A stitch in time saves nine
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THE NON-PHARMACALOGICAL BUNDLE TO PREVENT INFECTIONS ASSOCIATED WITH ENDOTRACHEAL TUBES AND VENTILATORS.
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A stitch in time saves nine
- 1. “ A STITCH IN TIME SAVES NINE” ALI SHAMSEDDINE, BS, RT AUBMC
- 6. How to Handle VAP? Prevention
- 9. Strategies aimed at prevention of VAP Kollef (1999)
Hinweis der Redaktion
- Since mechanically ventilated patients cannot be fed orally, their salivary secretions decrease, and self-cleansing of the oral cavity is markedly reduced. As a result, oral cavity hygiene worsens, and the number of bacteria increases excessively, leading to bacterial colonization of the oropharynx.
- Methods : Patients more than 18 years old receiving mechanical ventilation for more than 48 hours in a medical intensive care unit at a university-affiliated medical center were studied in 2 consecutive 24-month periods. Patients in the group studied before the intervention (n = 779) had no oral assessments, no suctioning of the subglottic space, no tooth brushing, and suctioning of secretions in the oral cavity as needed. The group studied during the intervention (n = 759) included patients treated under a protocol whereby the oral cavity was assessed, deep suctioning was done every 6 hours, oral tissue cleansing was done every 4 hours or as needed, and tooth brushing was done twice daily. Results: Compliance with protocol components exceeded 80%. The rate of ventilator-associated pneumonia was 12.0 per 1000 ventilator days before the intervention and decreased to 8.0 per 1000 ventilator days during the intervention ( P = .06). Duration of mechanical ventilation and length of stay in the intensive care unit differed significantly between groups, as did mortality.
- Prospective, randomized, single-blind, controlled study conducted in 54 centers in North America. A total of 9417 adult patients (18 years) were screened between 2002 and 2006. A total of 2003 patients expected to require mechanical ventilation for 24 hours or longer were randomized. Patients were assigned to undergo intubation with 1 of 2 high volume, low-pressure endotracheal tubes, similar except for a silver coating on the experimental tube.