Hospital Acquired Pneumonia, Pneumonia, Sepsis, Ventilator-Associated Pneumonia
Conditions
Keywords
Intensive care unit, Pneumonia, Ventilator associated, Hospital acquired pneumonia, Guidelines
Brief summary
hospital-acquired pneumonia are a common disease in intensive care unit. The prevention, the diagnosis and the treatment of hospital acquired pneumonia are a frequent challenge. Nevertheless it seems that there are great differences in standard of care between hospitals. The investigators hypothesized that medical education and implementation of evidence-base guidelines can reduce the duration of mechanical ventilation in patients presenting of hospital acquired pneumonia
Detailed description
The before period (phase 1) will consist of all consecutive patients admitted to the participating ICUs before the national guidelines publication concerning healthcare associated pneumonia. The second period (phase 2) will consist of all consecutive patients admitted to the participating ICUs after the publication of the national guidelines publication concerning healthcare associated pneumonia. Afterward, an interphase will occur during which all physicians, residents, physiotherapists and nurses will receive a formal training for the processes and procedures related to the new guidelines published in september 2017. In the intervention group, on top of the standard training, the centers receive an analysis of the evolution of the practices of their center and the future of their patients between phases 1 and 2, as well as these same values for the data set. The centers are then called to conduct a meeting to determine their priority improvement points based on this audit. The third and final period (phase 3) will consist of all consecutive patients admitted to the participating ICUs after the formal training.
Interventions
OTHERGuidelines publication and application
Passing recommendations on using the guidelines in the intensive care units
OTHERTargeted experience feedback
Targeted experience feedback: On top of the standard training, the centers receive an analysis of the evolution of the practices of their center and the future of their patients between phases 1 and 2, as well as these same values for the data set. The centers are then called to conduct a meeting to determine their priority improvement points based on this audi
Sponsors
Société Française d'Anesthésie et de Réanimation
Nantes University Hospital
Study design
Observational model
CASE_ONLY
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Age \> 18 years ; IGS-II score \> 15 ; Hospital stay \>= 3 days
Exclusion criteria
* Community-acquired pneumonia, pregnant women, refusal to participate
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Unit length of stay | 28 days | Duration of ICU hospitalization Safety Issue: NA |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Intensive Care Unit free-days at day 28 | 28 days | The number of days from day 1 to day 28 on which a patient is alive outside of intensive care unit Safety Issue |
| Hospital-acquired pneumonia | 28 days | definition based on the appearance of a new infiltrate or changes in an existing infiltrate on chest X-ray associated with any two of the following clinical signs: body temperature \>38°C, leucocytosis \>12,000/ml or leukopenia \<4000/ml, and purulent pulmonary secretions that were associated with a positive quantitative or semi-quantitative bacteriological culture of a respiratory tract sample. |
| Composite measure of compliance to guidelines | 28 days | defined as the total number of performed eligible measures divided by the total number of measures for which each patient was eligible |
| Empirical treatment failure | 28 days | Defined as one or more pathogen involved in the pneumonia is not susceptible to the antibiotics used empirically |
Countries
France
Outcome results
None listed