.

Wójkowska-Mach, J., Merritt, T. A., Borszewska-Kornacka, M., Domańska, J., Gulczyńska, E. & Nowiczewski, M. (2016). Device-associated pneumonia of very low birth weight infants in Polish Neonatal Intensive Care Units. Adv Med Sci, 61(1), 90-95.

Published

23/11/2023

How to Cite

SILVA, P. L. L. da .; COSTA, A. C. .; SILVA, L. E. da .; SILVA, A. R. A. da . Adherence to the mechanical ventilation-associated pneumonia prevention bundle in neonatal and pediatric ICU. Research, Society and Development, [S. l.], v. 12, n. 12, p. e01121244117, 2023. DOI: 10.33448/rsd-v12i12.44117. Disponível em: https://www.rsdjournal.org/index.php/rsd/article/view/44117. Acesso em: 26 feb. 2024.

Issue

Section

Health Sciences