Vap Bundles [PDF]

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PAPININ – IP INDONESIA



PENERAPAN BUNDLES



VENTILATOR ASSOCIATED PNEUMONIA (VAP) Disampaikan pada acara zoominar Pencegahan dan Pengendalian Infeksi



“ PENERAPAN BUNDLES HAIs” Tanggal 2 Agustus 2020 jam 13.00 - 16.00 wib



PAPININ – IP INDONESIA



POKOK BAHASAN           



Pendahuluan Latar Belakang Pengertian Tujuan Patogenesis Faktor-faktor penyebab Dampak Mikroorganisme penyebab Kriteria Bundles HAIs Kesimpulan



PENDAHULUAN



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 Ventilator Associated Pneumonia adalah Infeksi pneumonia akibat Pemasangan Ventilasi mekanik



 Ventilasi mekanik tidak dapat dihindari karena kondisi pasien yang gagal napas atau depresi pernapasan untuk memenuhi kebutuhan oksigensasi pasien  Untuk mencegah VAP maka dibuatlah suatu upaya untuk mencegah dengan menerapkan bundles VAP



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LATAR BELAKANG VAP adalah masalah HAIs yang terbesar di ICU, VAP di PICU mencapai 31.7 per 1000 hari pemakaian ventilator (INICC, 2009-2010) VAP: 8-28% (American Thoracic Society, 2005). VAP: 32 % (NHSN 2013) Kuman tertinggi pada VAP adalah Acinetobacter dan E.coli (INICC, 2004-2008) VAP berdampak kematian, kerugian, lama rawat menginap, mutu menurun



Craven,2005 NHSN :Nasional Healthcare Safety Network INICC: International Nosocomial Infection Control Consortium



Sumber : Komite PPI RSJPDHK



VAP bundle compliance rate and VAP rate



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PENGERTIAN



Tanpa Ventilasi mekanik /Ventilator



Ventilator Associated Pneumonia (VAP) adalah infeksi pneumonia yang terjadi pada parenkhim paru dengan pasien yang terpasang ventilasi mekanik baik pipa endotracheal maupun tracheostomy ≥ dua hari kalender



Terpasang Ventilasi mekanik /Ventilator



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PENGERTIAN Bundle Ventilator adalah serangkaian intervensi keperawatan berbasis bukti, diterapkan untuk mencegah insiden VAP



Bundle hanya terdiri dari 3 - 5 intervensi keperawatan



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PATOGENESIS



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FAKTOR RISIKO VAP Endogen           



Immunocompromised Penyakit penyerta Usia Ekstrem



Male gender



Malnutrisi Gangguan mental MOF (Multi Organ Failure) Acut Renal Failure ARDS Ulcer Diseases Pembedahan (Neuro, thorax, cardiac)  Kolonisasi mikroorganisme digestive dan oropharing



Exogen     



    



Pemakaian Ventilator Kebersihan tangan tidak adekuat Teknik aseptik tidak adekuat Pemakaian antibiotika Pemakaian APD tidak tepat dan benar Posisi pasien supine Lama pemakaian ventilator Sumber daya kurang (men, metode, material) Re-intubasi Pergantian sirkuit ventilator



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DAMPAK VAP       



Lama hari rawat meningkat Penggunaan antibiotika meningkat Biaya meningkat Angka kesakitan meningkat Angka kematian meningkat Biaya menurun Tuntutan hukum



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MIKROORGANISME PENYEBAB Early onset: Hemophilus influenza Streptococcus pneumoniae Staphylococcus aureus (methicillin sensitive) Escherichia coli Klebsiella Late onset: Pseudomonas aeruginosa Acinetobacter Staphylococcus aureus (methicillin resistant) • Most strains responsible for early onset VAP are antibiotic sensitive. Those responsible for late onset VAP are usually multiple antibiotic resistant



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MIKROORGANISME VAP



KRITERIA VAP



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Table 1: Specific Site Algorithms for Clinically Defined Pneumonia (PNU1) Imaging Test Evidence



Signs/Symptoms



Two or more serial chest imaging test results with at least one of the following: New and persistent or Progressive and persistent • Infiltrate • Consolidation • Cavitation



ANY PATIENT, at least one of the following: • Fever (>38.0°C ) • Leukopenia (≤4000 WBC/mm3 ) or leukocytosis (>12,000 WBC/mm3 ) • For adults >70 years old, altered mental status with no other recognized cause And at least two of the following: • New onset of purulent sputum or change in character of sputum4 , or increased respiratory secretions, or increased suctioning requirements • New onset or worsening cough, or dyspnea, or tachypnea5 • Rales6 or bronchial breath sounds • Worsening gas exchange (for example: O2 desaturations (for example: PaO2/FiO2 1 year old or ≤12 years old, at least three of the following: • Fever (>38. 0°C) or hypothermia (< 36 .0°C ) Leukopenia (≤4000 WBC/mm3 ) or leukocytosis (≥15,000 WBC/mm3 ) • New onset of purulent sputum or change in character of sputum4 , or increased respiratory secretions, or increased suctioning requirements • New onset or worsening cough, or dyspnea, apnea, or tachypnea5 . • Rales6 or bronchial breath sounds • Worsening gas exchange (for example: O2 desaturations [for example pulse oximetry < 94%, increased oxygen requirement or increased ventilation demand



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KRITERIA VAP



Table 2: Specific Site Algorithms for Pneumonia with Common Bacterial or Filamentous Fungal Pathogens and Specific Laboratory Findings (PNU2) Imaging Test Evidence



Signs/Symptoms



Laboratory



Two or more serial chest imaging test results with at least one of the following: New and persistent or Progressive and persistent • Infiltrate • Consolidation • Cavitation In patients without underlying pulmonary or cardiac disease (for example: respiratory distress syndrome, bronchopulmonary dysplasia, pulmonary edema, or chronic obstructive pulmonary disease), one definitive chest imaging test result is acceptable



At least one of the following: • Fever (>38.0°C) • Leukopenia (≤4000 WBC/mm3 ) or leukocytosis (>12,000 WBC/mm3 ) • For adults >70 years old, altered mental status with no other recognized cause And at least one of the following: • New onset of purulent sputum or change in character of sputum , or increased respiratory secretions, or increased suctioning requirements • New onset or worsening cough, or dyspnea or tachypnea • Rales or bronchial breath sounds • Worsening gas exchange (for example: O2 desaturations [for example: PaO2/FiO2 38.0°C • Leukopenia (≤4000 WBC/mm3 ) or leukocytosis (>12,000 WBC/mm3 ) • For adults >70 years old, altered mental status with no other recognized cause And at least one of the following: • New onset of purulent sputum or change in character of sputum , or increased respiratory secretions, or increased suctioning requirements • New onset or worsening cough or dyspnea, or tachypnea • Rales or bronchial breath sounds • Worsening gas exchange (for example: O2 desaturations [for example: PaO2/FiO2 38.0°C • For adults >70 years old, altered mental status with no other recognized cause • New onset of purulent sputum , or change in character of sputum , or increased respiratory secretions, or increased suctioning requirements • New onset or worsening cough, or dyspnea, or tachypnea5 • Rales6 or bronchial breath sounds • Worsening gas exchange (for example: O2 desaturations for example: PaO2/FiO2