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Master Thesis

Implémentation d'un programme de prévention des pneumopathies acquises sous ventilation mécanique en réanimation polyvalente non universitaire

Abstract : Introduction: Ventilator-Associated Pneumonia (VAP) is the most frequent nosocomial infection in the ICU and has a clear impact on patient outcome (duration of mechanical ventilation, length of stay and mortality). The aim of this study is to evaluate the impact of a multifaceted VAP prevention program on VAP rates in a medical-surgical ICU in a secondary care hospital. Patients and Methods: We conducted a retrospective observational monocentric study for two 6 months study-period (from January to June, 2013 and 2014). Were included all patients admitted in the ICU for more than 48 hours. The "Bundle" program involved all healthcare workers and included educational sessions, direct observations with performance feedback, and reminders. The bundle focused on a few number of targeted measures : Sub-glottic aspiration, tracheal cuff pressure monitoring, gastric overdistension avoidance, backrest elevation, chlorhexidine oral hygiene, nonessential tracheal suction elimination, sedation protocols, hand-hygiene and glove and gown use. VAP was diagnosed on the basis of clinical and radiological criteria, and quantitative cultures of distal specimens. The primary outcome was the VAP rate. Secondary outcomes included compliance rates with bundle measures, patient outcome and risk factors for VAP in our population. Results: We included 189 patients in 2013, 171 in 2014. Patient caracteristics and comorbidities were similar between the two study periods (average age 62 years, average IGS2= 44,8, average SOFA max=6,35). Our population was composed of 64% of medical patients, with 40% of them admitted for respiratory failure as main diagnosis. Our ICU also had trauma patients, with 6% of them admitted for severe head injury. Compliance with preventive measures significantally increased between the study periods (overall compliance : 2,2% versus 38,8%; p<0,001). Among intubated patients (105 in 2013, 108 in 2014), mechanical ventilation duration was higher during the intervention period (9,7±6,9 vs 7,4±5,5 days; p<0,05). Baseline and intervention VAP rates were 18,7 and 24,4 per 1000 ventilator days respectively (p=0,71). However, duration of mechanical ventilation without VAP was longer in the intervention group (8,7±7,5 vs 6,9±5,0 days; p<0,05). VAP risk factors in our population were : ARDS, severe head injury, duration of mechanical ventilation. The only protective factor was antibiotic therapy at admission. Conclusion: A multifaceted bundle program for VAP prevention didn't reduce VAP rates but increased duration of mechanical ventilation without VAP and had a significant effect on VAP prevention measures adherence.
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https://dumas.ccsd.cnrs.fr/dumas-01223875
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Submitted on : Tuesday, November 3, 2015 - 3:55:15 PM
Last modification on : Wednesday, August 23, 2017 - 4:29:05 PM
Long-term archiving on: : Thursday, February 4, 2016 - 11:15:52 AM

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Stanislas de Guillebon. Implémentation d'un programme de prévention des pneumopathies acquises sous ventilation mécanique en réanimation polyvalente non universitaire. Médecine humaine et pathologie. 2015. ⟨dumas-01223875⟩

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