Hospital-acquired infections PPT – ACE Star Model – NR451
Hospital-acquired infections PPT – ACE Star Model – NR451
The length of the PowerPoint presentation should be 15-20 slides; excluding the title and reference slides.
Below are the main topics or bullet points for your slides:
Title slide
Description of the Ace Star change model that you have used for this project.
Practice Issue (Using the one of the required articles)
Scope of the problem—use basic statistics from what you know of the problem in your work area.
Your team/stakeholders
Evidence to support your need for change—from your Evidence Summary
BUY A PLAGIARISM-FREE PAPER HERE
Action Plan
Timeline for the plan
The nurse’s role and responsibility in the pilot program
Procedure (what steps are to be taken to complete this change process, from start to finish?)
Forms that will be used (if applicable)
Resources available to the staff—including yourself
between 15-20 slides in length (not including the title slide and reference list slides) Hospital-acquired infections PPT – ACE Star Model – NR451.
Capstone Project Milestone 1:
Practice Issue and Evidence Summary Worksheets
For Use March 2018
Student Name: XXXX XXXX Date:
Directions
Refer to the guidelines for specific details on how to complete this assignment.
Type your answers directly into the worksheets below.
Submit to the Dropbox by the end of Week 3, Sunday at 11:59 p.m. MT.
Post questions about this assignment to the Q & A Forum. You may also email questions to the instructor for a private response Hospital-acquired infections PPT – ACE Star Model – NR451
Practice Issue Worksheet
List the topic and include the citation for the systematic review you have selected from our approved list (optional: an additional scholarly source of support):
Topic: Interventions to improving professional adherence to guidelines for prevention of device related infections
Flodgren G, Conterno LO, Mayhew A, Omar O, Pereira CR, Shepperd S. Interventions to improve professional adherence to guidelines for prevention of device-related infections. Cochrane Database of Systematic Reviews 2013, Issue 3, Art., No.: CD006559. doi:10.1002/14651858.CD006559.pub2. Hospital-acquired infections PPT – ACE Star Model – NR451.
Hocevar, S. N., Lessa, F. C., Gallagher, L., Conover, C., Gorwitz, R., & Iwamoto, M (2014).InfectionPrevention Practices in Neonatal Intensive Care Units Reporting to the National Healthcare Safety Network. Infection Control and Hospital Epidemiology, 35(9), 1126–1132. http://doi.org/10.1086/677636
What is the nursing practice issue you have identified related to the topic you have chosen?
The practice issue that I have identified concerning my topic is whether or not the need for intense NICU infection bundles related to decreasing the incidence of ventilator-associated pneumonia, necrotizing fasciitis and CLABSI’s are recommended for the NICU population. The question I have chosen for this topic is as followed: Hospital-acquired infections PPT – ACE Star Model – NR451.
Will implementing new infection bundles versus not implementing new infection bundles significantly decrease acquired infections in NICU babies?
As a traveling Registered Nurse, I have had the pleasure to work at several different NICU’s around the United States. At the hospital that I am currently working at, a level four nicus in Tacoma, Washington, they have implemented some brand new NICU infection bundles that I have never seen before. The purpose of my capstone will be to see if the newly implanted NICU bundles have an effect on helping to decrease the incidence of infections in the NICU population. Hospital-acquired infections PPT – ACE Star Model – NR451.
Fully describe the scope of the practice issue:
The scope of the practice issue that I have found is that in keeping tabs on some of the past hospitals that I have traveled to, I have seen that they have an above average reported CLABSI, necrotizing fasciitis, and ventilator-associated pneumonia infections. At the hospital that I am currently working at, I have noticed that regarding those three infections, there has been an overall decrease in the amount of these infections among the NICU population. Hospital-acquired infections PPT – ACE Star Model – NR451. Education, demonstration, and evaluation of NICU nurses during their hands-on assessment of their patients is crucial in determining whether or not the policies on infection prevention and whether or not the strict use of new infection bundles. Babies in the neonatal intensive care unit often have immature immune systems. They are exposed to many different caregivers and may have multiple blood test, IV lines, and other invasive procedures. The incidence of CLABSI reported from NICUs is consistently among the highest reported when compared to other hospital locations. Due to this factor, it is important to figure out what is the best plan of action regarding decreasing infections in this population. I will also be using the Standardized Infection Ratio (SIR) to compare the rate of central line infection/VAP/Necrotizing fasciitis Rates with other hospitals. Hospital-acquired infections PPT – ACE Star Model – NR451.
What is the practice area?
_x__ Clinical
_x__ Education
___ Administration
___ Other (List):
How was the practice issue identified? (check all that apply)
_x__ Safety/risk management concerns
___ Unsatisfactory patient outcomes
_x__ Wide variations in practice
___ Significant financial concerns
___ Difference between hospital and community practice
__x_ Clinical practice issue is a concern
___ Procedure or process is a time waster
___ Clinical practice issue has no scientific base
__ Other: Hospital-acquired infections PPT – ACE Star Model – NR451.
Describe the rationale for your checked selections:
Safety Risk Management Concerns:
I chose safety and risk management because critically ill infants that are cared for in the neonatal intensive care units are among the most vulnerable patient population in the hospital. NICU babies are at an increased risk for adverse outcomes related to nosocomial infections and unplanned readmission to the hospital. Nosocomial infections can affect nearly 1 in 6 very low birth weight infants (VLBW), which can double the risk of mortality and lengthen the NICU stay. Invasive equipment, such as central lines and ventilators, are a familiar source of nosocomial infection. Hospital-acquired infections PPT – ACE Star Model – NR451.
Wide Variation in practice:
I chose this area because every NICU that I have worked at practices differently concerning the maintenance of CLABSI, ventilators, and feedings. I have even worked within the same hospital system, just in a separate location and saw a vast difference in how they did things compared to their partners up the road. For example, some hospitals require everybody in the room to wear a hat and mask when inserting a central line, whereas other hospitals only require the person entering the catheter of a central line to wear a hat and mask. Some hospitals are strict about suctioning an intubated baby before turning their head or repositioning, while some hospitals have no preference on which order this happens. Hospital-acquired infections PPT – ACE Star Model – NR451. Some hospitals will clean an infant’s nasogastric/orogastric tube with alcohol before beginning a gavage feeding, while some hospitals don’t see it necessary.
Clinical practice issue is a concern:
I chose this because I believe that many hospitals are relaxed about their infection policies. I have worked in hospitals that are very strict about preventing infection in our NICU babies, and I have also worked in hospitals that hardly have a policy for infection written. Regardless of whether or not a NICU is a level IV or a level II, infection protocols should be followed consistently and concisely by all staff.
What evidence must be gathered? (check all that apply)
_x__ Literature search
___ Guidelines
___ Expert Opinion
___ Patient Preferences
___ Clinical Expertise
___ Financial Analysis
___ Standards (Regulatory, professional, community)
___ Other
Describe the rationale for your checked selections:
Literature Search:
A reasonable basis of literature is fundamental regarding proving the significance of a clinical problem. A literature search is a systematic, thorough search of all types of published literature to identify a magnitude of excellent quality references relevant to a specific topic and is a fundamental element of the methodology of any research project. A Literature search is necessary to research because it can help to draw information for making sound evidence-based guidelines. Hospital-acquired infections PPT – ACE Star Model – NR451.
Clinical Expertise:
Clinical expertise will need to be assessed to determine whether the newly implanted infection bundles are beneficial to our tiny patients. Evidence-based practice involves integrating the best evidence and clinical expertise.
Guidelines:
Guidelines from organizations such as the National Women’s Newborn Service, Centers for Disease Control and the World health organization should be evaluated to determine what infection procedures are recommended in the NICU setting. Hospital-acquired infections PPT – ACE Star Model – NR451.
Evidence Summary Worksheet
Directions: Please type your answers directly into the worksheet.
Describe the practice problem in your own words with reference to the identified population, setting and magnitude of the problem in measurable terms:
The practice problem that I have identified is whether or not the implementation of new NCU infection bundles are beneficial to our tiny NICU patients. The practice problem identified by our assigned article Interventions to improve professional adherence to guidelines for prevention of device-related infections refers to the fact that healthcare associated infections (HAI’s) are detrimental to the well-being of our patients. Hospital-acquired infections PPT – ACE Star Model – NR451. When infection procedures, or bundles, are not strictly followed in the NICU this can lead to patients to the subjection of acquiring device-related infections. Nosocomial infections in the NICU are a significant cause of morbidity. Premature infants are especially vulnerable since they can undergo many invasive procedures and are often times dependent on invasive devices such as feeding tubes, central lines, and ventilators. The very mechanisms that sustain life can be a reservoir for bacterial invasion, especially in those with immature immune systems. The use of Aseptic and sterile technique should always be involved when handling invasive devices in the NICU. This has been found to decrease the incidence of infection in the NICU. It would be essential to measure this outcome within a six-month time span to determine the number of babies that fall victim to infections related to invasive devices within this time frame regarding the different policies and bundles used in a particular NICU.
Type the complete APA reference for the systematic review article you chose from the list provided. It must be relevant to the practice issue you described above. Include the APA reference for any additional optional supplemental scholarly source related to the review you wish to use.
Flodgren G, Conterno LO, Mayhew A, Omar O, Pereira CR, Shepperd S. Interventions to improve professional adherence to guidelines for prevention of device-related infections. Cochrane Database of Systematic Reviews 2013, Issue 3, Art., No.: CD006559. doi:10.1002/14651858.CD006559.pub2. Hospital-acquired infections PPT – ACE Star Model – NR451.
Hocevar, S. N., Lessa, F. C., Gallagher, L., Conover, C., Gorwitz, R., & Iwamoto, M (2014).InfectionPrevention Practices in Neonatal Intensive Care Units Reporting to the National Healthcare Safety Network. Infection Control and Hospital Epidemiology, 35(9), 1126–1132. http://doi.org/10.1086/677636
Identify the objectives of the article:
The objective of the study that I have chosen is to figure out quality improvement strategies to change clinical practice in improving the rate of device-related infections in the healthcare setting. The article looks at the care bundles developed by the HAI’s and suggests that bundling interventions an effective form of decreasing healthcare-associated infections. The report assesses the effectiveness of different interventions, with or without various combinations, to target healthcare professionals/healthcare organizations to improve professional adherence to infection control guidelines on device-related infection rates and also aims to measure adherence to these guidelines.
Provide a statement of the questions being addressed in the work and how these relate to your practice issue:
The matters discussed in the article deal with assessing the different interventions in targeting infection control regarding device-related infections. This is similar to my capstone question because I am seeking to establish whether or not the use of newly implanted infection bundles has a profound effect on decreasing the incidence of infections in the NICU brought on invasive devices such as central lines, feeding tubes, and ventilators. The article also talks about the breakdown of aseptic technique during insertion of invasive devices as well as the duration of the devices use. These areas are all critical factors in whether or not NICU bundles will be successful in decreasing the incidence of invasive device-related infections Hospital-acquired infections PPT – ACE Star Model – NR451.
Summarize (in your own words) the interventions the author(s) suggest improving patient outcomes.
Some of the interventions that the authors have found to be effective in preventing ventilator-associated pneumonia include elevating the head of the bed by 30 degrees; continuous suctioning when there is evidence of increased sections, not changing circuits on ventilators unless it is entirely indicative, oral care and hand hygiene. The article talked about daily sedation use, however, in the NICU we rarely use sedation unless the baby is high risk for pulling out their endotracheal tube. The questions being addressed in the article deal with assessing the different interventions in targeting infection control concerning device-related infections. This is similar to my capstone question because I am seeking to establish whether or not the use of newly implanted infection bundles has a profound effect on decreasing the incidence of infections in the NICU brought on invasive devices such as central lines, feeding tubes, and ventilators. The article also talks about the breakdown of aseptic technique during insertion of invasive devices as well as the duration of the devices use. These areas are all critical factors in whether or not NICU bundles will be successful in decreasing the incidence of invasive device-related infections. In regards to the prevention of CLASI infections, the article has found that timely dressing changes using aseptic techniques, daily audits of central line site, chlorhexidine on the skin with the preparation of insertion of a sterile catheter, and the use of sterile barriers during catheter insertion, such as a hat, and mask. Hospital-acquired infections PPT – ACE Star Model – NR451.
Summarize the main findings by the authors of your systematic review including the strength of evidence for each main outcome. Consider the relevance to your project proposal for the Milestone 2 project paper. (If an optional supplemental source is also used, include a statement of relevance to it as well.)
The main findings of the studies showed that adherence to invasive device related bundles could help decrease the risk of nosocomial infections in this population. Many of these infection prevention practices are implemented in the newly recommended NICU bundles. The study found that there were beneficial effects regarding the use of these infection bundles up to three months, nine months, and twelve months after initiated. The study found a decrease in VAP rates between 5 and 23 cases per 1,000 ventilator days. The article highlights that for effective prevention of device-related hospital infections, it is vital to ensure that the clinical practice bundles/policies that are implemented have an evidence-based backing and target the critical risk factors for the specific indwelling medical devices in question. However, the study emphasizes that further research should be done to come to a definitive answer.
Outline evidence-based solutions that you will consider for your project.
● Whether or not suctioning an infant’s ET tube and oral secretions before repositioning decrease the incidence of VAP
● Whether or not cleaning a nasogastric/orogastric feeding tube with alcohol for at least 15 seconds decreases the incidence of necrotizing fasciitis
● Whether or not using a mask and hat is crucial for everybody to have one when PICC line placement has begun Hospital-acquired infections PPT – ACE Star Model – NR451.
● Providing education and demonstration to NICU nurses and doctors to make sure infection bundles are properly being followed
● Whether or not the use of aseptic/sterile technique is needed when handling invasive devices in the NICU
● If changing ventilator circuit only when visibly soiled or malfunctioning is beneficial in decreasing the incidence of VAP
● Minimizing days on ventilation
● Use of frequent hand hygiene when handling invasive devices
● Frequent caregiver education and demonstration of NICU bundles to ensure that bundles are being followed consistency and concisely Hospital-acquired infections PPT – ACE Star Model – NR451.
Discuss any limitations to the studies that you believe impacts your ability to utilize the research in our project.
The main limitation that I can see with my study is that a NICU may have a hospital policy/bundle in place, but it is not implemented effectively by all staff, including nurses and doctors. Even though there may be a strict and effective prevention of invasive device-related infections in place, studies may still show that the rate of NICU acquired infections are still steadily increasing. As there is no way to closely monitor every nurse, on every shift, at every assessment, this is the only barrier I can see that may skew the results of infections acquired in the NICU.
Design for Change Proposal
Hospital-acquired infections are a common cause of lengthened hospitalization, increased mortality, and increase in hospital costs. Inconsistent and inadequate hygiene practices are a leading cause of infection in the NICU. Major reservoirs for infection include ventilators, central lines, and feeding tubes. Different management approaches have been derived in various countries to reduce the rate of hospital-acquired infections Hospital-acquired infections PPT – ACE Star Model – NR451. The effects focus mainly on the roles of nurses in ensuring that the best practices in hygiene are utilized. Education focuses on hand hygiene and the use invasive device infection bundles in the NICU. Given that nurses are at the center stage when it comes to handling hygiene issues of patients in the NICU, nurses are upheld to the highest standard regarding ensuring that hospital-acquired infections are obsolete in the care setting. The use of evidence-based care is a reliable way that nurses can use to address this problem (Stevens, 2013).
Change Model Overview
The ACE Star Model is a tool used for understanding knowledge characteristics, nature and cycles as they are implemented in different aspects of evidence-based practice. The model presents a logical tool for organizing both new and old ideas for improving nursing care into an innovative framework that identifies issues of evidence-based practice approaches and processes. As such, the model can be construed as a simplified portrayal of the relationships that exist between the different knowledge transformation stages even as new knowledge is used to modify old data before it is applied into practice. The model includes common nursing processes and accentuates the application of distinctive features of evidence-based practice (Ellis, 2016). The five steps involved in the ACE star model include the implementation of knowledge development, evidence review, interpretation into practice recommendation, assimilation into practice, and evaluation (ANA, 2015). This design proposal places relevant previous research results within the context of evidence-based practice, allowing the model to serve as an organizer for evaluating and using evidence, and mainstreaming nursing practice into the use of evidence-based practice. Hospital-acquired infections PPT – ACE Star Model – NR451.
Define the Scope of the EBP
The scope of the issue at hand is to determine if implementing new infection bundles versus not implementing new infection bundles decrease acquired infections in NICU babies. Flodgren et al. (2013) are succinct in noting that mortality rate linked with infection vary from 5% in well-managed facilities to 35% in poorly management facilities. Only about 50% of NICUs were found to implement strict NICU infection bundles (Flodgren et al., 2013). Hocevar conducted a study in North America that determined that meta-analysis revealed a statistically significant reduction in VAP, CLABSI, and necrotizing enterocolitis when following strict newly developed infection bundles. The study found the rate of infection decreased by 60% in the first year with this implementation. Hocevar et al. (2014) are more proactive in exploring the problem by noting that the differences observed for infection rates can be attributed to variations links within nursing practices. Following this awareness, the project proposes that applying new nursing management strategies in the NICU that include prioritizing hygiene and the use of consistent invasive line bundles will reduce the acquired infections in NICU babies Hospital-acquired infections PPT – ACE Star Model – NR451.
The short-term objective is to improve prioritization of hygiene and safety and incorporate strict NICU bundles in nursing policies applied in NICU.
Three long-term objectives have been identified to include improving nurses’ service delivery, improving NICU patients’ outcomes, and reducing incidences of NICU acquired infections.
The project milestones include identifying the study sample from the population of interest, assigning the sample into control and treatment groups, subjecting the treatment group to new nursing policies that prioritize infection bundles and safety, collecting statistics on acquired infections in NICU for the study sample, conducting a ratio analysis on the statistics, and presenting results that establish the effect of the new nursing policies in comparison to the old nursing policies.
Stakeholders
A team should be inclusive of a team manager, several NICU nurses, a clinical nurse coach, neonatologist, dietician to aid in necrotizing enterocolitis bundles, and one facility administrator that will be in charge of implementing change. Hospital-acquired infections PPT – ACE Star Model – NR451.
Determine Responsibility of Team Members
The team manager (researcher) will identify goals associated with change before ensuring that these goals are met by allocating each member of the team a set of tangible and achievable tasks and responsibilities. Additionally, the team manager is responsible for collecting and presenting the outcomes of the change to the other stakeholders who include medical personnel employed in NICU. The facility administrator will be the leverage for support for change. The three NICU nurses will work under the supervision of a charge nurse to monitor whether infection bundles are being implemented consistently and concisely among all members of the team. A clinical nurse coach would be utilized in educating staff members on infection-related research data and implementation of infection bundles. The dietician will be a resource in decreasing necrotizing enterocolitis by recommending adequate feedings for infants at risk. Hospital-acquired infections PPT – ACE Star Model – NR451.
Evidence
An evaluation of available literature identified three journal articles as the supporting material that highlighted the need for change by calling for the implementation of new nursing policies that prioritize NICU infection bundles. The reports all agreed that while facility-acquired infections are an occurrence in the NICU, due mainly in part to babies’ deficient immunity and an environment that collects many pathogens from different sources, eliminating all possibilities of infections is a preferable outcome Hospital-acquired infections PPT – ACE Star Model – NR451. The reports mentioned that some diseases could have been avoided if medical personnel prioritized hygiene and safety and utilized strict infection bundles. The three journal articles are in agreement that most of the facility-acquired infections noted in NICU can be minimized through a change in nursing practice and policy. The two journal articles are Flodgren et al. (2013) and Hocevar et al. (2014).
Summarize the Evidence
Flodgren et al. (2013) report that facility associated infections are a source of concern in any medical facility. That is because they are linked with mortality that varies between 5% and 35%. These statistics imply that about 1 out of 3 babies in the NICU who get hospital-acquired infections are expected to die from this. In the 50% of hospitals found to utilize strict NICU infection bundles, the incidence of CLASI, VAP, and necrotizing enterocolitis decreased by 60%. The article goes on to note that infections are linked to the use of invasive medical devices and the inability to adhere and implement newly developed infection bundles to prevent disease (Flodgren et al., 2013). The incidence of VAP significantly reduced from 67.8% to 36.4% after the implementation of prevention bundles (Seham et al., 2014). This same meta-analysis showed that necrotizing enterocolitis bundles decreased the incidence of this disorder from 39% to 13% in a three-year time frame (Seham et al., 2014). Frequent manipulation of invasive line devices is found to be the leading cause contributing to infections. Hocevar et al. (2014) makes a similar assessment but adds that the heterogeneity linked with the different NICU activities may be to blame for the situation. Activity heterogeneity places a strain on nursing personnel and inhibits their capacity to follow the set nursing policies. There is a need to emphasize hygiene and safety in NICU nursing practices as a possible strategy for reducing the incidence of facility-acquired infection (Hocevar et al., 2014). As a result, it is projected that implementing new infection bundles decreases acquired infections in NICU babies. Hospital-acquired infections PPT – ACE Star Model – NR451.
Develop Recommendations for Change Based on Evidence
By the current substantiation from the three-primary journal article, it turns out that implementing new infection bundles that prioritize hygiene and safety will present with a better solution for decreasing the incidence of facility-acquired infections in NICU babies. Including these measures in nursing policies would increase medical care efficiency in the NICU by reducing the occurrence and frequency of preventable errors.
Translation
Action Plan
The action plan will point out NICU inter-professional team members who will directly implement change. NICU nursing personnel will be informed of the project intentions and will need to apply implementation of newly developed infection bundles. The results from the control group (using standard nursing practices) will be acquired from past NICU performance, whereby the outcomes of past and present NICU results will be paralleled to ascertain how the change affected hospital-acquired infections. This will be based on the awareness that if the nursing practice changes present positive outcomes, then the difference in care will be justified. The change program will be implemented for a year after which the findings will be correlated for before and after the nursing practice changes, following which the results will be offered, and concluding commendations made for NICU action. Hospital-acquired infections PPT – ACE Star Model – NR451.
Process, Outcomes Evaluation and Reporting
The anticipated conclusion of the change made will be to decrease the incidence and frequency of facility-associated infection in NICU babies. This will be evaluated by correlating the facility-associated infection rates before and after implementation of the proposal. These actions will illustrate whether the adherence to infection bundles leads to a decrease in infection prevalence. The results will be conveyed to the stakeholders (who include the NICU personnel, administrators, nurse manager, and clinical nurse coach) using charts and figures that depict the effects of changing nursing practices on facility-associated infection rates within NICU. Hospital-acquired infections PPT – ACE Star Model – NR451.
Identify Next Steps
Following the program completion and publication of the results, the clinical nurse coach will suggest to the stakeholders whether or not the program outcomes be implemented into the NICU. If implementing NICU bundles produces a beneficial result, then it will be suggested that it be incorporated as part of customary nursing practice. The project should then be utilized within the facility. Should the data provide negative results, then the status quo will be conserved while highlighting that change is not warranted. Hospital-acquired infections PPT – ACE Star Model – NR451. Also, a recommendation will be made that other facilities should adopt the implementation of invasive line infection bundles in their NICU.
Disseminate Findings
The outcomes of the project will be circulated through distribution in medical publications such as journals. Dissemination using this strategy will guarantee that medical practitioners and other stakeholders can easily access the results. This is based on the assumption that the outcomes will be informative and reliable enough to implement these evidence-based findings into NICU.
Conclusion
Infections related to invasive device usage in NICU babies is an epidemic. For this reason, infections diminish patient confidence in medical practice while harming patients through avoidable risks. The issue is best approached by reviewing nursing practice to prioritize hygiene and implementation of strict adherence to NICU bundles. Based on the information provided, it has been suggested that nursing policies for handling NICU activities should focus on the cleanliness and adherence to invasive devices bundles, adequate hygiene practices, and safety. Decreasing the incidence of infection begins it ensuring proper policies are followed when handling ventilators, central lines and feeding tubes. If the program outcomes backs the reviewed publications, then publishing the program outcomes will make them accessible to concerned stakeholders while reducing the incidence of hospital-acquired infection in the NICU. Hospital-acquired infections PPT – ACE Star Model – NR451.
References
American Nurses Association. (2015). Nursing: Scope and standards of practice (3rd ed.). Silver Spring, MD: Author.
Ellis, P. (2016). Evidence-based Practice in Nursing (3rd ed.). London: Learning Matter/SAGE Publications Ltd.
Flodgren, G., Conterno, L. O., Mayhew, A., Omar, O., Pereira, C. & Shepperd, S. (2013). Interventions to improve professional adherence to guidelines for prevention of device-related infections. Cochrane Database of Systematic Reviews, 2013 Issue 3, Art., No.: CD006559. doi:10.1002/14651858.CD006559.pub2. Hospital-acquired infections PPT – ACE Star Model – NR451.
Hocevar, S. N., Lessa, F. C., Gallagher, L., Conover, C., Gorwitz, R. & Iwamoto, M. (2014). Infection Prevention Practices in Neonatal Intensive Care Units Reporting to the National Healthcare Safety Network. Infection Control and Hospital Epidemiology, 35(9), 1126-1132. http://doi.org/10.1086/677636
Seham, F.A, Hanan, S.S., Safaa, H.S., Wafaa, F.E., Mona, M.E., Ahmed, G.S., Mohamed, A.A., (2014).Reducing ventilator-associated pneumonia in neonatal intensive care units using “VAP prevention Bundle”: a cohort study
