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ABSTRACT Background and Aim: Among nosocomial infections, ventilator associated pneumonia (VAP) is very important which can lead to increased mortality rate in the patients. The aim of the present study was to determine the incidence of VAP and its bacterial resistance pattern at the intensive care unit (ICU) of Besat Hospital in Sanandaj. Material and Methods: In a prospective descriptive study carried out between September 2007 and June 2008, 149 endotracheal samples were obtained from the patients after 48 hours of hospitalization in ICU units of Besat Hospital. The samples were sent to the microbiology laboratory of Besat Hospital. Bacteriologic diagnosis was performed by using Edward & Ewings standard methods and antibiotic susceptibility pattern was determined by CLSI system guidelines. Demographic data were collected and recorded in a check list. Data were introduced into SPSS software and analyzed by means of descriptive statistical tests. Results: Among 149 samples from endotracheal tube of the patients, 48 were positive for VAP with an incidence rate of 32.2%. Mean standard deviation of duration of hospitalization was 23.4±10.2 days. Microorganisms isolated from endotracheal tube were essentially Enterobacteriacae and included Klebsiella spp, enterobacter spp, and E.coli. Acintobacter spp and Staphylococcus epidermidis, Pseudomonas spp and Staphylococcus aureus were detected from 3, 3, 2 and 1 samples respectively. The maximum and minimum antibiotic resistance by gram negative bacteria were 93.3% to cefalotin and 50% to amikacin. Conclusions: The VAP incidence rate of 32.2% needs serious attention. Clinical isolates in the present study had a high antibiotic resistance especially to the third generation of cephalosporins. Close attention to the standards of infection control for prevention of VAP is recommended. Key Words: Incidence, Ventilator-Associated Pneumonia (VAP), Bacterial resistance pattern, Adult Intensive Care Unit, Sanandaj Conflict of Interest: Nill Received: July 28, 2010 Accepted: Dec 28, 2010

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Background and Aim: One of the indicators of recovery in the patients admitted to intensive care units is improvement of the level of consciousness. Various factors, including the type of care are effective in the changes of consciousness level of the patients. This study was conducted to determine the effect of nursing care plan based on “Roy adaptation model” in physiologic aspect on the level of consciousness of the patients in the intensive care unit.
Material and Methods: This triple-blind clinical trial included 100 patients in the intensive care unit in 2017. Two ICU units in Sanandaj hospitals were selected randomly as intervention and control groups. Eligible patients in each unit were randomly assigned to intervention and control groups. The intervention group received nursing care plan based on "Roy adaptation model” and the control group received routine care. We measured level of consciousness for every patient based on the GCS for 7 days, twice a day. We used SPSS version 21 for data analysis.
Results: The mean level of consciousness in the first three days and nights did not show any significant difference between the intervention and control groups. But there was a significant difference between the mean levels of consciousness from the fourth day and night on, between intervention and control groups (p <0.05).
Conclusion: Roy adaptation model was effective in increasing the level of consciousness after three days in the patients in the intensive care unit. Therefore, we recommend organized nursing care based on standard nursing models for all of the patients in the intensive care units.
Keywords: Level of consciousness, Roy adaptation model, Intensive care unit.
 
Received: Feb 4, 2017     Accepted: Jul 8, 2017

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Background and Aim: Ventilator-acquired pneumonia is common in invasive mechanical ventilatory patients. There are various methods to prevent and reduce the incidence of ventilator-acquired pneumonia, one of which is the use of combined mouthwashes. The purpose of this study was to evaluate the effect of combined mouthwash on the prevention of ventilator-acquired pneumonia.
Materials and Methods: In this clinical-trial study, patients were randomly selected and divided into control and study group. The patients with GCS = 3 and brain death and mechanical ventilation less than 48 hours were excluded from the study. The control group received 0.2% chlorhexidine for mouthwash and the study group received gentamicin 2%, colistin 2% and vancomycin 2%. Mouthwashes were used until the creation of pneumonia symptoms, patient mortality, and endotracheal intubation. Statistical analysis was completed after the study.
Results: The incidence of pneumonia was 19 (30.64%) in the study group and 16 (25.8%) in the control group (P = 0.23). In the study group, 39 (62/9%) patients and in the control group 40 patients (64/5%) were discharged (P = 49/0). Cultures endotracheal secretions were reported negatively in 40 patients (5.64%) of study group and 45 patients (58.72%) in control group (P = 0.04). The isolated bacteria in the study group included 11 cases of Acinetobacter (50%), four cases of Pseudomonas (18.18%), two cases of E.coli (9.09%), two cases of Klebsiella (9.09%) and three cases of Gram -positive (16.63%). Also these bacteria were reported as 11 cases of Acinetobacter (64.7%), three cases of Klebsiella (17/64%), two cases of Pseudomonas (11.76%), one case of E.coli (5.9%) in control group (P = 0.001).
Conclusion: This study showed that a mouthwash with a combination of Gentamicin-Clestin and Vancomycin, compared to chlorhexidine, was not more effective in preventing ventilator-associated pneumonia in patients undergoing mechanical ventilation.
 

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Background and Aim: Ventilator-associated pneumonia is a common, serious and costly complication in patients of intensive care units. Oral hygiene is one of the important clinical measures to reduce the amount of pulmonary infection in these patients. Therefore, this study compares the effects of chlorhexidine and orthodontal mouthwashes on prevention of pulmonary infection in patients with endotracheal tracheal intubation under mechanical ventilation in intensive care units.
Materials and Methods: This double-blind clinical trial study was performed on 60 patients undergoing mechanical ventilation in two groups of intervention (n = 30) and control (n = 30) in ICU department of Imam Reza hospital in Kermanshah. In the control group, chlorhexidine (0.2%) mouthwash and in the intervention group, Ortodontol mouthwash was used three times a day. Data on the rate of early and late pneumonia were compared based on CPIS criteria applying t-test and Chi-square.
Results: The incidence of early and delay pneumonia in the intervention group was lower than that of control, but no significant difference was observed (P >0.05). The overall frequency of pulmonary infection in the intervention group was significantly lower than the control group (P = 0.03). The frequency of pneumonia causes was lower in the intervention group, but this decrease was statistically significant in Staphylococcus aureus (P = 0.03).
Conclusion: According to the results of this study, orthodontol mouthwash can be effective in reducing the incidence of pulmonary infection associated with mechanical ventilation.

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Background and Aim: Deep vein thrombosis, especially in the lower extremities, is one of the complications of immobility. Major surgeries, especially orthopedic surgeries and inpatient care in the intensive care unit, predispose the patients to such complications. The aim of this study was to compare the prevalence rats of venous thromboembolism between the patients treated with enoxaparin and subcutaneous heparin in the intensive care unit.
Materials and Methods: This was a retrospective cross-sectional study. Sampling method was census. All the patients who had been admitted to the intensive care units of Imam Khomeini Hospital in Ahvaz from the beginning of September 2017 to the end of December 2017, were entered into this study. Data were extracted from the patients' medical records and recorded in a checklist for every patient. Using SPSS20 software, data were analyzed by descriptive and analytical statistics.
Results: Out of 600 patients, 64 (10.66%) patients had venous thromboembolism, of which 35 patients (54.7%) were in the heparin group and 29 patients (45.3%) in the enoxaparin group (P >0.05). 18 patients had deep venous thrombosis (3%), among them 13 (72.22%) patients were in the heparin group and 5 (27.78%) patients in the enoxaparin group (P <0.05).
Conclusion: In this study, enoxaparin administration was more effective than heparin in the prevention of deep vein thrombosis but the effects of these two drugs were the same in the prevention of pulmonary thromboembolism. More concrete conclusions require further studies with control of underlying and confounding factors.

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Background and Aim: Antibiotic resistance of pathogens responsible for nosocomial infections, has been a growing concern for healthcare system in recent decades. The aim of the current study was to identify the strains responsible for nosocomial infections and determine their frequency rates and antimicrobial resistance profiles in the patients admitted to intensive care units of Hazrat-e Rasool General Hospital in Tehran.
Materials and Methods: In this cross-sectional study we collected 936 blood, urine and sputum samples from the patients who had been admitted to the intensive care units of Hazrat-e Rasool General Hospital in Tehran between March 2020 and March 2021. Determination of strains and frequency rates of pathogens were carried out using multiple specific differential cultures. Then, we detected antibiotic resistance profile of each pathogen by using disc diffusion method.
Results: Acinetobacter (22.5%), Klebsiella pneumoniae (18.7%), Pseudomonas aeruginosa (13.6%), Candida albicans (11.2%) and Escherichia coli (7.2%) were the most common pathogens involved in nosocomial infections in this study. Acinetobacter isolates showed the highest sensitivity to clostin (100%) and cefotaxime (97.2%), respectively, and the highest resistant rate to ampicillin sulbactam (38.9%).
Conclusion: The results of the present study showed that in addition to the diversity of different pathogens in causing nosocomial infections in intensive care units, antibiotic resistance of these pathogens which is on the rise should be regarded important. Results of the current study and other similar periodic studies can provide valuable information for monitoring and management of emerging drug resistant infections.

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Background and Aim: Pain and restlessness are common problems in the intensive care unit. Sensory stimulation is one of the non-pharmacological methods of pain control. Dyang sensory stimulation includes visual, auditory, olfactory, tactile, and motor-sensory stimulation. In this study we investigated the effects of Dyang sensory stimulation on the level of consciousness, pain, and restlessness in the unconscious patients.
Materials and Methods: This clinical trial included 60 patients under mechanical ventilation. The patients were divided into two groups. The intervention group received Dyang sensory stimulation. Sensory stimulation was performed for one hour in the evening and at night for six consecutive days. Fifteen minutes after sensory stimulation, the level of consciousness, pain, and restlessness were measured using GlasgowComa Scale  , BPS (Behavioral Pain Scale), and Rass (Richmond Agitation Sedation Scale), respectively.
Results: The mean values for level of consciousness of the patients in the two groups before the intervention were below 7. The mean values for pain intensity (p=0.684) and restlessness (p=0.739) did not show any significant differences between the two groups before the intervention. After sensory stimulation on the second day, the level of consciousness of the patients in the intervention group increased compared to that in the control group (p=0.016). However, there were no significant differences between the two groups in terms of pain intensity and restlessness on all days of the study (p>0.05).
Conclusion: Dyang sensory stimulation can increase the level of consciousness.  Therefore, this multidimensional stimulation method can be used in the patients under mechanical ventilatation.

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Background and Aim: Drug-Drug Interactions (DDIs) can lead to decreased therapeutic efficacy, the occurrence of serious complications, and even mortality in patients. In the intensive care unit (ICU), the likelihood of these interactions increases due to the administration of a greater number of medications. Therefore, the present study aims to investigate the frequency, severity, and risk factors associated with DDIs in hospitalized patients in the ICU and its results may contribute to improving therapeutic management and reducing complications arising from DDIs.
Materials and Methods: This cross-sectional study was conducted on 79 hospitalized patients in the ICUs of Shohadaye Ashayer Hospital in Khorramabad city from March 21, 2021, to June 21, 2021. To identify drug interactions, three online drug databases—Medscape, Epocrates and Drugs.com—were utilized. Data analysis was performed using SPSS version 21.
Results: The median length of hospital stay was 11 days with interquartile range (IQR) of 15 days (mean ± standard deviation: 14.29 ± 11.67 days). In the intensive care unit (ICU), the median length of hospital stay was approximately 7 days and IQR was 11 days (mean ± standard deviation: 11.32 ± 10.87 days). Also, the mean number of medications used per patient was 18.08 ± 8.09. In this study, there was a significant correlation between the number of DDIs and various factors such as the duration of hospitalization and the ICU and the number of medications consumed (P<0.001). Also, no significant correlation was observed between DDIs and patients' age.
Conclusion: By educating healthcare personnel about potential DDIs and their adverse effects, replacing high-interaction Drugs with alternative options, and utilizing interaction detection software, it is possible to effectively prevent DDIs and harm to patients while reducing treatment costs.
 

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Background and Aim:
Klebsiella pneumoniae is an important opportunistic pathogen in hospital-acquired infections, which is associated with a significant increase in complications, especially in intensive care units (ICUs). The global rise in multidrug resistance (MDR) of this bacterium, including carbapenem-resistant Klebsiella pneumoniae (CRKP) strains, has made clinical management a serious challenge. This study was conducted to investigate the prevalence, resistance pattern, and clinical outcomes of Klebsiella pneumoniae in the intensive care unit of Kosar Hospital, Sanandaj 2023.

Materials and Methods:
This retrospective cohort study was performed on the records of 262 patients admitted to the ICU of Kosar Hospital during the year 2023. Information including demographic characteristics, length of hospital stay, cause of admission, sources of microbial culture, and clinical outcomes of patients was collected using a checklist and analyzed using SPSS softwareversion 24.

Results:
The results showed that 155 patients (59.2%) were infected with Klebsiella pneumoniae. The mean age of the patients was 57.35 ± 22.13 years, and 67.6% (177 individuals) were male. The most common causes of admission were cerebral infarction (24%) and multiple trauma (20.2%). In addition, the main source of microbial culture samples was tracheal secretions (49.6%). Statistical corelation analysis showed a significant association between Klebsiella pneumoniae infection and patients’ clinical outcomes (p = 0.042) as well as the length of hospital stay (p = 0.004).

Conclusion:
This study demonstrated a high prevalence of Klebsiella pneumoniae infection in the intensive care unit, which was associated with increased mortality and prolonged hospitalization. These findings highlight the importance of strict infection control, particularly regarding the use of invasive devices such as mechanical ventilators. The results of this research are consistent with global observations and emphasize the necessity of improving prevention and management strategies for multidrug-resistant infections.
 

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Background and Aim: Thrombocytopenia is one of the most common hematological disorders in infants, and more than one-third of affected infants are admitted to the neonatal intensive care unit, so the aim of this systematic review and meta-analysis is to determine the prevalence of thrombocytopenia in infants admitted to intensive care unit.
 

Materials and Methods: This study is a systematic review and meta-analysis by examining Scientific Information Database (SID), Medline (PubMed), ScienceDirect and Google Scholar until August 2023. Extracted data were analyzed by Comprehensive meta-analysis software (version 2).

Results: In a review of 8 studies with a sample size of 4507 children, based on a meta-analysis, the prevalence of thrombocytopenia in infants hospitalized in intensive care unit was reported as 14.8 (95% CI: 8.8-23.9), Also, examining publication bias in studies through the Egger test indicates the absence of publication bias in studies (p: 0.974).
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Conclusion: The results of the present study show that the prevalence of thrombocytopenia in infants hospitalized in intensive care unit is high and requires the special attention of health policymakers, hospital officials, and the necessary educational measures for pregnant mothers.