The VAP Prevention Protocol

Critically ill patients who are intubated on mechanical ventilation for more than 24 hours of are at an increased risk of 6 to 21 times of developing ventilator associated pneumonia (VAP). Patients intubated for lesser than 24 hours are at 3 times the risk of acquiring VAP.15

The prevention of VAP through standardized care can reduce mortality rates, reduce mechanical ventilation days, and decrease costs and improve patient outcome.

Ventilator Associated Pneumonia (VAP) is the second most common infection that patients develop while in the hospital and the leading cause of death due to hospital acquired infections (Augustyn, 2007). Hospital acquired infections are also known as nosocomial infections. VAP usually happens when patients are on mechanical ventilation (the ventilator) for over 48 hours. VAP is costly because it increases the hospital length of stay, often times in the Intensive Care Units (ICU). Patients are often on the ventilator and are receiving antibiotics to treat the pneumonia. This paper will show that

Based oral care protocol to decrease ventilator-associate pneumonia. Dimensions of Critical Care Nursing 31(5), 301-308. doi: 10.1097/DCC.0b013e3182619b6f

It is important for healthcare providers to acknowledge the evidence base that drives our clinical practice. Evidence-based practice (EBP) is at the forefront of our ability to deliver high quality care and is utilized when making clinical decisions concerning patient care. Ventilator-associated pneumonia (VAP) is a hospital-acquired infection that occurs in mechanically ventilated (MV) patients and contributes to increased levels of morbidity and mortality. VAP is a preventable condition and many efforts have been instituted to curb its incidence. A clinical care approach adopted by many

This truly is a problem that more professional health care providers need to be acutely aware of so that they can engage in more efficient methods of adequately preventing this condition. For many patients, receiving ventilation is not an option; it's a life-saving necessity. However, clinicians need to work harder to lower the rates of corresponding pneumonia associated with ventilation, so that it isn't such a "give-in" or overwhelming risk factor of receiving ventilation. Generally VAP occurs at a rate of just over 20 percent in clients who are put on mechanical ventilation (Augustyn, 2007). Mechanical ventilation bolsters the danger of acquiring pneumonia from a rate of three-fold, tripling it to ten-fold (Augustyn, 2007). These numbers reflect a lack of capability and deficit in high quality of care among members of the clinical staff. While certain hospital borne infections are unavoidable, and while

Promoting strategies to improve this quality measure is imperative because critically ill patients are more vulnerable and susceptible to infections. The focus of ICU’s and the nurses who work there is providing care that patients need and ensuring quality and safety. The purpose of this health care quality indicator is to help nurses and physicians reduce the occurrences of VAP, resulting in reduced mortality and morbidity among ICU patients who are mechanically ventilated, and to reduce costs for hospitals.

Combinations of various criteria to establish a diagnosis in patients with VAP have been suggested and validated (Table 1). The National Nosocomial Infection Surveillance (NNIS) system was developed in the 1970s by the Centers for Disease Control as a tool to describe the epidemiology of hospital-acquired infections and to produce aggregated rates of infection suitable for inter-hospital comparison, but was never compared to pathological results. The NNIS system was compared to bronchoalveolar lavage (BAL) fluid cultures in 292 trauma patients and had a sensitivity of 84% and a specificity of 69% [15]. More recently, the Clinical Pulmonary Infection Score (CPIS) was proposed by Pugin et al. [16], based on six variables (fever, leukocytosis, tracheal aspirates, oxygenation, radiographic infiltrates, and semi-quantitative cultures of tracheal aspirates with Gram stain) [16]. The original description showed a sensitivity of 93% and specificity of 100%, but this study included only 28 patients and the CPIS was compared to quantitative culture of BAL fluid using a 'bacterial index ' defined as the sum of the logarithm of all bacterial species recovered, which is not considered an acceptable gold standard for the diagnosis of VAP. Compared to pathological diagnosis, CPIS had a moderate performance with a sensitivity between 72 and 77% and specificity between 42 and 85% [11,17]. Likewise, CPIS was not sufficiently accurate compared to a BAL fluid-established

Ventilator-associated pneumonia (VAP) is a hospital-acquired condition that is currently not on the Centers for Medicare and Medicaid Services’ (CMS) list of non-payment hospital-acquired infections (CMS, 2015). However, the thought of adding VAP to the list occurred in past discussion by CMS (CMS, 2008). This may change when there is an improved definition with clearer inclusion criteria that is currently being constructed by the CDC (Klompas et al., 2014). Nonetheless, the goal is to prevent hospital-acquired illnesses, such as VAP. After performing a review of care interventions for the prevention of VAP, a collaborative team between the Society for Healthcare Epidemiology of America, the Infectious Diseases Society of America, the American Hospital Association, the

1.16. Explain the standard set of nursing observations that are completed on an individual who is in respiratory distress? Blood pressure, L&S manual or machine, SPo2 used on finger, ear or nose, Respirations for full minute, HR manual or through machine, neurovascular observation and capillary refill, pain scale, alert scale (Chrisp & Taylor, 2011)

A couple months ago, my unit (Cardiovascular intensive care unit) and the other ICU unit at my hospital started implementing a set scheduled time for performing spontaneous breathing trials (SBTs) for all ventilated and intubated patients during both the day and night shift. This change allows for a structured protocol with clear instructions on how to approach SBT and is part of our strategy to decrease the amount of time that the patients stay intubated. The sooner we remove the intubation tube; it will decrease the chances of the patient developing any ventilator-associated pneumonia because we are allowing their natural lungs to exercise.

To have a PHVP, a hospital needs to have a pediatric surgeon and pediatric ICU able to accommodate vent-dependent patients.

To have PHVP, there is an extensive amount of resources that are needed. This includes the intensive care unit room, equipment, medications, and personnel. A monetary discount may be granted depending on the patient’s financial status or condition.

In Egypt the incidence rate of VAP was 15.3% that increased the risk of mortality rate by 33% in contrast to the patient without VAP which was just 24.3% (Timsit, Zahar and Chevret, 2011, p.469). However, VAP independently cannot predict the death of the patient, there are other reasons associated with the VAP such as severity of disease, and duration of ICU stay (Myny et al., 2014, p.120). A study of Faisy et al.,(2011, p.1257) reveals that the risk factor associated with the VAP are: history of lungs diseases, immune compromised state, nutritional deficiency. In order to reduce the incidence rate of VAP in ICU settings, it is very necessary to follow the evidence based process indicator as a quality indicator because it tries to find out the obstacle that had been faced in the past and provides a proper guideline and feedback to improve the quality of service, in addition close surveillance, monitoring the previous outbreak and feedback from results could help to reduce the incidence rate (Wong, Mathieu and Williams, 2012, p.80). While working in ICU, the most patient experiences the problem of weaning. A study of Prasad, Chaudhry and Khanna,(2009, p. 221) reveals that patient experience the weaning failure at the time of extubate because of prolonged and dependency on mechanical ventilation. Other reason behind the weaning failure are: old age, increased minute ventilation, severe

As a brilliant discovery a mechanical ventilation was, it still has its disadvantages. A patient whose mechanically ventilated for more than 24 hours have a higher risk of de-veloping Ventilator Associated Pneumonia. The Journal for Respiratory Care Practi-tioners has stated “A person who had a machine to assist or control respiration contin-uously through a tracheostomy or by endotracheal intubation within the 48 hour peri-od” as definition of VAP (DeJUILIO et al, 2012). VAP is an infection colonization caused by either the inserting of foreign body into the airway resulting in a self de-fense mechanism against the tube or the aspiration of oropharyngeal secretion around the cuff. It is more appropriate described as an artificial airway infection.