Study design, setting, and definition
death, pneumonia, neutropenia, pulmonary infection, VAP, infection, Extrapulmonary infection
PNEUMONIA, NEUTROPENIA, CYSTIC FIBROSIS, PULMONARY INFECTION, INFECTION, PLEURAL EMPYEMA
A clinical trial with a pretest-posttest design and not blinded was conducted after registration in the Iranian registry for clinical trials (registration number and date: IRCT20180709040402N1; 28.09.2018). The study was conducted on patients under mechanical ventilation admitted to ICUs of Golestan and Imam Khomeini hospitals in Ahvaz, Iran.The sample size was calculated using the results of an earlier study [
Inclusion criteria included age over 18 years, having an orotracheal tube and being under mechanical ventilation, no ban for the elevation of the head of the bed, having no sign of pneumonia, cystic fibrosis, pleural empyema, neutropenia, and aspiration at the start of the study and till the first 48 h after the start of mechanical ventilation, and gaining a score < 5 from the modified clinical pulmonary infection scale (MCPIS).Exclusions criteria were: Extrapulmonary infection, Patients with incomplete clinical information and records, Discharge of the patient from the special ward, transferring the patient from the ICU, return of consciousness and extubation of the patient and lack of ventilator dependence during the study, death of the patient.The study was conducted in two consecutive periods. Patients admitted to the ICUs in the first period were allocated to the control group. After the sample size was completed in the control group, we recruited the patients in the intervention group. In each group patients with inclusion criteria were recruited consecutively. This method allowed researchers to prevent information contamination between the staff nurses involved in the two study phases. The control group was treated as usual, but those in the intervention group were treated according to VAP prevention guidelines. All participants or their legal guardians signed the written informed consent.In the intervention group, the infection prevention guideline was implemented according to Table 2. Four of the main components of the guidelines are: (a) Observance of hand hygiene principles in five critical moments (i.e. before touching the patient, before aseptic procedures, after exposure to body fluids, after touching the patient, and after touching the patient’s surroundings), (b) frequent checking and adjusting the cuff pressure between 20 and 30 cmH
Modified clinical pulmonary infection scale (MCPIS)Patients in the control group received no intervention other than routine care. Routine care did not include frequent monitoring and adjustment of cuff pressure using a special device. Instead, the cuff pressure was traditionally estimated by the fingers and only after oral suction. The patient’s bed head remained raised, but this action did not follow a particular pattern and was sometimes flattened to prevent slipping of the patient. In addition, due to the nurses’ high workload and lack of time, hand hygiene was not strictly observed. Caregivers and type of intubation method were homogeneous in both groups.The MCPIS was completed for all patients at their entry and then on the morning of the fifth day. All chest x-rays were interpreted by a radiologist and the laboratory tests were analyzed by the hospital laboratory. The body temperature of all patients was recorded axillary using a mercury thermometer for at least five minutes and then 0.5 °C was added to the reading [