A set of training materials for professionals working in intervention epidemiology, public health microbiology and infection control and hospital hygiene.
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Ventilator associated pneumonia (VAP) is a lung infection that develops in a patient who has been mechanically ventilated for >48 hours and is defined by clinical, radiographic, and microbiological criteria. These criteria are subjective, leading to substantial inter-observer variability. The clinical and surveillance definitions of VAP are compiled and summarized by SHEA/IDSA in a publication from 2014 .
2. Burden of disease.
The prevalence and incidence of VAP are difficult to calculate since definitions are subjective and non-specific. Clinical surveys suggest that 10-20% of ventilated patients will develop VAP . The attributable mortality of VAP is estimated to be approximately 10%, ranging between 3% and 17%, and varies for different kinds of patients. Critically ill patients who develop VAP appear to be twice as likely to die compared with similar patients without VAP. VAP increases direct medical costs since VAP extend patients’ duration of mechanical ventilation, increase intensive care and hospital length of stay, and are associated with increased use of antimicrobials.
3. How to prevent-specific requirements.
It has been shown that 55% of VAP cases can be prevented when evidence-based guidelines are followed . General conditions must be met to prevent HAIs described elsewhere regarding education of staff, surveillance and infrastructure. VAP develops due to microbial invasion of the normally sterile lung and is a result of either impaired host defences, the presence of a high dose of microorganisms or a particularly virulent pathogen. The predisposing factor is the endotracheal tube that bypasses the body’s natural defence mechanisms against respiratory infection. The tube impairs cough and mucociliary clearance and creates an abnormal passageway between the upper airway and the trachea. In addition, the tube may facilitate the entry of bacteria by pooling and leakage of contaminated secretions around the cuff. Non-invasive mechanical ventilation is associated with a lower incidence of nosocomial infection and the overall focus of guidelines is to prevent deep sedation for long times and to encourage patients to breathe spontaneously to decrease the need of an endotracheal tube. The following recommendations are based on recently published guidelines for adults . A bundled strategy with the following elements can decrease VAP incidence significantly [3,4].
– use noninvasive positive pressure ventilation if possible in selected populations;
– assess possibility to extubate daily.
– manage patients without sedation whenever possible,
– interrupt sedation daily;
– perform spontaneous breathing trials with sedatives turned off;
– facilitate early mobility;
– minimize pooling of secretions above the endotracheal tube cuff. Use endotracheal tubes with subglottic secretion drainage ports for patients expected to require greater than 48 or 72 hours of mechanical ventilation;
– change the ventilator circuit only if visibly soiled or malfunctioning;
– follow guidelines for sterilization and disinfection of respiratory care equipment.
– elevate the head of the bed to 30°-45°;
– use selective oral or digestive decontamination to decrease the microbial burden of the aerodigestive tract;
– perform regular oral care with chlorhexidine and provide mechanical tooth brushing.
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Jakob Schumacher posted on 10/10/2013 6:53:16 PM:
Software collection amongst EPIET Facilitators and Fellows collected at the introductory course 2013 in Spetses
Arnold Bosman replied on 10/10/2013 7:28:46 PM:
Is there some info on this post missing? Which were the software?
Arnold Bosman replied on 10/10/2013 7:30:13 PM:
Ah... I see... The formatting is a bit strange, probably copy-paste from another source?
Thanks a lot for the overview !!
Naomi Boxall replied on 10/11/2013 10:24:35 AM:
I still can't see it..?
Vladimir Prikazsky replied on 10/11/2013 12:31:25 PM:
You are right Nomes... we can see just the text. The page is visible in history mode but not in edit mode. In edit mode I could see the html code. there should be something incompatible in that code. I'll try to solve it....
Arnold Bosman replied on 10/11/2013 12:57:25 PM:
Dear all, I just discovered that when you click on the link to this forum, you will not see the chapter it refers to. Yet when you go to the chapter of software that Jakob made, you will see this forum discussion.
Hope this clarifies
Naomi Boxall replied on 10/11/2013 1:04:56 PM:
Aha! So, it's here!
Arnold Bosman replied on 10/11/2013 1:10:39 PM:
I started to add some hyperlinks. This page would be a very good page as roadmap to point to all online resources :)
Vladimir Prikazsky replied on 2/7/2014 9:49:41 AM:
Quick guide for experienced users of other statistical packages (e.g., SAS, SPSS, Stata) who would like to transition to R. http://www.statmethods.net/index.html
Vladimir Prikazsky replied on 10/16/2014 7:00:58 PM:
Thanks to Florian and the EAN - we can publish useful links:http://epiinfovhf.codeplex.com/this is the official CDC software used in this epidemic. It is an adapted EpiInfo7 version that supports contact tracing etc. Please refer to the website for details.Digital Maps:Humanitarian Open Street Map Teamhttp://hot.openstreetmap.org/These folks crowdsource the digital annotation of satellite maps and aerial photos. The latter are taken by high-quality aerial drones which quickly become standard equipment for missions.HOT creates the shapefiles for Guinea, Liberia, Sierra-Leone:https://wiki.openstreetmap.org/wiki/2014_West_Africa_Ebola_Response#ShapeFiles_for_GIS_softwaresThe site also has offline maps for GPS devices.Quick try:1. Install Qgis: http://qgis.org/de/site/forusers/download.html2. Load Liberia Shapefiles and extract: http://download.geofabrik.de/africa/liberia-latest.shp.zip3. Start QGis4. Move all *.shp files (and only the *.shp files) on the open and empty QGis map-window
Vladimir Prikazsky replied on 11/7/2014 12:38:36 AM: Epidata course developped by Hans L. Rieder (IUATLD):
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