2554

Ventilator-associated
Pneumonia

Rev: 20 November 2011

..

Ventilator-associated Pneumonia
(VAP)

ICU
6.8-32% NICU
VAP/1,000

ICU

3-4

 VAP

48 .

:
gold standard &

hypothermia
yp

secretions

Microbiological factors

pleural fluid / tracheal aspirate/BAL
CXR infiltrates

colonization
antibiotics

ICU

Gastroesophageal reflux

contact

: Antibiotic-resistant
Pseudomonas aeruginosa
Acinetobacter spp.
Klebsiella spp.
E t b t spp.
Enterobacter
Methicillin resistant staphylococcus
p y
aureus

Organisms causing VAP in NICU

Srinagarind Hospital
January-August 2010
30
25

P.aeruginosa

28.13

MRSA

25

21.87

20

Enterobacter sp.
Xanthomonas

15.62

K.pneumoniae

15
10
5

6.25

6.25

9.37

3.13

6.25

A.baumanii
E.coli
Candida albicans
Serratia sp.

0
VAP

Ch
Changing
i Views
Vi
off VAP
The Joint Commission on the Accreditation of
Healthcare Organizations (JCAHO)
Medical error

VAP

VAP
NICU .

2546

2548 KM

2549

retrospective (2546-2548)
2550
VAP

2552 close suction

2552 admit
TSC

2553 KM
100%


(2546-2553)
1.

Hand hygiene
yg

contact precautions

Hand Hygiene

alcohol-based waterless
antiseptic agent

secretion




: MRSA, MDR

2
2.

:

Nosocomial sinusitis


: Oral

suction
ti
ETT
-

ETT

No. 8

Oral
O l hygiene
h i

Care

2.

Neonatal Resuscitation Team

Non-invasive Ventilation
SiPAP

CPAP

2.

Wean

Individual assessment
for extubation

2.

30

 :


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

2-4

/

15-30
15
30O

 :

circuit
ETT
15-30
ETT, OG



ETT

Ambu
bag

Prevention of Contamination

ventilator circuits

Prevention of Contamination
suction

Open suction

Open suction

Closed-system
Closed
system suction

circuit

70% alcohol

Prevention of Contamination

70% alcohol

Prevention of Contamination

Ambu-

VAP score

ambu
b

OG tube

audit

 Hand Hygiene
1.

NB conference (PCT)
2.

3
3.

sensor

alcohol hand rub

Automatic
alcohol hand rub

1
2553 25
2553

scan

Lotion

scan

VDO

35

86.19
86 19

13.81

40.00

22.85

2.86
2 86


100%




tracheal aspirate

VAP/1000


12 /1000
/1000

 Prevention of Contamination

1.
1.

2.closed-system
2
closed-system

suction

 closed suction open suction

closed - system suction

1.

2.

off circuit suction

off circuitsuction

3.

suction

4.

55.
6.

open- system suction

 closed suction open suction

closed - system suction

open- system suction

Ambu bag

suction

pneumothorax
h

Ambu
b
bag

10

11

12

13

2551-2554
70
60
50

2551

40

2552

30

2553

20

2554

10
..

..

..

..

..

..

..

..

..

..

..

..

newborn conference (PCT)

feed back

newborn conference

 2554

1.

116
(100%)
-

N=290

78(100%)

2(100%)

288(99.32%)

2*(0.68%)

8**(10.25%)
( %)

2**(100%)
( %)

32(11.11%)
( %)

20(100%)
-

40(100%)
47(100%)
35(94.60%)
2*(5.40%)

23(100%)

39(100%)

2.

3.

2**(100%)
( %)

15(100%)
-

18(100%)
15(100%)

25(100%)

25(100%)

50(100%)

3(100%)
1(100%)
3(100%)
1(100%)
-

2(100%)
7(100%)
-

4 (100%)
2(100%)
-

1(100%)
5(100%)
28(100%)

8(100%)
-

2(100%)
-

4(100%)
3(100%)
9(100%)
23(100%)
28(100%)

25(100%)

25(100%)

50(100%)

4.
4.
5.
6.IVF
7. central-line
7.
8
8.
9. LP
10. + ,

11. ,

30(93.34%)

2*(6.66%)
*

10**
10**
(33.33%) (31.25%)
20(100%)
4(100%) 10(100%)
18(90%)
2(100%)
2*(10%)

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

1.
:

2.


3
3.

4.
:
5
5.

6.

7.

Thank
hank You