Clinical epidemiology and outcomes of ventilator-associated pneumonia in critically ill adult patients: protocol for a large-scale systematic review and planned meta-analysis.

BACKGROUND: An increasing number of studies have investigated the clinical epidemiology and outcomes of ventilator-associated pneumonia (VAP) in intensive care units. However, these findings have not been clearly defined in broad subgroups of mechanically ventilated adults. Hence, this protocol for a systematic review and meta-analysis is designed to better understand the clinical and epidemiological features of VAP in these patient populations by establishing its overall prognosis of and risk factors for morbidity and mortality and to determine the differences in clinical and economic outcomes between VAP and non-VAP patients. METHODS: This present review will systematically search available full-text articles without date and language restrictions and indexed in PubMed, CENTRAL, CINAHL, Web of Science, and EMBASE databases. In addition, reference lists and citations of retrieved articles and relevant medical and nursing journals will be manually reviewed. Supplementary search in other databases involving trials, reviews, and grey literatures, including conference proceedings, theses, and dissertations, will be performed. Study investigators will be contacted to clarify missing or unpublished data. All prognostic studies meeting the pre-defined eligibility criteria will be included. The study selection, risk of bias assessment, data extraction, and grading of the quality of evidence will be carried out in duplicate, involving independent evaluation by two investigators with consensus or a third-party adjudication. The degree of inter-rater agreement will be calculated using the kappa statistic. For meta-analysis, dichotomous and continuous outcome measures will be pooled using odds ratios and standardized mean differences with 95% confidence intervals, respectively. The Mantel-Haenszel or inverse variance methods with random effects model will be used as a guide for analysis. The heterogeneity of each outcome measure will be assessed using both X2 and I2 statistics. In addition, sensitivity and subgroup analyses will be performed to ensure consistency of pooled results. The review protocol described herein is in accordance with the PRISMA-P standards. DISCUSSION: The investigation of the epidemiological profiles, prognostic factors, and outcomes associated with VAP is critical for the identification of high-risk groups of mechanically ventilated patients and evaluation of possible clinical endpoints. This may provide substantial links for improved VAP prevention practices targeting modifiable risk factors. Implications for future research directions are discussed. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42017048158.

Exposure to reprocessed single-use tracheal suction catheter and ventilator-associated pneumonia risk: A preliminary, single unit-based, matched case-control study.

PURPOSE: The reuse of reprocessed single-use suction catheter for suctioning an amount of tracheal secretion among orally intubated, mechanically ventilated patients, who are at risk of acquiring ventilator-associated pneumonia (VAP), has not been thoroughly investigated. This study aimed to examine the association between the repetitive use of reprocessed single-use suction catheter and VAP development. MATERIALS AND METHODS: A preliminary, single unit-based investigation was designed as matched case-control study to extract data from hospital's existing 5-year VAP report and inpatients' clinical records. Cases were defined as patients, who developed VAP between December 2009 and October 2014. Controls were defined as patients, who had no evidence of VAP during study period. Six hundred eight controls were frequency matched to 152 cases in 4:1 ratio. Chart-extracted clinical data were stratified and included for conditional logistic regression analysis. RESULTS: Analysis showed a significant association between reprocessed single-use tracheal suction catheter exposure and VAP development [odds ratio (OR), 3.64; 95% confidence interval (CI), 2.47-5.35]. A statistically significant increase in VAP risk was found in male intubated patients (OR, 5.33; 95% CI, 1.22-23.3), who are older than 60 years (OR, 8.08; 95% CI, 1.47-44.3), had severe Glasgow Coma Scale scores (OR, 8.27; 95% CI, 1.83-37.3), and received mechanical ventilatory support for more than 96 hours (OR, 9.67; 95% CI, 1.98-47.1). In addition, a statistically significant increase in VAP risk was seen in intensive care unit, where reprocessed tracheal suction catheter changes were routinely provided (OR, 16.0; 95% CI, 2.40-106.7) and unsatisfactory hand hygiene percentage compliance was observed (OR, 8.40; 95% CI, 1.60-44.1). Ventilator-associated pneumonia proportion analysis revealed a higher number of unknown exogenous VAP among exposed cases compared to nonexposed case patients (32.2% vs 13.8%; OR, 2.31; 95% CI, 1.31-4.05; P < .005) that were mechanically ventilated for more than 96 hours (62.5% vs 25.7%; OR, 3.62; 95% CI, 2.40-5.46; P < .0001). CONCLUSIONS: This current study suggests that exposure to reprocessed single-use tracheal suction catheter may predispose orally intubated, mechanically ventilated patients in developing VAP. Further research studies are recommended to validate these findings. IMPLICATIONS FOR CLINICAL NURSING PRACTICE: The estimated VAP risk of this traditional-based practice is essential to provide strong basis for infection control measures to reduce, if not totally eliminate, VAP.