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Secretariat  \nFebruary 2012  \nFor information regarding this toolkit contact: Critical Care Secretariat  \nPhone: 416-340-4800 x.5577  \nEmail: [ccsadmin@uhn.ca](ccsadmin@uhn.ca)  \nAcknowledgements 5  \nExecutive Summary 6  \n Ontario’s Critical Care Strategy 8  \nBackground 8  \n Moving Towards Best Practices 9  \nThe Ventilator Associated Pneumonia and Central Line Infection Prevention Toolkit 9  \nA Focus on Quality 12  \n VAP and CLI Surveillance and Audit 16  \nProvincial Case Definitions 17  \n Best Practices: Updates on VAP and CLI Prevention 20  \nVAP Prevention 21  \nCLI Prevention 25  \nVascular Access 30  \nAntimicrobial Stewardship 30  \nUsing Services for Best Practice Implementation 33  \n Appendices 34  \nAppendix A: Change Concepts Template 35  \nAppendix B: Barriers and Solutions to Best Practice Uptake 37  \nAppendix C: ICU Daily Goals Checklist and Plan of Care 38  \nAppendix D: VAP and CLI Data Entry Process into CCIS 39  \nAppendix E: Rate Calculations – VAP and CLI 40  \nAppendix F: Using Statistical Process Control to Review Infection Data 41  \nAppendix G: Communication Tool for Surveillance and Improvement Practices 46  \nAppendix H: The Audit Process 48  \nAppendix I: VAP Surveillance Data Form 49  \nAppendix J: Needs Assessment and Survey of Current ICU Practices 50  \nAppendix K: Literature Review Process for Best Practice Recommendations 51  \nAppendix L: Mouth Care Protocol 52  \nAppendix M: Example of an Antimicrobial Stewardship Program in Ontario 54  \n References 55  \nReferences Related to Background 55  \nReferences Related to Quality 55  \nReferences Related to Surveillance and Audit 56  \nReferences Related to Best Practices 56  \nVentilator Associated Pneumonia and Central Line Infection Prevention Toolkit  \nDisclaimer: The contents ofthis toolkit may change over time. Clinicians should use judgment for individual patient encounters. CCBPSC and the Critical Care Secretariat will not be making absolute recommendations on a standardized bundle but will strongly recommend practices for which there is substantial evidence in the literature. To inform about the most recent evidence, this toolkit will be periodically updated as additional information becomes available.  \nThis toolkit is the result of collaborative efforts between the Critical Care Secretariat, led by Dr. Bernard Lawless and Julie Trpkovski, and the Ontario Critical Care Best Practice Steering Committee (CCBPSC), led by Dr. John Muscedere.  \nWe wish to thank all members of the CCBPSC for their support and guidance in the development, review of best practices, and publication of this document:  \nDebra Carew (Director of Operations for the Trauma, Emergency & Critical Care Program, Sunnybrook Health Sciences Centre)  \nDr. Howard Clasky (Director of Intensive Care, The Scarborough Hospital)  \nDr. Nick Daneman (Clinical Scientist, Division of Infectious Diseases, Sunnybrook Health Sciences Centre) Sue Jones (Charge Respiratory Therapist, Royal Victoria Hospital)  \nKari Kostiw (Clinical Coordinator Heart Function Clinic, Health Sciences North)  \nDr. Camille Lemieux (Associate Director, Infection Prevention and Control Unit, University Health Network)  \nOlga Livshits (Physiotherapist, Mount Sinai Hospital)  \nDale Mann (Manager, Respiratory Therapy, Grand River Hospital)  \nAnne Marie Marsigliese (Nurse Practitioner, Hotel Dieu Grace Hospital)  \nDr. John Muscedere (Critical Care LHIN Leader South East LHIN, Intensivist Kingston General Hospital) Brenda Morgan (Clinical Nurse Specialist, London Health Sciences Centre)  \nFran Priestap (Epidemiologist, London Health Sciences Centre)  \nDr. Damon Scales (Intensivist, Sunnybrook Health Sciences Centre)  \nCarol Shelton (ICU Nurse Manager, The Scarborough Hospital)  \nElisa Vincencio (Epidemiologist, Infection Prevention and Control, University Health Network)  \nExecutive Summary   \nVentilator Associated Pneumonia (VAP) and Central Line I","cbCaicVNaJlDL41U","https://ap.wps.com/l/cbCaicVNaJlDL41U","pdf",2395535,66,"English","# Acknowledgements\n# Executive Summary\n# Ontario’s Critical Care Strategy\n## Background\n## Moving Towards Best Practices\n## The Ventilator Associated Pneumonia and Central Line Infection Prevention Toolkit\n## A Focus on Quality\n# VAP and CLI Surveillance and Audit\n## Provincial Case Definitions\n# Best Practices: Updates on VAP and CLI Prevention\n## VAP Prevention\n## CLI Prevention\n## Vascular Access\n## Antimicrobial Stewardship\n## Using Services for Best Practice Implementation\n# Appendices\n## Appendix A: Change Concepts Template\n## Appendix B: Barriers and Solutions to Best Practice Uptake\n## Appendix C: ICU Daily Goals Checklist and Plan of Care\n## Appendix D: VAP and CLI Data Entry Process into CCIS\n## Appendix E: Rate Calculations – VAP and CLI\n## Appendix F: Using Statistical Process Control to Review Infection Data\n## Appendix G: Communication Tool for Surveillance and Improvement Practices\n## Appendix H: The Audit Process\n## Appendix I: VAP Surveillance Data Form\n## Appendix J: Needs Assessment and Survey of Current ICU Practices\n## Appendix K: Literature Review Process for Best Practice Recommendations\n## Appendix L: Mouth Care Protocol\n## Appendix M: Example of an Antimicrobial Stewardship Program in Ontario\n# References","[{\"question\":\"What problem does the toolkit address in critical care?\",\"answer\":\"It targets Ventilator Associated Pneumonia (VAP) and Central Line Infections (CLI), described as among the most common hospital-acquired infections in the critical care environment, associated with high morbidity and mortality and increased ICU length of stay.\"},{\"question\":\"How does the toolkit support hospitals in reducing VAP and CLI rates?\",\"answer\":\"It provides an organized, evidence-based process for surveillance, prevention, and improvement implementation, including local examples of tools and strategies to help guide healthcare providers’ initiatives.\"},{\"question\":\"What are the toolkit’s main areas for action?\",\"answer\":\"The toolkit is structured around four guiding principles, including Quality, and Surveillance and Audit, followed by best-practice updates for VAP and CLI prevention, with supporting sections such as vascular access and antimicrobial stewardship.\"}]","Ventilator Associated Pneumonia and Central Line Infection Prevention Toolkit - February 2012 | PDF",1791161427,166]