Ventilator-Associated Pneumonia Essay

Identification of infections is reviewed during the quarterly ICU meeting during Q&A sessions for potential VAEs, IVACs, possible and probable VAPs. All events will be reflected in the statistical reporting data individually.

Management of the acutely ill adult is a complex and perplexed procedure. It requires underpinning knowledge of the pathophysiology of the disease currently affecting the patient, as well as ensuring that professionals are equipped to deal with the development of a rapid deterioration. The National Institute for Clinical Excellence (2007) explain that patients are sometimes inadequately treated due to staff not acting in a sufficient time manner, and so a systematic assessment of the patient recommended by the Resuscitation Council (2006) should initially be followed (Jevon, 2009).

As Jane was presenting with a symptom of a life threatening event it was important that treatment was immediate. Priority was initially made from assessment of the airways, breathing and circulation, level of consciousness and pain. Jane’s respirations on admission were recorded at a rate of 28 breaths per minute, she looked cyanosed. Jane’s other clinical observations recorded a heart rate of 105 beats per minute (sinus tachycardia), blood pressure (BP) of 140/85 and oxygen saturation (SPO2) on room air 87%. It is important to establish a base line so that the nurse is altered to sudden deterioration in the patient’s clinical condition. Jane’s PEWS score (Physiological Early Warning Score) was 4 and indicated a need for urgent medical attention (BTS 2006). Breathing was the most obvious issue and was the immediate priority.

(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

After many years, research finally validated Semmelweis’s theory and showed that diseases and infections were spread from person to person by various forms. Hospital practices needed to change their policies after it was shown that infections spread by droplet, air, and contaminated surfaces. It was not long before the public realized that there are infinite opportunities to obtain infections in healthcare facilities. In order to create the most effective policies, they needed to investigate and determine potential problems. Some of the most common HAIs include: central line-associated bloodstream infection, catheter-associated urinary tract infections, (CAUTI commonly known as UTI), surgical site infection (SSI), and ventilator-associated pneumonia (VAP).

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.

In the study of Verani, McCracken, Arvelo, Estevez, Lopez, Reyes, Moir, Bernart, Moscoso, Gray, Olsen and Lindblade (2013), a total of 8,914 hospitalized patients

Gélinas, C., Arbour, C., Michaud, C., Robar, L., & Côté, J. (2013). Patients and ICU nurses'

Ventilator-associated pneumonia (VAP) refers to bacterial pneumonia developed in patients who have been mechanically ventilated for more than 48 hours. Whilst there is no universally accepted definition of ventilator-associated pneumonia (VAP)(Department of Health (DoH) 2010), it is viewed as a hospital-acquired infection caused by the aspiration of bacteria past the endotracheal cuff after 48 hours of being intubated, which can develop into pneumonia. VAP is known to extend intensive care unit (ICU) stay and has substantial cost implications of up to £12,000 per patient episode (Fletcher et al., 2008). Safadar et al., (2005) suggest that strategies for the prevention of VAP are urgently needed to help reduce hospitalisation costs, incidence of mortality and improve patient

Hospitalization for any family is a hard situation to deal with, when it is a child in the hospital the situation because even tougher to handle. Because of the delicate situation of family members in the hospital it is imperative that the patient does not obtain any hospital acccuired conditions. One of the most common hospital acquired infections (HAI) is ventilator-assocaited pneumonia (VAP). Although it is commonly seen in the hospital setting it can have devastating effects, especially on children. Prevention of VAP is the goal for critical care nurses in all hospitals.

One study conducted in five Danish hospital in Denmark.the sample size are 1000 patients its large sample size .and the study are Retrospective observational study.used list of triggers(VTE,pressure ulcer ,medication ,infection,falls,procedure ,gastrointestinal device failure)

As a nurse in the critical care unit I noticed an increase in CAUTIs over the last six months furthermore, there was also an increase in new clinical staff during that time. Using my skills learned in my Evidence Based Practice course I investigative the increase in CAUTIs on the unit. The patients in the ICU are at risk for CAUTIs because they are catheterized for an extended period of time, which is the single greatest risk factor for CAUTIs. Additionally, ICU patients are sicker than in the past which has increased length of stay. Additionally, this has also compromised their immune system, making them more susceptible to infection.

Implementation of the VAP bundle has greatly decreased VAP at various facilities. Even if the patient is unable to tolerate certain interventions there are various other interventions that could be put in place that would help halt the process of proliferation before it starts. The quality of care in relation to ventilated patients has greatly increased due to the frequency in which oral care, turning and sitting the patient up is recommended. The VAP bundle at the Regional Medical Center at Memphis consist of elevating the head of the bed (HOB) to 30º to 45º, twice-a-day oral care with chlorhexidine mouth rinse, stress ulcer prophylaxis, washing of hands before and after contact with each patient, daily sedative interruption, and daily assessment of patients readiness to wean from mechanical ventilation.

The annual incidence of ARDS is 13-23 people per 100,000 in the general population and it is higher in the mechanically ventilated population in intensive care units which represents 16.1% percent in ventilated. Pneumonia and sepsis are considered as leading trigger of ARDS as pneumonia represent in up to 60% of patients and may be either causes or complications of ARDS and according to literature approximately 30% of patients with severe sepsis may develop ARDS or ALI. Other triggers include aspiration, circulatory shock, mechanical ventilation, smoke inhalation, trauma especially pulmonary contusion major surgery, massive blood transfusions, drug reaction or overdose, fat emboli and reperfusion pulmonary edema after lung transplantation or pulmonary embolectomy. Alcohol excess appears to increase the risk of ARDS. Until the 1990s, majority of studies reported a 40-70% mortality rate for ARDS. However, 2 reports in the 1990s, one from a large county hospital in Seattle and one from the United Kingdom, suggested much lower mortality rates, in the range of 30-40%. Possible explanations for the improved survival rates may be better understanding and treatment of sepsis, recent changes in the mechanical ventilation, and better overall supportive care of critically ill patients. (Koh et al, 2012)

Ventilator associated pneumonia( VAP) is defined as pneumonia occurring after 48 hours of prolonged mechanical ventillation14