Vap Bundle Critical Care Analysis

38. American Journal of Respiratory care and critical care Medicine, Volume 175, issue 7, pages 698 – 704

It has been repeatedly stated that oral care is important in the prevention of ventilator-associated pneumonia (VAP). Endotracheal intubation predisposes patients to developing VAP. The tube acts as a conduit from the mouth to the lungs – a perfect track for bacteria to descend upon. Khezeri, et al. (2014) suggest that “the presence of an endotracheal tube (ETT) inhibits normal coughing, normal swallowing, and the protection of the trachea contact by epiglottis closure.” In addition, an endotracheal tube keeps the patients mouth open – leading to dryness. Bacteria are not washed away by saliva. Also, Landgraf, et al. (2017) mention that the presence of an endotracheal tube in the mouth causes “changes in the oral epithelium” which “might indicate risk for infection in intensive care patients

The VAP Prevention Protocol is intended primarily for the following healthcare professionals: • Respiratory Therapist • Nurses • Physicians • Physician Assistants • Anesthesia Technologist STATEMENT OF PURPOSE • To eliminate ventilator associated pneumonia in adult patients in an intensive care unit. • To encourage physicians, ICU nurses, and respiratory therapist to use the ventilator associated pneumonia bundle in all ventilated patients in an intensive care unit.

According to Hunter (2012, p.40) “VAP is a hospital acquired pneumonia that occurs 48 hours or more after tracheal intubation or acute tracheostomisation”. VAP is one of the most common nosocomial infection responsible for one third of mortal respiratory infections in European ICUs (Adib-Hajbaghery et al. 2011).

The VAP Bundle excerpted from the IHI (Institute for Healthcare Improvement) standards and VAE, IVAC, AND VAP definition criteria excerpted from NHSN continue to be utilized for all ventilator patients to monitor performance process and outcome measure compliance efforts.

Ventilator-Associated Pneumonia: A Quantitative Research Study Vanesia Davis Kelly Grand Canyon University Intro to Nursing Research-NRS/433V April 15, 2012 Ventilator-Associated Pneumonia 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

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

The Ganz et al. (2009) research was performed in order to evaluate the ICU nurses oral care routines and if they were using appropriate, up-to-date evidenced based techniques and lastly if evidence-based practices (EBP) was associated with personal demographics and professional characteristics. Ganz et al. (2009) had found that previous research and studies has shown that poor oral hygiene may contribute to greater risks for pneumonia which results in an increase in mortality and morbidity (Ganz et al., p 133). In fact some of the research studies had stated that there was no documentation of the nurses oral care practices and these practices were not even up-to-date with recent evidence (Ganz et al., p 133). In addition to that, ventilator-associated

• Alternative Devices o OPA o NPA o LMA o King Airway o BVM o Non-rebreather o Nasal cannula o CO2 detector for Philips monitor o End-tidal Co2 Ventilator Management Managing complex ventilator patients require critical thinking to solve problems pertaining to ventilator issues. Even though I am a certified ventilator paramedic, ventilator management is managed an respiratory therapist. Having the ventilator certification was useful in which I was able to apply my knowledge to

Abstract Clinical problem: Oral care and ventilator-associated pneumonia (VAP) is extremely important in all healthcare organizations and has gained increased attention. For this reason, oral care has been introduced in many hospital settings. However, there is not enough evidence on critically ill patients concerning the effect of oral care interventions on

BACKGROUND: Innovations within the healthcare industry related to scientific and technical advancements often lead to changes in healthcare delivery. To cope with these changes, it is necessary to prepare and train healthcare workers to improve employees ' knowledge and the quality of care. Limited clinical experience with the mechanical ventilation approach, like high frequency oscillatory ventilation (HFOV), makes its implementation difficult in the real critical care world. The authors investigated the effectiveness of technology-enhanced simulation with debriefing in improving participants’ confidence level, cognitive knowledge and psychomotor skills in using SensorMedics 3100B high frequency oscillatory ventilation (HFOV) in adult patients. METHODS: This is a quasi-experimental research design with pre and post-tests. The educational strategy involved technology-enhanced simulation training with debriefing. The population included critical care respiratory therapists, residents, fellows and attending physicians at Rush University Medical Center. RESULT: Twenty six participants were included for data analysis; 12 respiratory therapists and 14 critical care physicians. There were almost an equal number of females (53.8%) and males (46.2%). The improvement was statistically significant in cognitive knowledge test score with p value < .05; t (25) = 3.91. The mean for post-psychomotor skills test score was 3.15 (SD = .88) and the mean for pre-test total score was 2.35 (SD=

In this assignment, a case study will be discussed regarding a patient who is admitted for pneumonia and has a chronic obstructive pulmonary disease (COPD) as the comorbidity. To begin with, the epidemiology will be explored along with the NHS medical costs of pneumonia and COPD as the main rationale for the selected patient. Secondly, COPD and pneumonia 's pathophysiology will be looked at and the bio-psycho-social model will be used to present the impact on the patient. Thirdly, a systematic approach (ABCDE model) will be used to identify the patient 's complex care needs, by which breathing is the primary focus. Additionally, varieties of nursing assessments (eg. oxygen saturations, respiratory rate) for breathing will be considered, in conjunction with diagnostic assessments such as chest x-rays. Moreover, different nursing interventions, both pharmacological (e,g, bronchodilators, antibiotics) and non-pharmacological (eg. pulmonary rehabilitation) will be covered for the management of breathing. Last of all, the promotion of patient partnership in their decision-making process and the importance of inter-professional team working will be mentioned through the whole of this essay.

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

Staff in intensive care units have had several concerns about mobilizing patients receiving mechanical ventilation. There needs to be a change in mindset and practice of ICU staff in mobilizing patients receiving mechanical ventilation (Castro, Turcinovic, Platz, & Law, 2015).

The effect of innovations within the healthcare industry leads to many scientific and technical changes in healthcare delivery. To cope with these changes, there necessitate to prepare and train healthcare workers to improve employees ' knowledge and the quality of care. Limited clinical experience with new mode of mechanical ventilation, such as Airway Pressure Released Ventilation mode, make its implementation difficult in real critical world. Adequate staff training time, offsite support services, and backup from ventilator manufacturers are essential to improve employees ' knowledge and skills. My research topic seeks to investigate the effectiveness of scenario-based learning in training healthcare practitioners in the use of APRV. Airway Pressure Released Ventilation (APRV) was first introduced by Dr. Christine Stock and Dr. John Downs, in the late 1980s. The APRV application was originally used as a rescue therapy to manage ARDS patients who have difficulty in oxygenation.{40} The Drager Evita was the first ventilator provide APRV. Other ICU ventilator manufacturers incorporated APRV mode with different terminology. Such as, the Maquet Servoi refers to APRV as Bi-vent; the Puritan Bennett 840 uses the term Bi-level; the Cardinal AVEA uses Bi-phasic; and Hamilton G5 refers to APRV as DouPAP.{13}