2554

Ventilator-associated Pneumonia

..

Rev: 20 November 2011

Ventilator-associated Pneumonia(VAP)

ICU

6.8-32% NICU

VAP/1,000

ICU ICU

3-4

VAP

VAP

48 .

: gold standard & : gold standard &

hypothermia ypsecretions

Microbiological factors pleural fluid / tracheal aspirate/BAL

CXR infiltrates

colonization

antibiotics ICU ICU

Gastroesophageal refluxGastroesophageal reflux

contact

: Antibiotic-resistantPseudomonas aeruginosaAcinetobacter spp.Acinetobacter spp.Klebsiella spp.E t b tEnterobacter spp.Methicillin resistant staphylococcus aureusp y

Organisms causing VAP in NICU Srinagarind HospitalSrinagarind Hospital

January-August 2010

28.13

2530

P.aeruginosaMRSA

21.87

15.62

25

20

25 Enterobacter sp.Xanthomonas15.62

9.3715 K.pneumoniae

A.baumanii6.25

3.13

6.25 6.25

5

10 E.coliCandida albicans

0 VAP

Serratia sp.

Ch i Vi f VAPChanging Views of VAP

The Joint Commission on the Accreditation of Healthcare Organizations (JCAHO)Healthcare Organizations (JCAHO)

Medical error

VAP

VAP VAP NICU .

2546

2552 close suction

2548 KM 2549

2552 admit

TSC 2549 retrospective (2546-2548)

2550 VAP

TSC 2553 KM

100% 2550 VAP 100%

(2546-2553)

1.

Hand hygieneyg

contact precautions

Hand HygieneHand Hygiene

alcohol-based waterless antiseptic agentantiseptic agent

secretion secretion : MRSA, MDR

2

2.

: Nosocomial sinusitisNosocomial sinusitis

2

: Oral Care

ti ETT suction ETT

- ETT ETT No. 8

O l h i Oral hygiene

2.

Neonatal Resuscitation Team

SiPAPNon-invasive Ventilation

SiPAP

CPAP

2.

Wean

Individual assessment

for extubation

2.

:

30 30

:

80 100 10 15 -80 -100 . 10-15

2-4 /

15-30O15 30

:

:

:

circuit ETT

circuit ETT 15-30 ETT, OG

ETT ETT /

7

Ambu Ambu

bag

Prevention of Contamination

ventilator circuits 7

Prevention of Contamination suction

Open suction Open suction Closed-system suctionOpen suction Open suction Closed system suction

circuit

70% alcohol

Prevention of ContaminationPrevention of Contamination

70% alcohol 70% alcohol

Prevention of ContaminationPrevention of Contamination

Ambu-

b ambu-

OG tube

7

VAPVAP score

audit

audit

Hand Hygiene

1. 1. NB conference (PCT)

2.

3 3.

sensor Automatic alcohol hand rub

alcohol hand rub

1 2553 25 25531 2553 25 2553

scan

Lotion

6

scan 6 scan

6 6

VDO

35

86 19 86.19 13.81 40.00

22.85 2 86 2.86 100%

tracheal aspirate tracheal aspirate

VAP/1000

12 /1000 12 /1000

Prevention of Contamination Prevention of Contamination

1. 2 closed-system1.

2.closed-system suction

closed suction open suction closed - system suction open- system suction

1. 1 2 2. off circuit suction off circuitsuction

3. suction

4.

5 5. 6.

closed suction open suction closed - system suction open- system suction

7 Ambu bag suction 8

h

Ambub pneumothorax bag

9

10

11

12

13

2551-2554

70

5060

2551

3040 2552

25532030 2553

2554

010

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

newborn conference (PCT) feed back feed back

newborn conference

2554

N=2901. 23(100%) 39(100%) 30(93.34%) 116

(100%)78(100%) 2(100%) 288(99.32%)

2. - - 2*(6.66%)

- - - 2*(0.68%)*

3. - 2**(100%) 10** 10** 8**(10.25%) 2**(100%) 32(11.11%)( %)(33.33%) (31.25%)

( %) ( %) ( %)

4. - - - 20(100%) 20(100%) - 40(100%)4. 15(100%) 18(100%) 4(100%) 10(100%) - - 47(100%)

5. - 15(100%) 18(90%)2*(10%)

2(100%) - - 35(94.60%)2*(5.40%)

6.IVF - - - 25(100%) 25(100%) - 50(100%)

7. central-line 3(100%) - - 1(100%) - - 4(100%)7. 1(100%) - - - - 2(100%) 3(100%) 8 3(100%) 2(100%) 4 (100%) - - - 9(100%) 8. 3(100%) 2(100%) 4 (100%) 9(100%) 9. LP 1(100%) 7(100%) 2(100%) 5(100%) 8(100%) - 23(100%) 10.+,

- - - 28(100%) - - 28(100%)

1. 100%2. 290 3. * 4. **

11., - - - 25(100%) 25(100%) - 50(100%)

1. : :

2. 3 3.4.:5 5. 6.

7.

Thank Youhank You