What is the best evidence based nursing practice in attempting to reduce (VAP) ventilated associated pneumonia? I decided to do an evidence based paper on VAP after talking to respiratory therapy on the sixth floor of Chippenham hospital during my clinical studies. I have a friend who has spent many years as a RN in the critical care unit and has seen the effects of different methods in reducing VAP first hand. This is a nursing intervention and the sole responsibility of the nurse. I can’t think of a better topic to research considering I am in my first semester of nursing school. I am very excited to share what I have found. I have found a large amount of information on different methods to reduce VAP but have decided on three to …show more content…
According to the Annals of Internal Medicine 08/17/2004 article, keeping the HOB elevated between 30 and 45 degrees reduced the rate of VAP by 27% in a study from May 1, 2004 until July 31, 2004 in 275 patients. This article is only showing one source of a study at one hospital; however, in my research I have found that this method is recommended by doctors and nurses seeming to be a very effective measure in reducing the incidence of VAP combined with other methods. (American College of Physicians, August 2006) The Annals of Internal Medicine was established in 1927 by the American College of Physicians (ACP), Annals of Internal Medicine is the premier internal medicine journal. Our 2009 impact factor of 16.2 makes the Annals of Internal Medicine one of the most cited general medical journals in the world. Materials published in Annals are peer reviewed. Oral care plays a vital role in reducing VAP. Effective oral care starts with the assessment of the patient’s mouth and acts as measure for needs for each patient. There have been studies performed using different solutions including chlorhexidine gluconate (CHG) as an oral care agent to reduce VAP. A test study was done using 101 patients 51 patients being the control group (using pink mouth swabs and traditional methods of oral care) and 49 patients being the tested group (using chlorhexidine gluconate at a minimum two times per day) VAP
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VAP is defined as a patient who is mechanically ventilated for greater than 48 hours and exhibits three out the five symptoms: fever, increase leukocytosis, change in sputum color or amount, radiographic evidence of new/progressive infiltrates and worsening oxygen requirements along with a culture identifying a bacterial microorganism (CDC, 2008). Risk factors associated with the formation of VAP is the altered oral physiology where there is a decrease in saliva production decreasing the pH level forming an ideal environment for bacteria to grow, respiratory pathogens such as Staphylococcus aureus, Streptococcus pneumonia, Methicillin Resistant Staphylococcus aureus and Pseudomonoas aeruginosa which can form a biofilm on the teeth that we know as plaque that can then aspirate and travel down to the lungs (Koeman et al., 2006). Several studies (Munro et al., 2009) have verified that removing bacteria from the oropharynx requires the removal of dental plaque, and the only way to remove the plaque is with toothbrushing. Others found that the majority of nurses use a soft Toothette instead of toothbrushing and that the Toothettes do not
Instilling normal saline solution before endotracheal suctioning improves oxygenation, facilitates removal of secretions, and stimulates coughing to mobilize secretions. Is this to be considered evidence practice? Suctioning is one of the main procedures used by respiratory therapist and nurses in the acute care and home health to help patients who require the use of a ventilator. According to the literature there is little research supporting the practice of instilling normal saline prior to suctioning. In contrast, studies have revealed this practice is more dangerous because it increases the risk of ventilator associated pneumonia. (Miller, Drummond, & Carey, 2015). This type of pneumonia occurs when bacteria is present in the saline vials. The evidence based practice of sacred cow proposes this practice of saline instillation prior to suctioning a patient prior to intubation should not be done.
Ventilator-associated pneumonia is a bacterial infection that occurs in the lower respiratory system within the first 48 hours of endotrachal intubation (Lewis, Dirksen, Heitkemper, Bucher, & Camera, 2011). Although any hospital patient is susceptible to pneumonia, ventilator dependent patients are at the highest risk of acquiring pneumonia. The purpose of this paper is to identify the risk factors, incidences, and preventions of ventilator-associated pneumonia (VAP) using a quantitative research study performed in Malaysia. “The aim of this
(2012) evaluated whether oral care by swabbing with 0.2% CHX decreases the risk of ventilator-associated pneumonia (VAP) in hospitalized patients. Patients 18 years and older were included in the study if they had no episode of chemical pneumonitis and have never been diagnosed with thrombocytopenia. Eligible patients were randomly assigned to one of two groups as follows: a CHX group (n=29) and a control group (n=32). Oral care was performed by swabbing oral mucosa with either CHX or saline on sponge pellets, four times daily (at 6 AM, 12 AM, 6 PM and 12 PM). Approximately 30 mL of 0.2% CHX or saline was applied and this lasted for about 1 minute. The control group received the standard oral care (saline applications). All patients were followed for at least 14 days or until discharge from the hospital, extubation or death. The main outcome in this study was the incidence of VAP and was assessed using a mouth mirror together with a headlight. VAP was observed in 34/61 patients (55.7%) within 6.8 days. The rate of the development of VAP was significantly higher in the control group (68.8%) compared to the CHX group (41.4%) [p = 0.03] with a significant odds ratio of 3.12 (95% CI = 1.09-8.91). This study identified acinetobacter baumannii (64.7%) as the most frequent pathogen of all study
Healthcare-associated pneumonia (HAP) is a common complication of being hospitalized, especially in the elderly. On average, HAP increases the length of stay (LOS) to seven to nine days, adds $40,000 to $65,000 in cost of care, and is a big contributor to morbidity and mortality risks (Quinn, et al., 2014). The World Health Organization reports that 1.4 million people die annually related to pneumonia infections (Driver, 2012). A comparison of community-acquired pneumonia (CAP) and HAP indicates that it is more likely to contract a multi-drug resistant pathogen to HAP than it is to CAP (Pássaro, Harbarth, & Landelle, 2016 ). To ensure adequate patient care and to significantly decrease risks of infections, specifically HAP, it is essential for proper nursing care to be implemented to clients.
This paper will discuss the prevention of ventilator associated pneumonia utilizing the ventilator associated pneumonia care bundle and the impact it has on clinical practice. Topics that will also be discussed include potential barriers that may arise during the implementation of the bundle strategies, how they can be overcome and finally educational strategies for families.
Conclusions: The use of chlorhexidine has been proven to be of some value in reducing VAP, although may be more effective when used with a solution which targets gram-negative bacteria.Tooth-brushing is recommended in providing a higher standard of oral care to mechanically ventilated patients and reducing VAP when used with chlorhexidine. However, limitations in study design and inconsistency in results suggests that further research is required into the effects of
Dental plaque is a main culprit of causing VAP in young patients. The mouth harbors many bacterias including gram positive and gram negative bacterias. To prevent ventilator associated pneumonia from dental plaque guidelines have been set up to decrease the risks. For all infants and children every two hours the oral cavity should be moistened and the lips should be coated with petroleum jelly. For children with teeth it is recommended that the teeth be brushed every twelve hours with fluoride toothpaste, oral cavity suctioning should be done frequently but do not rinse the mouth. Daily oral care with 0.6% chlorhexidine for children over 6 who have teeth is also indicated.
In the ICU, an area of practice that has seen improved patient outcomes is through the use of Ventilator Associated Pneumonia (VAP) bundles. VAP is a pneumonia that affects patients who are on ventilation. It occurs when pathogens enter the patient’s lungs through the mouth, nose or throat. A ventilator strategy bundle was developed. In 1994, the Healthcare Infection Control Practices Advisory Committee (HICPAC) revised the CDC Guideline for Prevention of Nosocomial Pneumonia to address VAP, as there was growing concern regarding the mortality and morbidity associated with healthcare related pneumonia. In the report, the VAP strategy bundle was developed and included in the bundle are: elevation head of bed to help prevent aspiration, oral
Ventilator –associated pneumonia (VAP) is a hospital acquired infection affecting the respiratory system which occurs on hospitalized patients in critical care unit on mechanical ventilator. VAP is the second most common hospital acquired infection (HAI) with high mortality and morbidity rate for ventilated patients in intensive care unit. (Bingham. Ashley, Jong & Swift, 2010). Patients on mechanical ventilator spend more days in the hospital which in turn affects health care cost. VAP prevention is ongoing for nurses working in Intensive care unit. It is the duty of the nurses to help in VAP prevention by adhering to the interventions in the ventilator bundle in their daily
Nursing Diagnosis I for Patient R.M. is ineffective airway clearance related to retained secretions. This is evidenced by a weak unproductive cough and by both objective and subjective data. Objective data includes diagnosis of pneumonia, functional decline, and dyspnea. Subjective data include the patient’s complaints of feeling short of breath, even with assistance with basic ADLs. This is a crucial nursing diagnosis as pneumonia is a serious condition that is the eighth leading cause of death in the United States and the number one cause of death from infectious diseases (Lemon, & Burke, 2011). It is vital to keep the airway clear of the mucus that may be produced from the inflammatory response of pneumonia.
Dysphagia is a swallowing disorder that is described as an abnormality in transferring a solid or liquid bolus from the oral cavity to the stomach (Bernard, Loeslie, & Rabatin, 2015). With a diagnosis of dysphagia, a patient will likely aspirate foods and/or liquids of different consistencies. Aspiration is “the entry of food or liquid into the airway below the true vocal folds” (Logemann, 1998, p. 5). Specifically, thin liquid dysphagia occurs when a patient aspirates while consuming any liquids that are not thickened, such as water. Patients with thin-liquid dysphagia are often prescribed a modified thickened liquid-only diet, meaning they consume liquids that are thickened to a greater consistency of nectar, honey, or pudding (Carlaw et al., 2007). An increased viscosity reduces the flow rate of a bolus, makes it more cohesive, and is easier for many people to control intraorally, thus preventing spillage into the airway (Murray, Miller, Doeltgen, & Scholten, 2013). Dysphagia can also contribute to the occurrence of aspiration pneumonia. Aspiration pneumonia occurs “when organisms infiltrate the lower respiratory tract during an episode of aspiration and the
Ventilator associated pneumonia (VAP) is a nosocomial infection occurring in hospitalized patients who are mechanically ventilated. These infections are common in ICU settings, difficult to diagnose early, and unfortunately have a high rate of mortality and morbidity. VAP accounts for almost half of infections in ICU settings, up to 28% of mechanically ventilated patients will develop VAP and of these patients the mortality rate is between 20% and 70% (Craven & Steger, 1998). A patient that develops VAP while mechanically ventilated adds days to his recovery as well as thousands of dollars to the care costs. Numerous studies have been conducted across the county in an effort to understand VAP, however very few of those studies focus on
The intensive care unit provides patients with continuous and comprehensive care. This care should be safe and suitable for healing. However, especially in the ICU, the nosocomial infection is a common clinical problem in which nurses must consider the patient’s safety and be able to prevent these high incidences from occurring. The patient with airway infection can develop ventilator-associated pneumonia (VAP) after 48h of mechanical ventilation. This is usually caused by leakage of contaminated oropharyngeal secretions and aspiration around the endotracheal tube cuff and into the lung. VAP is the most common nosocomial infection in critically care ill patients and in patients receiving mechanical ventilation (Korhan, Yönt, Kılıç, & Uzelli, 2013). The second most common nosocomial infection in PICU, which is linked to increase mortality, morbidity, and lengths of stay in ICU and hospitals (Cooper & Haut, 2013; Nemat & Habibi, 2014). Major efforts to prevent VAP are to focus on the aspects of care, evaluate the knowledge levels of critical care nurses and the effectiveness of certain intervention and prevention strategies that reduce the risk for VAP. The true major efforts to prevent VAP are the use of use of oral health care program, re-intubating patients, suctioning, and bed elevation (Cooper & Haut, 2013; Liao, Tsai, & Chou, 2014; Nemat & Habibi, 2014). The purpose of this literature review is to identify the best preventions protocol to reduce the risk and