الفهرس 
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Abstract
Health care-associated infections (HCAIs) are those infections that patients acquire while getting health care and first appear 48 hours or more after admission to the hospital or during thirty days after receiving health care.
The second commonest HCAI in ICUs is Pneumonia, which affecting more than one-quarter of patients. Ventilator-Associated Pneumonia (VAP) denotes to pneumonia taking place 48 hours or more after starting of mechanical ventilation (MV).
The Institute of Health Improvement (IHI) has settled a ventilator bundle that includes several practices for prevention of morbidity related to the ventilator which included Head of the bed elevation, Oral care with chlorohexidine solution, Endotracheal tube and subglottic secretion suctioning, Peptic ulcer disease (PUD) prophylaxis, and Deep vein thrombosis (DVT) prophylaxis.
The aim of the present work was to compare between the compliance rate to the bundle and the incidence rate of VAP among patients on mechanical ventilator before and after an educational program.
The present study was conducted within two ICUs at the main Alexandria University Hospital (MAUH) in 3 phases. During first phase data was collected about compliance rate of ventilator bundle, VAP incidence rate and ventilator utilization days. During second phase an educational program was planned and implemented about VAP and its preventive strategies that contained lectures and posters. During the third phase data was collected again and analyzed to determine whether the applied strategies had improved the VAP rate or not.
During the present study we used an observational audit tool to monitor the compliance rate of performing VAP prevention bundle at the two selected ICUs containing the 5 actions (VAP prevention bundle). Our study results showed that there was a significant improvement between the baseline phase and the evaluation phase in performing all the five actions completely together in both ICUs.
Also the present study showed that action 4 and 5 performance was good both before and after the educational phase. While actions 1, 2 and 3 had the lowest performance rate at baseline phase but there was a significant improvement of them at the evaluation phase.
In our study we also monitored the rate of incidence of VAP and causative micro-organism according to laboratory findings of BAL culture results that were collected from the patient’s records. VAP Incidence rate at unit 1 decreased from 18.3% to 12.5%, while it decreased from 16.4% to 8.2% at unit 2, while VAP incidence density at unit 1 decreased from 15.3% to 8.5%, while it decreased from 21.6% to 10.9% at unit 2. But this difference in VAP incidence rates didn’t reach level of significance.
Chapter (6): Summary, Conclusion & Recommendations
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According to the causative micro-organisms at unit 1 Acinetobacter Baumanii was the most frequent micro-organism at the baseline phase (46.2%), followed by Klebsiella Pneumoniae (30.8%), and then Pseudomonas Aeruginosa and Escherichia Coli (15.4%), Candida Albicans (7.7%). While in the evaluation phase the most frequent causative micro-organism was Klebsiella Pneumoniae (50.0%), followed by Acinetobacter Baumanii (33.3%), and then Pseudomonas Aeruginosa, Escherichia Coli and MRSA with the same rates (16.7%).
As regards to the causative micro-organisms at unit 2 Pseudomonas Aeruginosa was the most frequent micro-organism in baseline phase (45.5%), followed by Klebsiella Pneumoniae and Acinetobacter Baumanii (36.4%), then Burkholderia Cepacia, Escherichia Coli and Candida Albicans with the same rates (9.1%). While at the evaluation phase the most frequent causative micro-organism was Klebsiella Pneumoniae (60.0%), then Pseudomonas Aeruginosa (40.0%), followed by Acinetobacter Baumanii and Escherichia Coli with the same rate (20.0%).
The results of the present study showed that there was negative co-relation between compliance rates of performing ventilator bundle and VAP rates. As when compliance rate increased, there was observed decreasing at VAP rates as compared to patient’s number and ventilation utilization days.
6.2. Conclusion
1- Pneumonia is a common HCAI in ICU patients regardless the cause of admission.
2- VAP is a severe infection that should be managed early or better prevented to decrease the patient’s morbidity and mortality rates.
3- Identifying the risk factors, causative micro-organisms that causing VAP in addition to detection of antibiotics sensitivity are all vital steps to manage VAP and to decrease patient suffering in addition to decrease financial burden for both patient and healthcare system.
4- VAP bundles implementation strategy is very important and effective measure to reduce the rate of VAP in MV patients.
5- The bundle strategy is relatively easy to implement and do not require the purchase of expensive technologies.
6- VAP bundle should be performed collectively together to be more effective and failure of any step of the bundle will decrease the effect of its performance on VAP rate reduction.
7- Several improvements are considered for the near future such as the addition of even more prevention measures in the basic VAP bundle that have been shown to be effective.