ABSTRACT
Resumen Introducción: La neumonía asociada a la ventilación mecánica (NAVM) es un evento adverso que aumenta la morbi-mortalidad y costos. Genera días adicionales de hospitalización y de procedimientos diagnósticos y terapéuticos para su tratamiento. No existen datos actualizados nacionales respecto al exceso de costos por NAVM. Objetivo: Dimensionar el costo de las NAVM en un hospital general de la Región Metropolitana. Pacientes y Métodos: Aplicación del protocolo caso-control de costos de infecciones intrahospitalarias de la Organización Panamericana de la Salud (OPS) y cálculo directo de gasto en exceso por evento de NAVM. Se comparó el exceso de días de hospitalización, de antimicrobianos en dosis diaria definida (DDD) y de cultivos. Resultados: Se recolectaron 18 casos de NAVM entre los años 2012 y 2015 en pacientes adultos. Se seleccionaron 18 controles pareados por edad y género. Se observó una mayor estadía promedio de 6,1 días en los casos (p < 0,05), una mayor prescripción de antimicrobianos (diferencia promedio de 11,7 DDD, sin significancia estadística) y un exceso de solicitud de cultivos con una diferencia promedio de 3,2 (p < 0,05). El costo unitario por NAVM fue de 4.475 USD. Conclusiones: Los eventos de NAVM generan una mayor estadía hospitalaria, consumo de recursos diagnósticos y terapéuticos.
Background: Ventilator-associated pneumonia (VAP) is an adverse event that increases morbidity, mortality and costs due to a prolonged stay and requirement of microbiological studies and antimicrobial therapy. There is not recent data of VAP costs in Chile. Aim: To evaluate additional costs in adult patients with VAP compared to controls in a general hospital in the Metropolitan Area. Patients and Methods: Use of the PAHO paired casecontrol protocol for cost evaluation associated to nosocomial infections and estimation of cost in excess per VAP event. Length of stay (LOS) in excess, antimicrobial consumption in daily-defined doses (DDD), and number of microbiological studies were compared between both groups. Results: From 2012 to 2015, 18 patients with VAP events were identified with their respective controls. LOS exceeded 6.1 days on average among patients with VAP respect to controls (p < 0.05). DDD was higher among patients with VAP (difference 11.7 DDD) as well as number of cultures (3.2 higher on average, p < 0.05). Cost in excess per VAP event reached 4,475 USD. Conclusions: In our Centre, VAP events are associated to a higher LOS, antimicrobial consumption and microbiological studies.
Subject(s)
Humans , Male , Female , Adult , Health Care Costs/statistics & numerical data , Pneumonia, Ventilator-Associated/economics , Chile , Statistics, Nonparametric , Pneumonia, Ventilator-Associated/drug therapy , Hospitals, General/economics , Length of Stay/economics , Anti-Infective Agents/economics , Anti-Infective Agents/therapeutic useABSTRACT
RESUMO Objetivo: avaliar os impactos e fatores determinantes no cumprimento do bundle para redução da pneumonia associada à ventilação mecânica. Método: estudo longitudinal retrospectivo, descritivo, com abordagem quantitativa, realizado no Hospital público de ensino. Coleta realizada entre maio de 2014 e abril de 2015. Participaram da pesquisa, os pacientes da UTI, notificados com PAV. Para a organização dos dados foi utilizado o programa Microsoft Excel 2010. Estabeleceu-se uma análise crítica entre os dados levantados e as taxas de infecção. A pesquisa obteve parecer favorável, sob o n° 566.136. Resultados: observou-se aumento na incidência de PAV após implementação do bundle; os patógenos prevalentes foram bactérias gram-negativas. Os óbitos foram iguais ou maiores a 50%. As mudanças de profissionais e a falta de insumos foram fatores determinantes. Conclusão: nesse contexto, ressalta-se a necessidade de qualificação permanente da equipe, com o propósito de favorecer a adesão ao protocolo e prevenir a PAV.
RESUMEN Objetivo: evaluar los impactos y factores determinantes en el cumplimiento del bundle para reducir la neumonía asociada a la ventilación mecánica (NAV). Método: se trata de un estudio descriptivo retrospectivo longitudinal con un enfoque cuantitativo, realizado en el hospital público universitario. La recolección de datos se ha llevado a cabo entre mayo de 2014 y abril de 2015. Los participantes fueron los pacientes de la UCI reportados con NAV. Para la organización de los datos se utilizó el programa Microsoft Excel 2010. Se estableció un análisis crítico de los datos recogidos y las tasas de infección. La investigación fue aprobada bajo el número de registro 566.136. Resultados: hubo un aumento en la incidencia de NAV después de la implementación del bundle; los patógenos prevalentes fueron las bacterias gramnegativas. Las muertes eran igual o superior al 50%. Cambios profesionales y la falta de insumos fueron factores determinantes. Conclusión: en este contexto, se destaca la necesidad de una formación continua del personal, con el fin de promover la adhesión al protocolo y prevenir la NAV.
ABSTRACT Objective: Assessing the determining impacts and factors in ventilator-associated pneumonia (VAP) bundle. Method: descriptive retrospective longitudinal study, with quantitative approach, held at a public teaching hospital. Collection held between May 2014 and April 2015. Patients of the ICU with VAP participated in the research. For organizing data, the Microsoft Excel 2010 program was used. A critical analysis between the data collected and infection rates was performed. The survey was approved under no. 566,136. Results: an increase in the incidence of VAP after implementing the bundle was observed; the prevalent pathogens were gram-negative bacteria. Deaths were equal to or greater than 50%. Changes of professionals and lack of supplies were determining factors. Conclusion: in this context, the need for permanent qualification of the team is emphasized, with the purpose of promoting the adherence to the protocol and preventing VAP.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Young Adult , Patient Care Bundles , Pneumonia, Ventilator-Associated/epidemiology , Brazil/epidemiology , Intensive Care Units , Longitudinal Studies , Outcome Assessment, Health Care , Pneumonia, Ventilator-Associated/economics , Pneumonia, Ventilator-Associated/etiology , Pneumonia, Ventilator-Associated/microbiology , Pneumonia, Ventilator-Associated/prevention & control , Retrospective Studies , Risk FactorsABSTRACT
Abstract Objectives The aim of this study was to evaluate the impact of a bundle called FAST HUG in ventilator-associated pneumonia, weigh the healthcare costs of ventilator-associated pneumonia patients in the intensive care unit, and hospital mortality due to ventilator-associated pneumonia. Material and methods The study was performed in a private hospital that has an 8-bed intensive care unit. It was divided into two phases: before implementing FAST HUG, from August 2011 to August 2012 and after the implementation of FAST HUG, from September 2012 to December 2013. An individual form for each patient in the study was filled out by using information taken electronically from the hospital medical records. The following data was obtained from each patient: age, gender, reason for hospitalization, use of three or more antibiotics, length of stay, intubation time, and outcome. Results After the implementation of FAST HUG, there was an observable decrease in the occurrence of ventilator-associated pneumonia (p < 0.01), as well as a reduction in mortality rates (p < 0.01). In addition, the intervention resulted in a significant reduction in intensive care unit hospital costs (p < 0.05). Conclusion The implementation of FAST HUG reduced the number of ventilator-associated pneumonia cases. Thus, decreasing costs, reducing mortality rates and length of stay, which therefore resulted in an improvement to the overall quality of care.
Subject(s)
Humans , Male , Female , Aged , Infection Control/methods , Critical Care/methods , Pneumonia, Ventilator-Associated/prevention & control , Brazil/epidemiology , Clinical Protocols , Survival Rate , Hospital Mortality , Hospital Costs , APACHE , Pneumonia, Ventilator-Associated/economics , Pneumonia, Ventilator-Associated/mortality , Intensive Care Units , Anti-Bacterial Agents/therapeutic useABSTRACT
We conducted a clinical trial to determine the impact of coating surfaces with copper in reducing hospital-acquired infections, mortality associated with nosocomial infections and antimicrobial costs in the UCI. The study took place at Carlos Van Buren Hospital, Valparaíso, Chile. No differences in the frequency of nosocomial infections were found. Not in rates of ventilator-associated pneumonia (p = 0.9), nor in catheter- associated urinary tract infection (p = 0.9) or in central venous catheter associated bacteremia (p = 0.3). There were no differences in infection-free survival (p = 0.9). There were less costs of antimicrobials in patients in which copper was used. The fact that the sample size was not completed could explain that no significant differences in infections were found. Conclusion: The use of copper as a surface in the ICU showed no statistically significant differences in rates of nosocomial infections during the study period, however, these results could be related to the sample size.
Introducción: Las infecciones nosocomiales incrementan la mortalidad y costos en las instituciones de salud. El revestimiento con cobre, de superficies de alto contacto en la unidad clínica en torno a los pacientes, reduce la colonización bacteriana de las mismas. Objetivo: Determinar el impacto del revestimiento de las superficies con cobre en la disminución de las infecciones intrahospitalarias, la mortalidad asociada a las infecciones intrahospitalarias y los costos en antimicrobianos en pacientes hospitalizados en UCI adultos en el Hospital Carlos Van Buren. Pacientes y Métodos: Estudio prospectivo, comparativo, mayo de 2011-mayo de 2012. Asignación aleatoria de pacientes adultos ingresados en UCI, que permanecieran al menos por 24 h en dicha unidad, a unidades de aislamiento recubiertas (n: 7) o no recubiertas con cobre (n: 7). Resultados: Ingresaron al estudio 440 pacientes, 217 pacientes (49,3%) en el grupo sin cobre y 223 en el grupo con cobre (50,7%). No se encontraron diferencias en la frecuencia de infecciones intrahospitalarias en ambos grupos. Tampoco se encontraron diferencias significativas en las tasas de neumonía asociada a ventilación mecánica (p = 0,9), infección urinaria asociada a catéter urinario (p = 0,9) y bacteremias asociada a catéter venoso central (p = 0,3). Tampoco se encontraron diferencias en la sobrevida libre de infección (p = 0,9). Se encontró un gasto menor de antimicrobianos en pacientes atendidos en unidades revestidas con cobre. Durante el período del estudio no se completó el tamaño de muestra y las diferencias no significativas podrían deberse a este hecho. Conclusión: El uso del cobre como revestimiento de las superficies hospitalarias en UCI, mostró diferencia en la tasa de bacteriemia asociada a dispositivos venosos, aunque no significativa, y no mostró diferencia en neumonías e infecciones urinarias. Las diferencias no significativas pueden deberse a que no se completó el tamaño de la muestra. Se observó un mayor gasto de antimicrobianos en pacientes de unidades no cobrizadas, lo que plantea una nueva área de investigación.