Impacto de una estrategia multifacética para prevenir la neumonía asociada a la ventilación mecánica en una Unidad de Cuidados Intensivos Pediátricos polivalente: un estudio antes-después
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ENCUESTA ANONIMA SOBRE PREVENCION DE NEUMONIA ASOCIADA A LA VENTILACION MECANICA
PRIMERA PAGINA

Palabras clave

neumonía asociada a ventilación mecánica
unidad de cuidados intensivos pediátricos
prevención

Cómo citar

1.
Fortini YV, Frydman J. Impacto de una estrategia multifacética para prevenir la neumonía asociada a la ventilación mecánica en una Unidad de Cuidados Intensivos Pediátricos polivalente: un estudio antes-después. Rev Arg de Ter Int. [Internet]. 19 de enero de 2016 [citado 28 de marzo de 2024];33(1). Disponible en: https://revista.sati.org.ar/index.php/MI/article/view/439

Resumen

La neumonía asociada a ventilación mecánica es una entidad de alta mortalidad que se desarrolla luego de las 48 horas del inicio de la ventilación mecánica. Es la segunda infección nosocomial más frecuente entre los pacientes pediátricos.

Objetivos: evaluar el conocimiento de las medidas de prevención de neumonía asociada a ventilación mecánica entre los profesionales de la salud y  valorar el impacto de la implementación de un programa de medidas durante 12 meses.

Diseño: estudio antes-después de intervención con análisis de series temporales,  luego de la implementación de un paquete de medidas tendientes a reducir la neumonía asociada a ventilación mecánica desde el 1 de enero hasta el 31 de diciembre de 2014. Las tasas de infección respiratoria se compararon con cifras correspondientes al año 2013. 

Ambito: Unidad de Cuidados Intensivos Pediátricos del Hospital Abete, Provincia de Buenos Aires, Argentina.

Pacientes: Se incluyeron todos los pacientes entre 30 días de vida y 16 años con requerimiento de ventilación mecánica invasiva de al menos 48 horas de duración.

Resultados: luego de la implementación del paquete de medidas se observó una disminución de los eventos de neumonía asociada a ventilación mecánica con una tasa de 0.7‰.

Conclusiones: el descenso de eventos de neumonía asociada a ventilación mecánica se debió a un sistema de vigilancia epidemiológica continua que demostró tener un efecto beneficioso en la sensibilización de los profesionales en relación con las prácticas de prevención y control de infecciones.

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Citas

<p class="MsoListParagraphCxSpFirst" style="margin-top: 0cm; margin-right: 0cm; margin-bottom: .0001pt; margin-left: -10.35pt; mso-add-space: auto; text-align: justify; text-justify: inter-ideograph; text-indent: -18.0pt; line-height: 200%; mso-list: l0 level1 lfo1;"><!--[if !supportLists]--><span style="font-size: 12.0pt; line-height: 200%; font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; mso-fareast-font-family: Arial; mso-ansi-language: EN-US;" lang="EN-US">1-<span style="font-stretch: normal; font-size: 7pt; line-height: normal; font-family: 'Times New Roman';">&nbsp;&nbsp;&nbsp; </span></span><!--[endif]--><span style="font-size: 12.0pt; line-height: 200%; font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; mso-ansi-language: EN-US;" lang="EN-US">Foglia E, Dawn Meier M, Elward A. Ventilated-Associated Peumonia en Neonatal and Pediatric Intensive Care Unit Patients. Clin Microbiol Rev 2007;20(3):409-425.</span></p> <p class="MsoListParagraphCxSpMiddle" style="margin-top: 0cm; margin-right: 0cm; margin-bottom: .0001pt; margin-left: -10.35pt; mso-add-space: auto; text-align: justify; text-justify: inter-ideograph; text-indent: -18.0pt; line-height: 200%; mso-list: l0 level1 lfo1;"><!--[if !supportLists]--><span style="font-size: 12.0pt; line-height: 200%; font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; mso-fareast-font-family: Arial; mso-ansi-language: EN-US;" lang="EN-US">2-<span style="font-stretch: normal; font-size: 7pt; line-height: normal; font-family: 'Times New Roman';">&nbsp;&nbsp;&nbsp; </span></span><!--[endif]--><span style="font-size: 12.0pt; line-height: 200%; font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; mso-ansi-language: EN-US;" lang="EN-US">Perez-Granda M, Mu&ntilde;oz P, Heras C, Sanchez G, Rello J, Bouza E. Prevention of Ventilator-Associated Pneumonia: Can Knowledge and Clinical Practice Be Simply Assessed in a Large Institution? Respir Care 2013;58(7):1213-1219.</span></p> <p class="MsoListParagraphCxSpMiddle" style="margin-top: 0cm; margin-right: 0cm; margin-bottom: .0001pt; margin-left: -10.35pt; mso-add-space: auto; text-align: justify; text-justify: inter-ideograph; text-indent: -18.0pt; line-height: 200%; mso-list: l0 level1 lfo1;"><!--[if !supportLists]--><span style="font-size: 12.0pt; line-height: 200%; font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; mso-fareast-font-family: Arial; mso-ansi-language: ES-MX;">3-<span style="font-stretch: normal; font-size: 7pt; line-height: normal; font-family: 'Times New Roman';">&nbsp;&nbsp;&nbsp; </span></span><!--[endif]--><span style="font-size: 12.0pt; line-height: 200%; font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; mso-ansi-language: EN-US;" lang="EN-US">Mietto C, Pinciroli R, Patel N, Berra L. Ventilator Associated Pneumonia: Evolving Definitions and Preventive Strategies. Respir Care 2013;58(6):990-1007.</span></p> <p class="MsoListParagraphCxSpMiddle" style="margin-top: 0cm; margin-right: 0cm; margin-bottom: .0001pt; margin-left: -10.35pt; mso-add-space: auto; text-align: justify; text-justify: inter-ideograph; text-indent: -18.0pt; line-height: 200%; mso-list: l0 level1 lfo1;"><!--[if !supportLists]--><span style="font-size: 12.0pt; line-height: 200%; font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; mso-fareast-font-family: Arial; mso-ansi-language: ES-MX;">4-<span style="font-stretch: normal; font-size: 7pt; line-height: normal; font-family: 'Times New Roman';">&nbsp;&nbsp;&nbsp; </span></span><!--[endif]--><span style="font-size: 12.0pt; line-height: 200%; font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; mso-ansi-language: ES-MX;">Bologna R. Neumon&iacute;a asociada a respirador. Temas de Actualizaci&oacute;n. Temas de infectolog&iacute;a pedi&aacute;trica. Conocimientos para la pr&aacute;ctica cl&iacute;nica. Sociedad Argentina de Pediatr&iacute;a 2012;6:71-90.</span></p> <p class="MsoListParagraphCxSpMiddle" style="margin-top: 0cm; margin-right: 0cm; margin-bottom: .0001pt; margin-left: -10.35pt; mso-add-space: auto; text-align: justify; text-justify: inter-ideograph; text-indent: -18.0pt; line-height: 200%; mso-list: l0 level1 lfo1;"><!--[if !supportLists]--><span style="font-size: 12.0pt; line-height: 200%; font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; mso-fareast-font-family: Arial; mso-ansi-language: EN-US;" lang="EN-US">5-<span style="font-stretch: normal; font-size: 7pt; line-height: normal; font-family: 'Times New Roman';">&nbsp;&nbsp;&nbsp; </span></span><!--[endif]--><span style="font-size: 12.0pt; line-height: 200%; font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; mso-ansi-language: EN-US;" lang="EN-US">Safdar N, Crnich C, Maki D. The Pathogenesis of Ventilator-Associated Pneumonia: Its Relevance to Developing Effective Strategies for Prevention. Respir Care 2005;50(6):725-741.</span></p> <p class="MsoListParagraphCxSpMiddle" style="margin-top: 0cm; margin-right: 0cm; margin-bottom: .0001pt; margin-left: -10.35pt; mso-add-space: auto; text-align: justify; text-justify: inter-ideograph; text-indent: -18.0pt; line-height: 200%; mso-list: l0 level1 lfo1;"><!--[if !supportLists]--><span style="font-size: 12.0pt; line-height: 200%; font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; mso-fareast-font-family: Arial; mso-ansi-language: ES-MX;">6-<span style="font-stretch: normal; font-size: 7pt; line-height: normal; font-family: 'Times New Roman';">&nbsp;&nbsp;&nbsp; </span></span><!--[endif]--><span style="font-size: 12.0pt; line-height: 200%; font-family: &quot;Arial&quot;,&quot;sans-serif&quot;;" lang="ES">Calvo M, Delpiano L, Chac&oacute;n E, Jemenao I, Pe&ntilde;a A, Zambrano A. Actualizaci&oacute;n Consenso Neumon&iacute;a asociada a ventilaci&oacute;n mec&aacute;nica. Segunda parte. Prevenci&oacute;n. Rev Chil Infect 2011;28(4):316-332.</span></p> <p class="MsoListParagraphCxSpMiddle" style="margin-top: 0cm; margin-right: 0cm; margin-bottom: .0001pt; margin-left: -10.35pt; mso-add-space: auto; text-align: justify; text-justify: inter-ideograph; text-indent: -18.0pt; line-height: 200%; mso-list: l0 level1 lfo1;"><!--[if !supportLists]--><span style="font-size: 12.0pt; line-height: 200%; font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; mso-fareast-font-family: Arial; mso-ansi-language: ES-MX;">7-<span style="font-stretch: normal; font-size: 7pt; line-height: normal; font-family: 'Times New Roman';">&nbsp;&nbsp;&nbsp; </span></span><!--[endif]--><span style="font-size: 12.0pt; line-height: 200%; font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; mso-ansi-language: EN-US;" lang="EN-US">Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 2008;36(5):309-332.</span></p> <p class="MsoListParagraphCxSpMiddle" style="margin-top: 0cm; margin-right: 0cm; margin-bottom: .0001pt; margin-left: -10.35pt; mso-add-space: auto; text-align: justify; text-justify: inter-ideograph; text-indent: -18.0pt; line-height: 200%; mso-list: l0 level1 lfo1;"><!--[if !supportLists]--><span style="font-size: 12.0pt; line-height: 200%; font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; mso-fareast-font-family: Arial; mso-ansi-language: EN-US;" lang="EN-US">8-<span style="font-stretch: normal; font-size: 7pt; line-height: normal; font-family: 'Times New Roman';">&nbsp;&nbsp;&nbsp; </span></span><!--[endif]--><span style="font-size: 12.0pt; line-height: 200%; font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; mso-ansi-language: EN-US;" lang="EN-US">NNIS System. National Nosocomial Infections Surveillance (NNIS) System Report, data summary from January 1992 through June 2003, issued August 2003. Am J Infect Control 2003;31:481-498. </span></p> <p class="MsoListParagraphCxSpMiddle" style="margin-top: 0cm; margin-right: 0cm; margin-bottom: .0001pt; margin-left: -10.35pt; mso-add-space: auto; text-align: justify; text-justify: inter-ideograph; text-indent: -18.0pt; line-height: 200%; mso-list: l0 level1 lfo1;"><!--[if !supportLists]--><span style="font-size: 12.0pt; line-height: 200%; font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; mso-fareast-font-family: Arial; mso-ansi-language: ES-MX;">9-<span style="font-stretch: normal; font-size: 7pt; line-height: normal; font-family: 'Times New Roman';">&nbsp;&nbsp;&nbsp; </span></span><!--[endif]--><span style="font-size: 12.0pt; line-height: 200%; font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; mso-ansi-language: EN-US;" lang="EN-US">Bonsal Cooper V, Haut C. Preventing Ventilator-Associated Pneumonia in Children: An Evidence-Based Protocol. Critical Care Nurse 2013;33(3):21-30.</span></p> <p class="MsoListParagraphCxSpMiddle" style="margin-top: 0cm; margin-right: 0cm; margin-bottom: .0001pt; margin-left: -10.35pt; mso-add-space: auto; text-align: justify; text-justify: inter-ideograph; text-indent: -18.0pt; line-height: 200%; mso-list: l0 level1 lfo1;"><!--[if !supportLists]--><span style="font-size: 12.0pt; line-height: 200%; font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; mso-fareast-font-family: Arial; mso-ansi-language: ES-MX;">10-<span style="font-stretch: normal; font-size: 7pt; line-height: normal; font-family: 'Times New Roman';"> </span></span><!--[endif]--><span style="font-size: 12.0pt; line-height: 200%; font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; mso-ansi-language: ES-MX;">Fica A, Cifuentes M, Herve B. Actualizaci&oacute;n del Consenso &ldquo;Neumon&iacute;a asociada a ventilaci&oacute;n mec&aacute;nica&rdquo;. Primera parte. Aspectos diagn&oacute;sticos. Rev Chil Infect 2011;28(2):130-151.</span></p> <p class="MsoListParagraphCxSpMiddle" style="margin-top: 0cm; margin-right: 0cm; margin-bottom: .0001pt; margin-left: -10.35pt; mso-add-space: auto; text-align: justify; text-justify: inter-ideograph; text-indent: -18.0pt; line-height: 200%; mso-list: l0 level1 lfo1;"><!--[if !supportLists]--><span style="font-size: 12.0pt; line-height: 200%; font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; mso-fareast-font-family: Arial; mso-ansi-language: ES-MX;">11-<span style="font-stretch: normal; font-size: 7pt; line-height: normal; font-family: 'Times New Roman';"> </span></span><!--[endif]--><span style="font-size: 12.0pt; line-height: 200%; font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; mso-ansi-language: EN-US;" lang="EN-US">The Canadian Critical Care Trials Group. A Randomized Trial of Diagnostic Techniques for Ventilator-Associated Pneumonia. N Engl J Med 2006;355(25):2619-2630.</span></p> <p class="MsoListParagraphCxSpMiddle" style="margin-top: 0cm; margin-right: 0cm; margin-bottom: .0001pt; margin-left: -10.35pt; mso-add-space: auto; text-align: justify; text-justify: inter-ideograph; text-indent: -18.0pt; line-height: 200%; mso-list: l0 level1 lfo1;"><!--[if !supportLists]--><span style="font-size: 12.0pt; line-height: 200%; font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; mso-fareast-font-family: Arial; mso-ansi-language: EN-US;" lang="EN-US">12-<span style="font-stretch: normal; font-size: 7pt; line-height: normal; font-family: 'Times New Roman';"> </span></span><!--[endif]--><span lang="ES"><a href="http://www.cdc.gov/"><span style="font-size: 12.0pt; line-height: 200%; font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; mso-ansi-language: EN-US;" lang="EN-US">www.cdc.gov</span></a></span><span style="font-size: 12.0pt; line-height: 200%; font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; mso-ansi-language: EN-US;" lang="EN-US">. National Healthcare Safety Network (NHSN) Report, Data Summary for 2013 and 2014. Module. Dudeck M, Vemier L, Allen-Bridson K, et al. American Journal of Infection Control 41:1148-66.</span></p> <p class="MsoListParagraphCxSpMiddle" style="margin-top: 0cm; margin-right: 0cm; margin-bottom: .0001pt; margin-left: -10.35pt; mso-add-space: auto; text-align: justify; text-justify: inter-ideograph; text-indent: -18.0pt; line-height: 200%; mso-list: l0 level1 lfo1;"><!--[if !supportLists]--><span style="font-size: 12.0pt; line-height: 200%; font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; mso-fareast-font-family: Arial; mso-ansi-language: ES-MX;">13-<span style="font-stretch: normal; font-size: 7pt; line-height: normal; font-family: 'Times New Roman';"> </span></span><!--[endif]--><span style="font-size: 12.0pt; line-height: 200%; font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; mso-ansi-language: ES-MX;">Programa VIHDA (Vigilancia Infecciones Hospitalarias de Argentina)-INE-ANLIS-MSP. Reporte anual VIHDA: 2013 y 2014.</span></p> <p class="MsoListParagraphCxSpMiddle" style="margin-top: 0cm; margin-right: 0cm; margin-bottom: .0001pt; margin-left: -10.35pt; mso-add-space: auto; text-align: justify; text-justify: inter-ideograph; text-indent: -18.0pt; line-height: 200%; mso-list: l0 level1 lfo1;"><!--[if !supportLists]--><span style="font-size: 12.0pt; line-height: 200%; font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; mso-fareast-font-family: Arial; mso-ansi-language: ES-MX;">14-<span style="font-stretch: normal; font-size: 7pt; line-height: normal; font-family: 'Times New Roman';"> </span></span><!--[endif]--><span style="font-size: 12.0pt; line-height: 200%; font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; mso-ansi-language: EN-US;" lang="EN-US">Garcia R, Jendresky L, Colbert L, Bailey A, Zaman M, Majumder M. Reducing Ventilator-Associated Pneumonia Through Advanced Oral-Dental Care: A 48-month Study. AJCC 2009;18:523-532.</span></p> <p class="MsoListParagraphCxSpMiddle" style="margin-top: 0cm; margin-right: 0cm; margin-bottom: .0001pt; margin-left: -10.35pt; mso-add-space: auto; text-align: justify; text-justify: inter-ideograph; text-indent: -18.0pt; line-height: 200%; mso-list: l0 level1 lfo1;"><!--[if !supportLists]--><span style="font-size: 12.0pt; line-height: 200%; font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; mso-fareast-font-family: Arial; mso-ansi-language: ES-MX;">15-<span style="font-stretch: normal; font-size: 7pt; line-height: normal; font-family: 'Times New Roman';"> </span></span><!--[endif]--><span style="font-size: 12.0pt; line-height: 200%; font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; mso-ansi-language: EN-US;" lang="EN-US">Lorente L, Blot S, Rello J. Evidence on measures for the prevention of ventilator-associated pneumonia. </span><span style="font-size: 12.0pt; line-height: 200%; font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; mso-ansi-language: ES-MX;">Eur Respir J 2007;30:1193-1207.</span></p> <p class="MsoListParagraphCxSpMiddle" style="margin-top: 0cm; margin-right: 0cm; margin-bottom: .0001pt; margin-left: -10.35pt; mso-add-space: auto; text-align: justify; text-justify: inter-ideograph; text-indent: -18.0pt; line-height: 200%; mso-list: l0 level1 lfo1;"><!--[if !supportLists]--><span style="font-size: 12.0pt; line-height: 200%; font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; mso-fareast-font-family: Arial; mso-ansi-language: ES-MX;">16-<span style="font-stretch: normal; font-size: 7pt; line-height: normal; font-family: 'Times New Roman';"> </span></span><!--[endif]--><span style="font-size: 12.0pt; line-height: 200%; font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; mso-ansi-language: EN-US;" lang="EN-US">Raoof S, Baumann M. Ventilator-Associated Events: The New Definition. AJCC 2014;23:7-9.</span></p> <p class="MsoListParagraphCxSpMiddle" style="margin-top: 0cm; margin-right: 0cm; margin-bottom: .0001pt; margin-left: -10.35pt; mso-add-space: auto; text-indent: -18.0pt; line-height: 200%; mso-list: l0 level1 lfo1; mso-layout-grid-align: none; text-autospace: none;"><!--[if !supportLists]--><span style="font-size: 12.0pt; line-height: 200%; font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; mso-fareast-font-family: Arial; mso-ansi-language: EN-US;" lang="EN-US">17-<span style="font-stretch: normal; font-size: 7pt; line-height: normal; font-family: 'Times New Roman';"> </span></span><!--[endif]--><span style="font-size: 12.0pt; line-height: 200%; font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; mso-ansi-language: EN-US;" lang="EN-US">First Global Patient safety challenge. Clean Care is Safer Care. World&nbsp; Health Organization (WHO) 2010. Disponible en: http://whqlibdoc.who.int/publications/2009/9789241597906 eng.pdf.</span></p> <p class="MsoListParagraphCxSpMiddle" style="margin-top: 0cm; margin-right: 0cm; margin-bottom: .0001pt; margin-left: -10.35pt; mso-add-space: auto; text-align: justify; text-justify: inter-ideograph; text-indent: -18.0pt; line-height: 200%; mso-list: l0 level1 lfo1;"><!--[if !supportLists]--><span style="font-size: 12.0pt; line-height: 200%; font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; mso-fareast-font-family: Arial; mso-ansi-language: EN-US;" lang="EN-US">18-<span style="font-stretch: normal; font-size: 7pt; line-height: normal; font-family: 'Times New Roman';"> </span></span><!--[endif]--><span style="font-size: 12.0pt; line-height: 200%; font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; mso-ansi-language: EN-US;" lang="EN-US">Centers for Disease Control and Prevention Guideline for Hand Hygiene in Health-Care Settings: Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Morbidity and Mortality Weekly Report (MMWR) 2002; 51(N0.RR-16).</span></p> <p class="MsoListParagraphCxSpMiddle" style="margin-top: 0cm; margin-right: 0cm; margin-bottom: .0001pt; margin-left: -10.35pt; mso-add-space: auto; text-align: justify; text-justify: inter-ideograph; text-indent: -18.0pt; line-height: 200%; mso-list: l0 level1 lfo1;"><!--[if !supportLists]--><span style="font-size: 12.0pt; line-height: 200%; font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; mso-fareast-font-family: Arial; mso-ansi-language: EN-US;" lang="EN-US">19-<span style="font-stretch: normal; font-size: 7pt; line-height: normal; font-family: 'Times New Roman';"> </span></span><!--[endif]--><span style="font-size: 12.0pt; line-height: 200%; font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; mso-ansi-language: EN-US;" lang="EN-US">Pittet D, Allegranzi B, Sax H, Dharan S, Pessoa-Silva CL, Donaldson L, et al. Evidence-based model for hand transmission during patient care and the role of improved practices. Lancet Infect Dis. 2006;6:641-52.</span></p> <p class="MsoListParagraphCxSpMiddle" style="margin-top: 0cm; margin-right: 0cm; margin-bottom: .0001pt; margin-left: -10.35pt; mso-add-space: auto; text-align: justify; text-justify: inter-ideograph; text-indent: -18.0pt; line-height: 200%; mso-list: l0 level1 lfo1;"><!--[if !supportLists]--><span style="font-size: 12.0pt; line-height: 200%; font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; mso-fareast-font-family: Arial; mso-ansi-language: EN-US;" lang="EN-US">20-<span style="font-stretch: normal; font-size: 7pt; line-height: normal; font-family: 'Times New Roman';"> </span></span><!--[endif]--><span style="font-size: 12.0pt; line-height: 200%; font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; mso-ansi-language: EN-US;" lang="EN-US">. Pittet D, Allegranzi B, Boyce J. The World Health Organization Guidelines on Hand Hygiene in Health Care and their Consensus recommendations. </span><span style="font-size: 12.0pt; line-height: 200%; font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; mso-ansi-language: ES-MX;">Infect Control Hosp Epidemiol. 2009;30:611-22.</span></p> <p class="MsoListParagraphCxSpMiddle" style="margin-top: 0cm; margin-right: 0cm; margin-bottom: .0001pt; margin-left: -10.35pt; mso-add-space: auto; text-align: justify; text-justify: inter-ideograph; text-indent: -18.0pt; line-height: 200%; mso-list: l0 level1 lfo1;"><!--[if !supportLists]--><span style="font-size: 12.0pt; line-height: 200%; font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; mso-fareast-font-family: Arial; mso-ansi-language: EN-US;" lang="EN-US">21-<span style="font-stretch: normal; font-size: 7pt; line-height: normal; font-family: 'Times New Roman';"> </span></span><!--[endif]--><span style="font-size: 12.0pt; line-height: 200%; font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; mso-ansi-language: EN-US;" lang="EN-US">Han J, Liu Y. Effect of Ventilator Circuit Changes on Ventilator-Associated Pneumonia: A Systematic Review and Meta-analysis. Respir Care 2010;55(4):467-474.</span></p> <p class="MsoListParagraphCxSpMiddle" style="margin-top: 0cm; margin-right: 0cm; margin-bottom: .0001pt; margin-left: -10.35pt; mso-add-space: auto; text-align: justify; text-justify: inter-ideograph; text-indent: -18.0pt; line-height: 200%; mso-list: l0 level1 lfo1;"><!--[if !supportLists]--><span style="font-size: 12.0pt; line-height: 200%; font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; mso-fareast-font-family: Arial; mso-ansi-language: EN-US;" lang="EN-US">22-<span style="font-stretch: normal; font-size: 7pt; line-height: normal; font-family: 'Times New Roman';"> </span></span><!--[endif]--><span style="font-size: 12.0pt; line-height: 200%; font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; mso-ansi-language: EN-US;" lang="EN-US">Branson R. The Ventilator Circuit and Ventilator-Associated Pneumonia. Respir Care 2005;50(6):774-787.</span></p> <p class="MsoListParagraphCxSpMiddle" style="margin-top: 0cm; margin-right: 0cm; margin-bottom: .0001pt; margin-left: -10.35pt; mso-add-space: auto; text-indent: -18.0pt; line-height: 200%; mso-list: l0 level1 lfo1; mso-layout-grid-align: none; text-autospace: none;"><!--[if !supportLists]--><span style="font-size: 12.0pt; line-height: 200%; font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; mso-fareast-font-family: Arial; mso-ansi-language: EN-US;" lang="EN-US">23-<span style="font-stretch: normal; font-size: 7pt; line-height: normal; font-family: 'Times New Roman';"> </span></span><!--[endif]--><span style="font-size: 12.0pt; line-height: 200%; font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; mso-ansi-language: ES-MX;">Bonora J, Frachia D, Garcia M, Fillipini S, Haimovich A, Olguin G. Ventilaci&oacute;n no invasiva en cuidado Intensivo Pedi&aacute;trico, cuatro a&ntilde;os de experiencia. </span><span style="font-size: 12.0pt; line-height: 200%; font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;" lang="EN-US">Arch Argent Pediatr 2011;109(2):124-128. </span></p> <p class="MsoListParagraphCxSpMiddle" style="margin-top: 0cm; margin-right: 0cm; margin-bottom: .0001pt; margin-left: -10.35pt; mso-add-space: auto; text-align: justify; text-justify: inter-ideograph; text-indent: -18.0pt; line-height: 200%; mso-list: l0 level1 lfo1;"><!--[if !supportLists]--><span style="font-size: 12.0pt; line-height: 200%; font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; mso-fareast-font-family: Arial; mso-ansi-language: EN-US;" lang="EN-US">24-<span style="font-stretch: normal; font-size: 7pt; line-height: normal; font-family: 'Times New Roman';"> </span></span><!--[endif]--><span style="font-size: 12.0pt; line-height: 200%; font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; mso-ansi-language: EN-US;" lang="EN-US">Elward A, Warren D, Fraser V. Ventilator-Associated Pneumonia in Pediatric Intensive Care Unit Patients: Risk Factors and Outcomes. Pediatrics 2002;109(5):758-764.</span></p> <p class="MsoListParagraphCxSpMiddle" style="margin-top: 0cm; margin-right: 0cm; margin-bottom: .0001pt; margin-left: -10.35pt; mso-add-space: auto; text-align: justify; text-justify: inter-ideograph; text-indent: -18.0pt; line-height: 200%; mso-list: l0 level1 lfo1;"><!--[if !supportLists]--><span style="font-size: 12.0pt; line-height: 200%; font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; mso-fareast-font-family: Arial; mso-ansi-language: EN-US;" lang="EN-US">25-<span style="font-stretch: normal; font-size: 7pt; line-height: normal; font-family: 'Times New Roman';"> </span></span><!--[endif]--><span style="font-size: 12.0pt; line-height: 200%; font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; mso-ansi-language: EN-US;" lang="EN-US">Huang WY, Lee MS, Lee CH, Tsao LY, Chiu HY. Risk Factors and Outcomes of Ventilator-Associated Pneumonia in Children without Pneumonia on Admission.J Pediatr Resp Dis 2012;8:78-84</span></p> <p class="MsoListParagraphCxSpLast" style="margin-top: 0cm; margin-right: 0cm; margin-bottom: .0001pt; margin-left: -10.35pt; mso-add-space: auto; text-align: justify; text-justify: inter-ideograph; text-indent: -18.0pt; line-height: 200%; mso-list: l0 level1 lfo1;"><!--[if !supportLists]--><span style="font-size: 12.0pt; line-height: 200%; font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; mso-fareast-font-family: Arial; mso-ansi-language: ES-MX;">26-<span style="font-stretch: normal; font-size: 7pt; line-height: normal; font-family: 'Times New Roman';"> </span></span><!--[endif]--><span style="font-size: 12.0pt; line-height: 200%; font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; mso-ansi-language: ES-MX;">Borgatta B, Lopez C, Ram&iacute;rez S, Rello J. Neumon&iacute;a asociada a la ventilaci&oacute;n mec&aacute;nica: enfoque cl&iacute;nico, fisiopatol&oacute;gico y terap&eacute;utico, y medidas de prevenci&oacute;n. En: Terapia Intensiva. Sociedad Argentina de Terapia Intensiva. Editorial Panamericana 5&deg; edici&oacute;n. 2015. Tomo 2. 826-836</span></p> <p class="MsoNormal" style="margin-top: 0cm; margin-right: 0cm; margin-bottom: .0001pt; margin-left: -1.0cm; text-align: justify; text-justify: inter-ideograph;"><span style="font-size: 12.0pt; line-height: 115%; font-family: &quot;Arial&quot;,&quot;sans-serif&quot;;" lang="ES-AR">&nbsp;</span></p>

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