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Strategies to Prevent Ventilator-Associated Pneumonia in Acute Care Hospitals

Published online by Cambridge University Press:  02 January 2015

Susan E. Coffin ,
Michael Klompas ,
David Classen ,
Kathleen M. Arias ,
Kelly Podgorny ,
Deverick J. Anderson ,
Helen Burstin ,
David P. Calfee ,
Erik R. Dubberke  and
Victoria Fraser
...Show all authors
Susan E. Coffin
Affiliation:
Children's Hospital of Philadelphia andUniversity of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
Michael Klompas
Affiliation:
Brigham and Women's Hospitaland Harvard Medical School, Boston
David Classen
Affiliation:
University of Utah, Salt Lake City
Kathleen M. Arias
Affiliation:
Association for Professionals in Infection Control and Epidemiology, Washington, D.C.
Kelly Podgorny
Affiliation:
Joint Commission, Oakbrook Terrace, Illinois
Deverick J. Anderson
Affiliation:
Duke University Medical Center, Durham, North Carolina
Helen Burstin
Affiliation:
National Quality Forum, Washington, D.C.
David P. Calfee
Affiliation:
Mount Sinai School of Medicine, New York, New York
Erik R. Dubberke
Affiliation:
Washington University School of Medicine, St. Louis, Missouri
Victoria Fraser
Affiliation:
Washington University School of Medicine, St. Louis, Missouri
Dale N. Gerding
Affiliation:
Loyola University Chicago Stritch School of Medicine, Chicago Hines Veterans Affairs Medical Center, Hines, Illinois
Frances A. Griffin
Affiliation:
Institute for Healthcare Improvement, Cambridge, Massachusetts
Peter Gross
Affiliation:
Hackensack University Medical Center, Hackensack University of Medicine and Dentistry–New Jersey Medical School, Newark, New Jersey
Keith S. Kaye
Affiliation:
Duke University Medical Center, Durham, North Carolina
Evelyn Lo
Affiliation:
University of Manitoba, Winnipeg, Canada
Jonas Marschall
Affiliation:
Washington University School of Medicine, St. Louis, Missouri
Leonard A. Mermel
Affiliation:
Warren Alpert Medical School of Brown Universityand Rhode Island Hospital, Providence, Rhode Island
Lindsay Nicolle
Affiliation:
University of Manitoba, Winnipeg, Canada
David A. Pegues
Affiliation:
David Geffen School of Medicine at the University of California, Los Angeles
Trish M. Perl
Affiliation:
Johns Hopkins Medical Institutions and University, Baltimore, Maryland
Sanjay Saint
Affiliation:
Ann Arbor Veterans Affairs Medical Center and theUniversity of Michigan Medical School, Ann Arbor, Michigan
Cassandra D. Salgado
Affiliation:
Medical University of South Carolina, Charleston
Robert A. Weinstein
Affiliation:
Stroger (Cook County) Hospital and theRush University Medical Center, Chicago
Robert Wise
Affiliation:
Joint Commission, Oakbrook Terrace, Illinois
Deborah S. Yokoe
Affiliation:
Brigham and Women's Hospitaland Harvard Medical School, Boston
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Extract

Previously published guidelines are available that provide comprehensive recommendations for detecting and preventing healthcare-associated infections. The intent of this document is to highlight practical recommendations in a concise format designed to assist acute care hospitals in implementing and prioritizing their ventilator-associated pneumonia (VAP) prevention efforts. Refer to the Society for Healthcare Epidemiology of America/Infectious Diseases Society of America “Compendium of Strategies to Prevent Healthcare-Associated Infections” Executive Summary and Introduction and accompanying editorial for additional discussion.

1. Occurrence of VAP in acute care facilities.

a. VAP is one of the most common infections acquired by adults and children in intensive care units (ICUs).

i. In early studies, it was reported that 10%-20% of patients undergoing ventilation developed VAP. More-recent publications report rates of VAP that range from 1 to 4 cases per 1,000 ventilator-days, but rates may exceed 10 cases per 1,000 ventilator-days in some neonatal and surgical patient populations. The results of recent quality improvement initiatives, however, suggest that many cases of VAP might be prevented by careful attention to the process of care.

2. Outcomes associated with VAP

a. VAP is a cause of significant patient morbidity and mortality, increased utilization of healthcare resources, and excess cost.

i. The mortality attributable to VAP may exceed 10%.

ii. Patients with VAP require prolonged periods of mechanical ventilation, extended hospitalizations, excess use of antimicrobial medications, and increased direct medical costs.

Type
SHEA/IDSA Practice Recommendations
Information
Infection Control & Hospital Epidemiology , Volume 29 , supplement S1: A Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals , October 2008 , pp. S31 - S40
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2008

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References

1.Richards, MJ, Edwards, JR, Culver, DH, Gaynes, RP. Nosocomial infections in pediatric intensive care units in the United States. National Nosocomial Infections Surveillance System. Pediatrics 1999;103:e39.CrossRefGoogle ScholarPubMed
2.Richards, MJ, Edwards, JR, Culver, DH, Gaynes, RP. Nosocomial infections in combined medical-surgical intensive care units in the United States. Infect Control Hosp Epidemiol 2000;21:510–515.Google Scholar
3.Ibrahim, EH, Tracy, L, Hill, C, Fraser, VJ, Kollef, MH. The occurrence of ventilator-associated pneumonia in a community hospital: risk factors and clinical outcomes. Chest 2001;120:555–561.CrossRefGoogle Scholar
4.Safdar, N, Dezfulian, C, Collard, HR, Saint, S. Clinical and economic consequences of ventilator-associated pneumonia: a systematic review. Crit Care Med 2005;33:2184–2193.Google Scholar
5.American Thoracic Society, Infectious Diseases Society of America. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med 2005;171:388–416.Google Scholar
6.Stover, BH, Shulman, ST, Bratcher, DF, Brady, MT, Levine, GL, Jarvis, WR. Nosocomial infection rates in US children's hospitals' neonatal and pediatric intensive care units. Am J Infect Control 2001;29:152–157.CrossRefGoogle ScholarPubMed
7.Elward, AM, Warren, DK, Fraser, VJ. Ventilator-associated pneumonia in pediatric intensive care unit patients: risk factors and outcomes. Pediatrics 2002;109:758–764.Google Scholar
8.Apisarnthanarak, A, Holzmann-Pazgal, G, Hamvas, A, Olsen, MA, Fraser, VJ. Ventilator-associated pneumonia in extremely preterm neonates in a neonatal intensive care unit: characteristics, risk factors, and outcomes. Pediatrics 2003;112:1283–1289.CrossRefGoogle Scholar
9.Edwards, JR, Peterson, KD, Andrus, ML, et al.National Healthcare Safety Network (NHSN) report, data summary for 2006, issued June 2007. Am J Infect Control 2007;35:290–301.CrossRefGoogle ScholarPubMed
10.Chastre, J, Fagon, JY. Ventilator-associated pneumonia. Am J Respir Crit Care Med 2002;165:867–903.Google Scholar
11.Rello, J, Ollendorf, DA, Oster, G, et al.Epidemiology and outcomes of ventilator-associated pneumonia in a large US database. Chest 2002;122:2115–2121.Google Scholar
12.Shorr, AF, Kollef, MH. Ventilator-associated pneumonia: insights from recent clinical trials. Chest 2005;128:583S–591S.CrossRefGoogle ScholarPubMed
13.Shorr, AF, Wunderink, RG. Dollars and sense in the intensive care unit: the costs of ventilator-associated pneumonia. Crit Care Med 2003;31:1582–1583.Google Scholar
14.Warren, DK, Shukla, SJ, Olsen, MA, et al.Outcome and attributable cost of ventilator-associated pneumonia among intensive care unit patients in a suburban medical center. Crit Care Med 2003;31:1312–1317.CrossRefGoogle Scholar
15.Crouch Brewer, S, Wunderink, RG, Jones, CB, Leeper, KV JrVentilator-associated pneumonia due to Pseudomonas aeruginosa. Chest 1996;109:1019–1029.Google Scholar
16.Fagon, JY, Chastre, J, Hance, AJ, Montravers, P, Novara, A, Gibert, C. Nosocomial pneumonia in ventilated patients: a cohort study evaluating attributable mortality and hospital stay. Am J Med 1993;94:281–288.CrossRefGoogle ScholarPubMed
17.Kollef, MH, Silver, P, Murphy, DM, Trovillion, E. The effect of late-onset ventilator-associated pneumonia in determining patient mortality. Chest 1995;108:1655–1662.CrossRefGoogle ScholarPubMed
18.Cordero, L, Ayers, LW, Miller, RR, Seguin, JH, Coley, BD. Surveillance of ventilator-associated pneumonia in very-low-birth-weight infants. Am J Infect Control 2002;30:32–39.Google Scholar
19.Grossman, RF, Fein, A. Evidence-based assessment of diagnostic tests for ventilator-associated pneumonia. Executive summary. Chest 2000;117:177S–181S.CrossRefGoogle ScholarPubMed
20.Papazian, L, Bregeon, F, Thirion, X, et al.Effect of ventilator-associated pneumonia on mortality and morbidity. Am J Respir Crit Care Med 1996;154:91–97.Google Scholar
21.Kollef, M. Prolonged use of ventilator circuits and ventilator-associated pneumonia: a model for identifying the optimal clinical practice. Chest 1998;113:267–269.CrossRefGoogle Scholar
22.Luna, C, Vujacich, P, Niederman, M, et al.Impact of BAL data on the therapy and outcome of ventilator-associated pneumonia. Chest 1997;111:676–685.CrossRefGoogle ScholarPubMed
23.Fischer, JE, Allen, P, Fanconi, S. Delay of extubation in neonates and children after cardiac surgery: impact of ventilator-associated pneumonia. Intensive Care Med 2000;26:942–949.CrossRefGoogle ScholarPubMed
24.Safdar, N, Crnich, CJ, Maki, DG. The pathogenesis of ventilator-associated pneumonia: its relevance to developing effective strategies for prevention. Respir Care 2005;50:725–739; discussion 739-741.Google Scholar
25.Torres, A, Gatell, JM, Aznar, E, et al.Re-intubation increases the risk of nosocomial pneumonia in patients needing mechanical ventilation. Am J Respir Crit Care Med 1995;152:137–141.CrossRefGoogle ScholarPubMed
26.Ibrahim, E, Mehringer, L, Prentice, D, et al.Early versus late enteral feeding of mechanically ventilated patients: results of a clinical trial. JPEN J Patenter Enteral Nutr 2002;26:174–181.Google Scholar
27.Cook, DJ, Walter, SD, Cook, RJ, et al.Incidence of and risk factors for ventilator-associated pneumonia in critically ill patients. Ann Intern Med 1998;129:433–440.Google Scholar
28.Kollef, MH. Ventilator-associated pneumonia: a multivariate analysis. JAMA 1993;270:1965–1970.Google Scholar
29.Klompas, M, Platt, R. Ventilator-associated pneumonia—the wrong quality measure for benchmarking. Ann Intern Med 2007;147:803–805.Google Scholar
30.Klompas, M. Does this patient have ventilator-associated pneumonia? JAMA 2007;297:1583–1593.CrossRefGoogle ScholarPubMed
31.Torres, A, Ewig, S. Diagnosing ventilator-associated pneumonia. N Engl J Med 2004;350:433–435.CrossRefGoogle ScholarPubMed
32.Baltimore, RS. The difficulty of diagnosing ventilator-associated pneumonia. Pediatrics 2003;112:1420–1421.CrossRefGoogle ScholarPubMed
33. National Healthcare Safety Network members page. Available at: http://www.cdc.gov/ncidod/dhqp/nhsn_members.html. Accessed August 7, 2008.Google Scholar
34.Cook, D, Walter, S, Freitag, A, et al.Adjudicating ventilator-associated pneumonia in a randomized trial of critically ill patients. J Crit Care 1998;13:159–163.Google Scholar
35.Fagon, JY, Chastre, J, Hance, AJ, Domart, Y, Trouillet, JL, Gibert, C. Evaluation of clinical judgment in the identification and treatment of nosocomial pneumonia in ventilated patients. Chest 1993;103:547–553.CrossRefGoogle ScholarPubMed
36.Schurink, CA, Van Nieuwenhoven, CA, Jacobs, JA, et al.Clinical pulmonary infection score for ventilator-associated pneumonia: accuracy and inter-observer variability. Intensive Care Med 2004;30:217–224.CrossRefGoogle ScholarPubMed
37.Shorr, A, Sherner, JH, Jackson, WL, Kollef, M. Invasive approaches to the diagnosis of ventilator-associated pneumonia: a meta-analysis. Crit Care Med 2005;33:46–53.CrossRefGoogle Scholar
38.Sherman, ER, Heydon, KH, St John, KH, et al.Administrative data fail to accurately identify cases of healthcare-associated infection. Infect Control Hosp Epidemiol 2006;27:332–337.CrossRefGoogle ScholarPubMed
39.Julian, KG, Brumbach, AM, Chicora, MK, et al.First year of mandatory reporting of healthcare-associated infections, Pennsylvania: an infection control–chart abstractor collaboration. Infect Control Hosp Epidemiol 2006;27:926–930.CrossRefGoogle ScholarPubMed
40.Fagon, JY, Chastre, J, Wolff, M, et al.Invasive and noninvasive strategies for management of suspected ventilator-associated pneumonia: a randomized trial. Ann Intern Med 2000;132:621–630.Google Scholar
41.Fabregas, N, Ewig, S, Torres, A, et al.Clinical diagnosis of ventilator associated pneumonia revisited: comparative validation using immediate post-mortem lung biopsies. Thorax 1999;54:867–873.Google Scholar
42.Heyland, D, Dodek, P, Muscedere, J, Day, A. A randomized trial of diagnostic techniques for ventilator-associated pneumonia. N Engl J Med 2006;355:2619–2630.Google Scholar
43.Haas, JP, Mendonca, EA, Ross, B, Friedman, C, Larson, E. Use of computerized surveillance to detect nosocomial pneumonia in neonatal intensive care unit patients. Am J Infect Control 2005;33:439–443.Google Scholar
44.Klompas, M, Kleinman, K, Platt, R. Development of an algorithm for surveillance of ventilator-associated pneumonia with electronic data and comparison of algorithm results with clinician diagnoses. Infect Control Hosp Epidemiol 2008;29:31–37.Google Scholar
45.Boyce, JM, White, RL, Spruill, EY, Wall, M. Cost-effective application of the Centers for Disease Control Guideline for Prevention of Nosocomial Pneumonia. Am J Infect Control 1985;13:228–232.Google Scholar
46.Gaynes, RP, Solomon, S. Improving hospital-acquired infection rates: the CDC experience. Jt Comm J Qual Improv 1996;22:457–467.Google ScholarPubMed
47.Goldmann, DA, Weinstein, RA, Wenzel, RP, et al.Strategies to prevent and control the emergence and spread of antimicrobial-resistant microorganisms in hospitals: a challenge to hospital leadership. JAMA 1996;275:234–240.Google Scholar
48.Joiner, GA, Salisbury, D, Bollin, GE. Utilizing quality assurance as a tool for reducing the risk of nosocomial ventilator-associated pneumonia. Am J Med Qual 1996;11:100–103.Google Scholar
49.Kelleghan, SI. An effective continuous quality improvement approach to the prevention of ventilator-associated pneumonia. Am J Infect Control 1993;21:322–330.Google Scholar
50.Resar, R, Pronovost, P, Haraden, C, Simmonds, T, Rainey, T, Nolan, T. Using a bundle approach to improve ventilator care processes and reduce ventilator-associated pneumonia. Jt Comm J Qual Patient Saf 2005;31:243–248.Google ScholarPubMed
51.Dodek, P, Keenan, S, Cook, D, et al.Evidence-based clinical practice guideline for the prevention of ventilator-associated pneumonia. Ann Intern Med 2004;141:305–313.CrossRefGoogle ScholarPubMed
52.Tablan, OC, Anderson, LJ, Besser, R, Bridges, C, Hajjeh, R. Guidelines for preventing health-care–associated pneumonia, 2003: recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee. MMWR Recomm Rep 2004;53:1–36.Google ScholarPubMed
53.Erhart, LM, Rangel, MC, Lu, PJ, Singleton, JA. Prevalence and characteristics of children at increased risk for complications from influenza, United States, 2000. J Pediatr 2004;144:191–195.CrossRefGoogle ScholarPubMed
54.Antonelli, M, Conti, G, Rocco, M, et al.A comparison of noninvasive positive-pressure ventilation and conventional mechanical ventilation in patients with acute respiratory failure. N Engl J Med 1998;339:429–435.Google Scholar
55.Brochard, L. Mechanical ventilation: invasive versus noninvasive. Eur Respir J Suppl 2003;47:31s–37s.Google Scholar
56.Girou, E, Brun-Buisson, C, Taille, S, Lemaire, F, Brochard, L. Secular trends in nosocomial infections and mortality associated with noninvasive ventilation in patients with exacerbation of COPD and pulmonary edema. JAMA 2003;290:2985–2991.Google Scholar
57.Kollef, MH. Prevention of hospital-associated pneumonia and ventilator-associated pneumonia. Crit Care Med 2004;32:1396–1405.Google Scholar
58.Brochard, L, Mancebo, J, Wysocki, M, et al.Noninvasive ventilation for acute exacerbations of chronic obstructive pulmonary disease. N Engl J Med 1995;333:817–822.CrossRefGoogle ScholarPubMed
59.Nava, S, Ambrosino, N, Clini, E, et al.Noninvasive mechanical ventilation in the weaning of patients with respiratory failure due to chronic obstructive pulmonary disease: a randomized, controlled trial. Ann Intern Med 1998;128:721–728.Google Scholar
60.Girou, E, Schortgen, F, Delclaux, C, et al.Association of noninvasive ventilation with nosocomial infections and survival in critically ill patients. JAMA 2000;284:2361–2367.Google Scholar
61.Nourdine, K, Combes, P, Carton, MJ, Beuret, P, Cannamela, A, Ducreux, JC. Does noninvasive ventilation reduce the ICU nosocomial infection risk? A prospective clinical survey. Intensive Care Med 1999;25:567–573.Google Scholar
62.Burns, KE, Adhikari, NK, Meade, MO. Noninvasive positive pressure ventilation as a weaning strategy for intubated adults with respiratory failure. Cochrane Database Syst Rev 2003;(4):CD004127.CrossRefGoogle ScholarPubMed
63.Kollef, MH. Avoidance of tracheal intubation as a strategy to prevent ventilator-associated pneumonia. Intensive Care Medicine 1999;25:553–555.CrossRefGoogle ScholarPubMed
64.Brook, AD, Ahrens, TS, Schaiff, R, et al.Effect of a nursing-implemented sedation protocol on the duration of mechanical ventilation. Crit Care Med 1999;27:2609–2615.Google Scholar
65.Dellinger, R, Vincent, J. The Surviving Sepsis Campaign sepsis change bundles and disease. Crit Care 2005;9:653–654.CrossRefGoogle Scholar
66.Kress, JP, Pohlman, AS, O'Connor, MF, Hall, JB. Daily interruption of sedative infusions in critically ill patients undergoing mechanical ventilation. N Engl J Med 2000;342:1471–1477.CrossRefGoogle ScholarPubMed
67.Needleman, J, Buerhaus, P, Mattke, S, Stewart, M, Zelevinsky, K. Nurse-staffing levels and the quality of care in hospitals. N Engl J Med 2002;346:1715–1722.CrossRefGoogle ScholarPubMed
68.Marelich, GP, Murin, S, Battistella, F, Inciardi, J, Vierra, T, Roby, M. Protocol weaning of mechanical ventilation in medical and surgical patients by respiratory care practitioners and nurses: effect on weaning time and incidence of ventilator-associated pneumonia. Chest 2000;118:459–467.Google Scholar
69.Thorens, JB, Kaelin, RM, Jolliet, P, Chevrolet, JC. Influence of the quality of nursing on the duration of weaning from mechanical ventilation in patients with chronic obstructive pulmonary disease. Crit Care Med 1995;23:1807–1815.CrossRefGoogle ScholarPubMed
70.Babcock, HM, Zack, JE, Garrison, T, et al.An educational intervention to reduce ventilator-associated pneumonia in an integrated health system: a comparison of effects. Chest 2004;125:2224–2231.CrossRefGoogle Scholar
71.Ely, EW, Meade, MO, Haponik, EF, et al.Mechanical ventilator weaning protocols driven by nonphysician health-care professionals: evidence-based clinical practice guidelines. Chest 2001;120:454S–463S.CrossRefGoogle ScholarPubMed
72.Torres, A, Serra-Baflles, J, Ros, E, et al.Pulmonary aspiration of gastric contents in patients receiving mechanical ventilation: the effect of body position. Ann Intern Med 1992;116:540–543.Google Scholar
73.Drakulovic, MB, Torres, A, Bauer, TT, Nicolas, JM, Nogue, S, Ferrer, M. Supine body position as a risk factor for nosocomial pneumonia in mechanically ventilated patients: a randomised trial. Lancet 1999;354:1851–1858.Google Scholar
74.Helman, DL JrSherner, JH 3rdFitzpatrick, TM, Callender, ME, Shorr, AF. Effect of standardized orders and provider education on head-of-bed positioning in mechanically ventilated patients. Crit Care Med 2003;31:2285–2290.Google Scholar
75.Orozco-Levi, M, Torres, A, Ferrer, M, et al.Semirecumbent position protects from pulmonary aspiration but not completely from gastroesophageal reflux in mechanically ventilated patients. Am J Respir Crit Care Med 1995;152:1387–1390.Google Scholar
76.Collard, HR, Saint, S, Matthay, MA. Prevention of ventilator-associated pneumonia: an evidence-based systematic review. Ann Intern Med 2003;138:494–501.CrossRefGoogle ScholarPubMed
77.van Nieuwenhoven, CA, Vandenbroucke-Grauls, C, van Tiel, FH, et al.Feasibility and effects of the semirecumbent position to prevent ventilator-associated pneumonia: a randomized study. Crit Care Med 2006;34:396–402.Google Scholar
78.Girou, E, Buu-Hoi, A, Stephan, F, et al.Airway colonisation in long-term mechanically ventilated patients: effect of semi-recumbent position and continuous subglottic suctioning. Intensive Care Med 2004;30:225–233.Google Scholar
79.Heyland, DK, Drover, JW, MacDonald, S, Novak, F, Lam, M. Effect of postpyloric feeding on gastroesophageal regurgitation and pulmonary microaspiration: results of a randomized controlled trial. Crit Care Med 2001;29:1495–1501.Google Scholar
80.Niederman, MS, Craven, DE. Devising strategies for preventing nosocomial pneumonia—should we ignore the stomach? Clin Infect Dis 1997;24:320–323.Google Scholar
81.Rello, J, Torres, A. Microbial causes of ventilator-associated pneumonia. Semin Respir Infect 1996;11:24–31.Google Scholar
82.Valles, J, Artigas, A, Rello, J, et al.Continuous aspiration of subglottic secretions in preventing ventilator-associated pneumonia. Ann Intern Med 1995;122:179–186.CrossRefGoogle ScholarPubMed
83.Mahul, P, Auboyer, C, Jospe, R, et al.Prevention of nosocomial pneumonia in intubated patients: respective role of mechanical subglottic secretions drainage and stress ulcer prophylaxis. Intensive Care Med 1992;18:20–25.Google Scholar
84.Kollef, MH, Skubas, NJ, Sundt, TM. A randomized clinical trial of continuous aspiration of subglottic secretions in cardiac surgery patients. Chest 1999;116:1339–1346.CrossRefGoogle ScholarPubMed
85.Dezfulian, C, Shojania, K, Collard, HR, Kim, HM, Matthay, MA, Saint, S. Subglottic secretion drainage for preventing ventilator-associated pneumonia: a meta-analysis. Am J Med 2005;118:11–18.Google Scholar
86.Cook, DJ, Kollef, MH. Risk factors for ICU-acquired pneumonia. JAMA 1998;279:1605–1606.Google Scholar
87.Rello, J, Sonora, R, Jubert, P, Artigas, A, Rue, M, Valles, J. Pneumonia in intubated patients: role of respiratory airway care. Am J Respir Crit Care Med 1996;154:111–115.CrossRefGoogle ScholarPubMed
88.Salord, F, Gaussorgues, P, Marti-Flich, J, et al.Nosocomial maxillary sinusitis during mechanical ventilation: a prospective comparison of orotracheal versus the nasotracheal route for intubation. Intensive Care Med 1990;16:390–393.CrossRefGoogle ScholarPubMed
89.Rouby, JJ, Laurent, P, Gosnach, M, et al.Risk factors and clinical relevance of nosocomial maxillary sinusitis in the critically ill. Am J Respir Crit Care Med 1994;150:776–783.CrossRefGoogle ScholarPubMed
90.Holzapfel, L, Chastang, C, Demingeon, G, Bohe, J, Piralla, B, Coupry, A. A randomized study assessing the systematic search for maxillary sinusitis in nasotracheally mechanically ventilated patients: influence of nosocomial maxillary sinusitis on the occurrence of ventilator-associated pneumonia. Am J Respir Crit Care Med 1999;159:695–701.Google Scholar
91.Holzapfel, L, Chevret, S, Madinier, G, et al.Influence of long-term oro-or nasotracheal intubation on nosocomial maxillary sinusitis and pneumonia: results of a prospective, randomized, clinical trial. Crit Care Med 1993;21:1132–1138.Google Scholar
92.Saint, S, Matthay, MA. Risk reduction in the intensive care unit. Am J Med 1998;105:515–523.CrossRefGoogle ScholarPubMed
93.Cook, DJ. Stress ulcer prophylaxis: gastrointestinal bleeding and nosocomial pneumonia: best evidence synthesis. Scand J Gastroenterol Suppl 1995;210:48–52.Google Scholar
94.Cook, DJ, Reeve, BK, Guyatt, GH, et al.Stress ulcer prophylaxis in critically ill patients: resolving discordant meta-analyses. JAMA 1996;275:308–314.Google Scholar
95.Tryba, M, Cook, DJ. Gastric alkalinization, pneumonia, and systemic infections: the controversy. Scand J Gastroenterol Suppl 1995;210:53–59.Google Scholar
96.Tryba, M. Sucralfate versus antacids or H2-antagonists for stress ulcer prophylaxis: a meta-analysis on efficacy and pneumonia rate. Crit Care Med 1991;19:942–949.CrossRefGoogle ScholarPubMed
97.Messori, A, Trippoli, S, Vaiani, M, Gorini, M, Corrado, A. Bleeding and pneumonia in intensive care patients given ranitidine and sucralfate for prevention of stress ulcer: meta-analysis of randomised controlled trials. BMJ 2000;321:1103–1106.Google Scholar
98.Cook, D, Guyatt, G, Marshall, J, et al.A comparison of sucralfate and ranitidine for the prevention of upper gastrointestinal bleeding in patients requiring mechanical ventilation. Canadian Critical Care Trials Group. N Engl J Med 1998;338:791–797.CrossRefGoogle ScholarPubMed
99.Lopriore, E, Markhorst, DG, Gemke, RJ. Ventilator-associated pneumonia and upper airway colonisation with Gram negative bacilli: the role of stress ulcer prophylaxis in children. Intensive Care Med 2002;28:763–767.Google Scholar
100.Yoneyama, T, Yoshida, M, Ohrui, T, et al.Oral care reduces pneumonia in older patients in nursing homes. J Am Geriatr Soc 2002;50:430–433.CrossRefGoogle ScholarPubMed
101.DeRiso, AJ 2ndLadowski, JS, Dillon, TA, Justice, JW, Peterson, AC. Chlorhexidine gluconate 0.12% oral rinse reduces the incidence of total nosocomial respiratory infection and nonprophylactic systemic antibiotic use in patients undergoing heart surgery. Chest 1996;109:1556–1561.Google Scholar
102.Rumbak, MJ, Cancio, MR. Significant reduction in methicillin-resistant Staphylococcus aureus ventilator-associated pneumonia associated with the institution of a prevention protocol. Crit Care Med 1995;23:1200–1203.CrossRefGoogle ScholarPubMed
103.Mori, H, Hirasawa, H, Oda, S, Shiga, H, Matsuda, K, Nakamura, M. Oral care reduces incidence of ventilator-associated pneumonia in ICU populations. Intensive Care Med 2006;32:230–236.CrossRefGoogle ScholarPubMed
104.Bergmans, DC, Bonten, MJ, Gaillard, CA, et al.Prevention of ventilator-associated pneumonia by oral decontamination: a prospective, randomized, double-blind, placebo-controlled study. Am J Respir Crit Care Med 2001;164:382–388.Google Scholar
105.Houston, S, Hougland, P, Anderson, JJ, LaRocco, M, Kennedy, V, Gentry, LO. Effectiveness of 0.12% chlorhexidine gluconate oral rinse in reducing prevalence of nosocomial pneumonia in patients undergoing heart surgery. Am J Crit Care 2002;11:567–570.Google Scholar
106.Segers, P, Speekenbrink, RG, Ubbink, DT, van Ogtrop, ML, de Mol, BA. Prevention of nosocomial infection in cardiac surgery by decontamination of the nasopharynx and oropharynx with chlorhexidine gluconate: a randomized controlled trial. JAMA 2006;296:2460–2466.Google Scholar
107.Silvestri, L, van Saene, JJ, van Saene, HK, Weir, I. Topical chlorhexidine and ventilator-associated pneumonia. Crit Care Med 2007;35:2468.Google Scholar
108.Chan, EY, Ruest, A, Meade, MO, Cook, DJ. Oral decontamination for prevention of pneumonia in mechanically ventilated adults: systematic review and meta-analysis. BMJ 2007;334:889.Google Scholar
109.Craven, DE, Goularte, TA, Make, BJ. Contaminated condensate in mechanical ventilator circuits: a risk factor for nosocomial pneumonia? Am Rev Respir Dis 1984;129:625–628.Google Scholar
110.Stamm, AM. Ventilator-associated pneumonia and frequency of circuit changes. Am J Infect Control 1998;26:71–73.Google Scholar
111.Kollef, MH, Shapiro, SD, Fraser, VJ, et al.Mechanical ventilation with or without 7-day circuit changes: a randomized controlled trial. Ann Intern Med 1995;123:168–174.CrossRefGoogle ScholarPubMed
112.Hess, DR, Kallstrom, TJ, Mottram, CD, Myers, TR, Sorenson, HM, Vines, DL. Care of the ventilator circuit and its relation to ventilator-associated pneumonia. Respir Care 2003;48:869–879.Google Scholar
113.Dreyfuss, D, Djedaini, K, Weber, P, et al.Prospective study of nosocomial pneumonia and of patient and circuit colonization during mechanical ventilation with circuit changes every 48 hours versus no change. Am Rev Respir Dis 1991;143:738–743.Google Scholar
114.Markowicz, P, Ricard, JD, Dreyfuss, D, et al.Safety, efficacy, and cost-effectiveness of mechanical ventilation with humidifying filters changed every 48 hours: a prospective, randomized study. Crit Care Med 2000;28:665–671.Google Scholar
115.Canadian Task Force on the Periodic Health Examination. The periodic health examination. Can Med Assoc J 1979;121:1193–1254.Google Scholar
116.Ntoumenopoulos, G, Presneill, JJ, McElholum, M, Cade, JF. Chest physiotherapy for the prevention of ventilator-associated pneumonia. Intensive Care Med 2002;28:850–856.Google Scholar
117.Goldhill, DR, Imhoff, M, McLean, B, Waldmann, C. Rotational bed therapy to prevent and treat respiratory complications: a review and meta-analysis. Am J Crit Care 2007;16:50–61; quiz 62.CrossRefGoogle ScholarPubMed
118.Hoth, JJ, Franklin, GA, Stassen, NA, Girard, SM, Rodriguez, RJ, Rodriguez, JL. Prophylactic antibiotics adversely affect nosocomial pneumonia in trauma patients. J Trauma 2003;55:249–254.Google Scholar
119.Kahn, JM, Doctor, JN, Rubenfeld, GD. Stress ulcer prophylaxis in mechanically ventilated patients: integrating evidence and judgment using a decision analysis. Intensive Care Med 2006;32:1151–1158.CrossRefGoogle ScholarPubMed
120.Kantorova, I, Svoboda, P, Scheer, P, et al.Stress ulcer prophylaxis in critically ill patients: a randomized controlled trial. Hepatogastroenterology 2004;51:757–761.Google ScholarPubMed
121.Yildizdas, D, Yapicioglu, H, Yilmaz, HL. Occurrence of ventilator-associated pneumonia in mechanically ventilated pediatric intensive care patients during stress ulcer prophylaxis with sucralfate, ranitidine, and omeprazole. J Crit Care 2002;17:240–245.CrossRefGoogle ScholarPubMed
122.Levy, MJ, Seelig, CB, Robinson, NJ, Ranney, JE. Comparison of omeprazole and ranitidine for stress ulcer prophylaxis. Dig Dis Sci 1997;42:1255–1259.Google Scholar
123.Liberati, A, D'Amico, R, ****Pifferi, , Torri, V, Brazzi, L. Antibiotic prophylaxis to reduce respiratory tract infections and mortality in adults receiving intensive care. Cochrane Database Syst Rev 2004;(1):CD000022.CrossRefGoogle ScholarPubMed
124.van Nieuwenhoven, CA, Buskens, E, van Tiel, FH, Bonten, MJ. Relationship between methodological trial quality and the effects of selective digestive decontamination on pneumonia and mortality in critically ill patients. JAMA 2001;286:335–340.Google Scholar
125.Bonten, MJ. Selective digestive tract decontamination—will it prevent infection with multidrug-resistant gram-negative pathogens but still be applicable in institutions where methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci are endemic? Clin Infect Dis 2006;43(Suppl 2):S70–S74.CrossRefGoogle ScholarPubMed
126.de Jonge, E, Schultz, MJ, Spanjaard, L, et al.Effects of selective decontamination of digestive tract on mortality and acquisition of resistant bacteria in intensive care: a randomised controlled trial. Lancet 2003;362:1011–1016.Google Scholar
127.Krueger, WA, Lenhart, FP, Neeser, G, et al.Influence of combined intravenous and topical antibiotic prophylaxis on the incidence of infections, organ dysfunctions, and mortality in critically ill surgical patients: a prospective, stratified, randomized, double-blind, placebo-controlled clinical trial. Am J Respir Crit Care Med 2002;166:1029–1037.CrossRefGoogle ScholarPubMed
128.Silvestri, L, van Saene, HK, Milanese, M, Gregori, D, Gullo, A. Selective decontamination of the digestive tract reduces bacterial bloodstream infection and mortality in critically ill patients: systematic review of randomized, controlled trials. J Hosp Infect 2007;65:187–203.Google Scholar
129.Pacheco-Fowler, V, Gaonkar, T, Wyer, PC, Modak, S. Antiseptic impregnated endotracheal tubes for the prevention of bacterial colonization. J Hosp Infect 2004;57:170–174.CrossRefGoogle ScholarPubMed
130.Berra, L, De Marchi, L, Yu, ZX, Laquerriere, P, Baccarelli, A, Kolobow, T. Endotracheal tubes coated with antiseptics decrease bacterial colonization of the ventilator circuits, lungs, and endotracheal tube. Anesthesiology 2004;100:1446–1456.Google Scholar
131.Collier, B, Diaz, J JrForbes, R, et al.The impact of a normoglycemic management protocol on clinical outcomes in the trauma intensive care unit. JPEN J Parenter Enteral Nutr 2005;29:353–358; discussion 359.Google Scholar
132.van den Berghe, G, Wouters, P, Weekers, F, et al.Intensive insulin therapy in the critically ill patients. N Engl J Med 2001;345:1359–1367.Google Scholar
133.Toschlog, EA, Newton, C, Allen, N, et al.Morbidity reduction in critically ill trauma patients through use of a computerized insulin infusion protocol: a preliminary study. J Trauma 2007;62:1370–1375; discussion 1375-1376.Google ScholarPubMed
134.Brunkhorst, FM, Engel, C, Bloos, F, et al.Intensive insulin therapy and pentastarch resuscitation in severe sepsis. N Engl J Med 2008;358:125–139.CrossRefGoogle ScholarPubMed
135.Wong, ES, Rupp, ME, Mermel, L, et al.Public disclosure of healthcare-associated infections: the role of the Society for Healthcare Epidemiology of America. Infect Control Hosp Epidemiol 2005;26:210–212.Google Scholar
136.McKibben, L, Horan, TC, Tokars, JI, et al.Guidance on public reporting of healthcare-associated infections: recommendations of the Healthcare Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol 2005;26:580–587.Google Scholar
137. The Healthcare-Associated Infection Working Group of the Joint Public Policy Committee. Essentials of public reporting of healthcare-associated infections: a tool kit. Available at: http://www.cdc.gov/ncidod/dhqp/pdf/ar/06_107498_Essentials_Tool_Kit.pdf. Accessed April 6, 2007.Google Scholar
138.The National Quality Forum. National voluntary consensus standards, endorsed November 15, 2007. Available at: http://www.qualityforum.org/pdf/news/lsCSACMeasures.pdf. Accessed December 20, 2007.Google Scholar