The Rising Incidence of Ventilator-Acquired Pneumonia - Essay Example

? Ventilator Acquired Pneumonia: Literature Review and Theory Application Literature Review The problem identified is the rising incidence of ventilator-acquired Pneumonia within the healthcare setup. The studies and articles presented will outline management and preventive strategies in tackling Ventilator Acquired Pneumonia (VAP). VAP is the commonest type of nosocomial infection, occurring forty eight hours after the initiation of mechanical ventilation. It affects between 10 to 20% of patients under mechanical ventilation. VAP leads to increased ventilator duration, increased hospital stays, increased mortality and increased cost. Most health care givers consider it the leading cause of mortality among the nosocomial diseases. The presented articles strive to elaborate on VAP and the effective strategy in addressing this problem. One of the studies done pertaining to the subject matter elaborates a multidisciplinary approach that is aimed at reducing the incidence of VAP. The study was published in 2009 and was carried out by Arroliga et al. The aim of the study was to describe a multifaceted approach of evidence based practices geared at decreasing the rates of VAP in Intensive Care Units. The study also sought to describe the implementation of these evidence based practices within the same setup. Arroliga undertook the study in a teaching institution offering tertiary care. It employed a prospective surveillance system in identifying the cases emerging in the five ICUs. Cases included were confirmed by microbiology and used mini-BAL methods. A multidisciplinary approach was instituted in 2007 in the institution (Arroliga, 2009). The approach included education and awareness, use of standardized diagnosis and the direct confirmation of the adoption of VAP preventive and management measures. Pertaining to these measures, Nurses implemented oral care. Respiratory Therapists also assumed Oral care, and the Chlorhexidine was adopted in Oral care. Silver coated endotracheal tubes were also introduced. The rates of VAP before the implementation of these measures were compared to the rates after the implementation of the measures. The rate of VAP before the measures was approximately 5 cases per 1,000 ventilator/days. After the multipronged approach, the rate dropped to approximately 0.5 cases per 1,000 ventilator/days (Arroliga, 2009). This study objectifies the imperativeness of a multidisciplinary approach in tackling VAP. For effective management and preventive strategy, one needs to approach the disease from several angles. Another study was conducted by Keeley in 2007 sought to identify whether the occurrence of ventilator acquired pneumonia can be reduced by elevating the head of the patient to 45 degrees. This study was carried out in the Royal Sussex County Hospital in the Critical Care department. The study utilized 30 patients. The treatment group had 17 patients and the control 13 patients. The study implemented a randomized control trial to carry out the research. The bed of the patients in the treatment group was elevated at 45 degrees while that of those in the control group was elevated to 25 degrees (Keeley, 2007). The results of the study relied upon the diagnosis of ventilator acquired pneumonia either clinically or confirmed through microbiological tests. The results of the study demonstrated that about five patients in the treatment group (25% of patients) and seven of those in the control group (54% of patients) developed ventilator acquired pneumonia. The study indicated that there is a decreased incidence of VAP in patients nursed at a head elevation of 45 degrees. Unfortunately, the sample size was not adequate to reach statistical significance and thus, the study is not reliable (Keeley, 2007). Lacherade et al. carried out a research in various centres to demonstrate the relationship between intermittent sub-glottis secretion drainage in the reduction of VAP (Lacherade, 2010). The aim of the study was to demonstrate that intermittent sub-glottis secretion drainage reduces the incidence of VAP in mechanically ventilated patients. The study employed a randomized control trial method that was used in four French based medical centres. The study included 333 adult patients. These patients were expected to require mechanical ventilation for more than 48 hours. Of these patients, 169 were in the treatment group while 164 were randomly selected as the control group. Cases with VAP were identified based on clinical findings and were confirmed using microbiological culture of the distal pulmonary secretion samples. Other outcomes noted were the occurrence of early or late onset VAP, hospital mortality and influence of duration in the mechanical ventilator. In the study, a total of 67 patients contracted VAP of which 14.8% (25 out of 169) in the treatment group and 25.6% (42 patients) in the control group. In addition, intermittent sub-glottis secretion drainage (SSD) was demonstrated to reduce the occurrence of both early and late onset VAP (Lacherade, 2010). There was no significant variation among the 2 groups in relation to the mortality rate and the duration of mechanical ventilation. The study concluded that intermittent SSD was effective in reducing the incidence of VAP in mechanically ventilated patients (Lacherade, 2010). Ventilator acquired pneumonia is associated with high mortality and morbidity in mechanically ventilated patients. A study conducted by Vincent et al. revealed that it affects about 10-20% of the patients in the critical care unit receiving mechanical ventilation (Vincent, 2010). The above studies reveal that there are various ways of preventing the occurrence of VAP in these patients. According to Vincent et al. early diagnosis both using clinical and microbiological methods is crucial so as to initiate antimicrobial therapy for the patient. Treatment of VAP relies on the aggressive application of antimicrobial therapy with consideration to the patient’s length of stay in hospital under the mechanical ventilator, resistant and local infection in the patient (Vincent, 2010). According to Vincent et al., the high mortality and morbidity rates associated with VAP demonstrate the need to execute strategies in reducing the incidence of infection in mechanically ventilated patients. These include semirecumbent positioning as demonstrated by Keeley (2007) and the application of non invasive procedures. Others include the use of antimicrobial coated endotracheal tube, oral decontamination and sub-glottal suctioning. Although these methods are beneficial, there are is a need to study whether the application of these methods in the management of ventilator acquired pneumonia is cost effective. According to Vincent et al., it is also imperative to carry out studies to identify the methods that are beneficial. It is also vital to identify the methods that are cost effective considering the individual factors of the patients. The literature reviewed shows positive evidence that there is a need to include various preventive measures in the nursing care of mechanically ventilated patients so as to prevent VAP. The above studies indicate a reduction in contracting VAP in patients where the preventive measures were employed. In addition, the high incidence rates, cost of treatment of the patient and increased mortality of patients that acquire VAP is alarming calling for preventive measures. Therefore, it is important to employee preventive nursing strategies in the care of these patients so as to prevent the incidence of VAP. In order for this, a multifaceted approach is mandatory. Different angles should be used so as to tackle the problem in an effective manner. Simple and basic procedures have been found to be imperative. Such include oral hygiene and toileting. This has been shown to decrease the incidence of VAP by a significant margin. Head elevation at 45 degrees is another measure that has been proven to be effective. Intermittent sub-glottis secretion drainage has yielded success in preventing early onset and late onset VAP. Antimicrobial coated endo-tracheal tubes are also imperative when it comes to the prevention of VAP. All the above procedures are simple to carry out. They are also cost effective. However, they have been proven to be life saving in tackling Ventilator Acquired Pneumonia. Theory The theory that is chosen is Orlando’s Nursing Process Theory. It was developed by Jean Orlando. According to this theory, the role of the Nurse is to seek out and meet the immediate patient’s need for help (Marilyn & Marlaine, 2010). The theory notes that the presentation of a patient in terms of acute changes in health status and vitals is a plea for help (Marilyn & Marlaine, 2010). The help needed may not be immediately apparent. Therefore, the nurse should use their own perception and feelings to explore the help that the patient needs. This nursing process will help to discover the type of distress and the appropriate help that should be accorded to the patient. In this theory, distress is termed as the experience or presentation of a patient who has unmet needs. So as to recognize the distress, the nurse should identify the situation as being problematic. The presenting patient behavior leads to an internal response in a nurse. The behavior of the nurse then causes a response in a patient. With this theory in mind, one should identify that patients in ICU will go into distress if due measures are not instituted. If VAP preventive measures are not utilized, the patient may go into distress. These preventive measures should be regarded as needs of mechanically ventilated and ICU patients. Henceforth, it will be the obligation of the nurse to ensure that such measures are utilized. This will generate an improvement in the patient condition and lead to a positive outcome. The nursing process involves the recognition of the needs of the mechanically ventilated patients. This is via assessment, arriving at diagnosis, planning and implementation and then evaluation. As an example, the mechanically ventilated patients require oral hygiene and toileting. Head elevation and sub-glottis secretion drainage are also imperative in preventing the acute changes in the health status and vitals of the patient. If we recognize this as a patient’s need, we can plan and implement measures that can improve oral hygiene. Later on, the patient will be evaluated to see if oral hygiene is successful. Such measures in oral hygiene may include the use of Chlorhexidine as noted by Arroliga et al. (2009). Reference List Arroliga, A.C. et al. (2012). Reduction in the incidence of ventilator-associated pneumonia: A multidisciplinary approach. Respiratory Care, 57(5): pp. 688-696. Keeley, L. (2007). Reducing the risk of ventilator-acquired pneumonia through head of bed elevation. Nursing in Critical Care, 12(2): pp. 287-294. Lacherade, J., De Jonghe, B., Guezennec, P., Debbat, K., Hayon, J., Ramaut, C., Outin, H., & Bastuji-Garin, S. (2010). Intermittent sub-glottis secretion drainage and ventilator-associated pneumonia: a multicenter trial. American Journal of Respiratory Critical Care Med, 182, 7: 910-917. Marilyn, P., & Marlaine, S. (2010). Nursing Theories and Nursing Practice. London: Routledge. Vincent, J.L., Barros, D.S. & Cianferoni, S. (2010). Diagnosis, management and prevention of ventilator-associated pneumonia. Drugs, 70(15): pp. 1927-1944. Read More