Ventilator Lack: A Case Study

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

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).

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

VAP is one of the common hospitals acquired infections, which got significant importance in following evidence based practice to prevent it. The authors of this study used a retrospective single center observational cohort study, done in the ICU at Scott and White Hospital, Temple, Texas. The study took almost two years for its completion. The research team implemented the ventilator bundle about 258 patients in mechanical ventilator. The limitations of the study were its retrospective nature, single center study and the database does not have metrics for severity, such as Acute Physiology and Chronic Health Evaluation (APACHE) score.

The purpose of this paper is to assess the effects of oral care on ventilator-associated pneumonia for inpatient

Ventilator-associated pneumonia compounds the risks that critically-ill patients face in hospitalization. It affects a high proportion of patients on ventilators and has a fluctuating morbidity rate. The goal of this paper is to demonstrate the potential usefulness of chlorhexidine in preventing ventilator-associated pneumonia in adults. The paper features a review of literature found via MedScape using the keywords “chlorhexidine,” “ventilator-associated pneumonia,” “long-term ventilation” and “prevention.” The results show that there is a positive correlation between using chlorhexidine in the oral care of patients using a ventilator; however, the evidence thus far does not present an opportunity to promote any clinical recommendations.

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

Ventilator Associated Pneumonia (VAP) is defined as pneumonia in a patient who is intubated and ventilated at the time of the onset of the event or 48 hours before, and VAP rate as the number of ventilator-associated pneumonias per 1,000 ventilator days (Institute for Healthcare Improvement, 2014a). The Institute for Healthcare Improvement (IHI) gives the following example of how to calculate the number of VAP’s in a month: “if 25 patients were ventilated during the month and, for purposes of example, each was on mechanical ventilation for 3 days, the number of ventilator days would be 25 x 3 = 75

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

The study was conducted for many reasons. First, in order to achieve optimal outcomes for the patient, the most current research based practice must be employed as improper techniques can have detrimental results to the patient in terms of inadequate oxygenation, injury to pulmonary tissues, infections and increased anxiety to the patient. The second reason is to identify if ICU Nurses are in compliance to the practice recommendations based on current research & knowledge, and if not, to implement actions to rectify deficiencies. The hypotheses statement is that ICU nurse’s ETS performance does not adhere to the best practice recommendation for ETS. The null hypothesis is that ICU nurses adheres to ETS best practice recommendation standards when suctioning patients.

While working in ICU settings I realized that the patient condition, clinical skills, physical environment and work culture were the main causes for the development of VAP.

Patients who require advanced monitoring, treatment, and nursing care due to injury or disease are cared for in the intensive care unit (ICU). Approximately 50% of these patients need mechanical ventilation (Tingsvik, Johansson, Martensson, 2015). A ventilator is a machine that supports breathing if the patient is unable to do so. Some patients need ventilators for a short period of time, while others require prolonged ventilation, which increases the risk of complications. Indications for mechanical ventilation arise when the patient cannot uphold spontaneous ventilation to sustain life, which include apnea, acute respiratory failure, severe hypoxia, coma, neuromuscular disease, and respiratory muscle fatigue.