Successful prevention of tracheostomy associated pneumonia in step-down units

Background Prevention of health care-associated infections is well described in critical care. However, surveillance in step-down unit (SDU) patients who need intermediate care with bilevel mechanical ventilation pressure through tracheotomy needs to be better understood. We evaluated the implementa...

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Bibliographic Details
Published in:American journal of infection control 2011-08, Vol.39 (6), p.500-505
Main Authors: Eid, Raquel Caserta, PT, Domingues, Fernanda, PT, Silva Barreto, Joyce Kelly, PT, Marra, Alexandre R., MD, Silva, Claudia Vallone, RN, Paes, Ângela Tavares, PhD, dos Santos, Oscar Fernando Pavão, MD, Edmond, Michael B., MD, MPH, MPA
Format: Article
Language:English
Subjects:
Aged
Biological and medical sciences
Critical care
Disease prevention
Epidemiology. Vaccinations
General aspects
Health Services Research
Humans
Incidence
Infection Control
Infection Control - methods
Infectious Disease
Infectious diseases
Medical equipment
Medical sciences
Nosocomial infections
Pneumology
Pneumonia
Pneumonia, Bacterial - epidemiology
Pneumonia, Bacterial - prevention & control
Pneumonia, Ventilator-Associated - epidemiology
Pneumonia, Ventilator-Associated - prevention & control
prevention
Respiratory system : syndromes and miscellaneous diseases
step-down unit
tracheostomy
Tracheostomy - adverse effects
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Summary:Background Prevention of health care-associated infections is well described in critical care. However, surveillance in step-down unit (SDU) patients who need intermediate care with bilevel mechanical ventilation pressure through tracheotomy needs to be better understood. We evaluated the implementation of preventive measures in SDU over 2 different periods on device (bilevel mechanical ventilation)-associated pneumonia. Methods A quasi-experimental, interrupted time series study was conducted in SDUs. Interventions were implemented to optimize the prevention of pneumonia associated with tracheostomy and evaluated in 2 phases. From January to October of 2007 (phase 1), some practices recommended by the Centers for Disease Control and Prevention were implemented, and the epidemiology unit carried out surveillance for pneumonia associated with tracheostomy. From November of 2007 to August of 2008 (phase 2) the same practices recommended by the Centers for Disease Control and Prevention were followed, but, in addition, the assessment of these processes as well as bedside interventions were initiated. Results The mean incidence density of tracheostomy associated pneumonia per 1,000 tracheostomy-days in the SDUs was 6.0 in phase 1 and 0.7 in phase 2, P = .002. Conclusion Reducing pneumonia associated with tracheostomy is a continuous multidisciplinary process that involves the measurement of multiple performance metrics.
ISSN:0196-6553
1527-3296
DOI:10.1016/j.ajic.2010.09.015