Ventilator Associated Pneumonia - Essay Example

? Ventilator Associated Pneumonia (VAP An Appraisal Report Grand Canyon Professional Capstone Project December 13 Presented : Ventilator Associated Pneumonia (VAP) Ventilator Associated Pneumonia (VAP) is a common nosocomial infections that affect administered with mechanical ventilation; it is responsible for most antibiotic drugs given to ICU patients. The reported incidences depend on mechanical ventilation exposure time, case mix, and finally the approach used to diagnose this infection. It is estimated that between 9% and 27 % of all mechanically ventilated patients are at risk of VAP infection, at a rate of about five cases per 1000 ventilations a day (Hunter, 2012). Such infections lead a patient to spend more time in ICU and hospital; the infection is responsible for a mortality rate of about 9%. The infection is estimated to occur 48 hours, or more after the patient receives tracheal intubation. Such pneumonia infection may be early onset or when it occurs at the initial stages or late onset at the late stages of mechanical ventilation. Below is the appraisal of several studies on VAP, with their findings and study designs illustrated, and a critical review of their strengths and weaknesses where relevant. Tolentino-DelosReyes, F. A., Ruppert, D. S., & Pamela, K. S. (2007). Evidence-based practice: Use of the ventilator bundle to prevent ventilator associated pneumonia. American Journal of Critical Care, 3 (4), 12-13. http://www.ncbi.nlm.nih.gov/pubmed/17192523 The study examined the knowledge of critical care nurses related to the use of ventilator bundles in preventing VAP. It was found nurses who complied with study findings improved n their knowledge and practical performance in preventing VAP cases. The study showed that short education session can indeed improve the performance of nurses and their knowledge. The study investigated factors that contribute to VAP. It was found that VAP rate increased in in CCU patients by 4%, from 24% to 28% in the fourth day caused by high secretions. Therefore, the education program on nurses to improve their knowledge regarding the use of VAP bundles was successful and resulted to the required change in nurses’ practices (Hawe et al., 2009). Zaydfudim, V. et al. (2009). Implementation of a real-time compliance dashboard to help reduce SICU ventilator-associated pneumonia with the ventilator bundle. Archives of Surgery, 144(7), 656-62 doi: 10.1001/archsurg.2009.117. This study investigated the effects of an electronic dashboard in improving compliance in reduction of VAP rates, and bundle parameters in surgical intensive care units (SICU). It was found that dashboard intervention increased the ventilator bundle compliance in SICU from 39% to 89% after the study. Therefore, the article demonstrates that adherence to using such ventilator bundles was effective in reducing VAP cases considerably. The study investigated the relationship between use of ventilator bundles and VAP infections. It was found that compliance with ventilator bundle improved from 39% to 89% by the end of July 2008 decreasing VAP rates by about 6.0 per 1000 ventilator days, from an initial mean of 15.2 t0 9.3 per 1000 ventilator days following the dashboard intervention. Therefore use of the dashboard resulted to the required change (Zambuto et al., 2010). Hawe, S. C., Ellis, S. K., Cairns, S. C., & Longmate, A. (2009). Reduction of ventilator associated pneumonia: Active versus passive guideline implementation. Intensive Care Med. 35(7), 1180-6 doi: 10.1007/s00134-009-1461-0. Epub The article involved the use of an active multifaceted bundle aimed at improving staff compliance with evidence based practices in reducing VAP cases. A VIP prevention bundle implemented actively and integrated in staff evaluation process resulted in compliance with VAP bundle use. The article analyzed VAP incidences and both mortality and morbidity rates in ICUs. In the findings, compliance with a VAP bundle increased with implementation of active multifaceted approach reducing VAP cases from 19.2 to 7.5 per each 1000 ventilator days. Therefore, the study portrayed effectiveness of an active program in increasing evidence based interventions in nurses thereby reducing VAP cases. Zambuto, A. et al. (2010). Adherence to ventilator-associated pneumonia bundle and incidence of ventilator-associated pneumonia in the surgical intensive care unit. Archives of Surgery, 145 (5), 465-470. doi: 10.1001/archsurg.2010.69. The study involved examination of data from infection Control Committee Surveillance database of SICU patients over a time frame of 38 months. In this case, patients were assessed for VAP infections, while staff was accessed for compliance with all bundle requirements. The study portrayed the use of VAP bundle can drastically reduce VAP cases and save costs to patients and the hospital. The study investigated effects of using the VAP bundles in e surgical intensive care units (SICU) and trauma surgical care units (TICU). It was found that compliance to VAP bundles increased from 53% and 63% before the study to 91% and 81% in SICU and TICU respectively r the study. Therefore, the use of VAP bundled in this case supported the required change (Tolino-DelosReyes et al., 2007). Rello, J., Lode, H., Cornaglia, G., & Masterton, R. (2010). A European care bundle for prevention of ventilator-associated pneumonia. Intensive Care Medicine, 36,773–780. doi: 10.1007/s00134-010-1841-5. Epub  The study involved a multi-disciplinary approach in designing a VAP prevention buddle based on Hospital Acquired Pneumonia (HAP), and VAP guidelines across Europe. The study showed that practices such as alcohol hand hygiene, trained and educated staff, oral care among other hygienic practices in ICU patients were part of a critical VAP care bundle in VAP prevention. Therefore, the article showed effectiveness of rationalizing the above care bundles in VAP prevention as intended (Keeley et al., 2007). Fields, B. L. (2008). Oral care of intervention to reduce incidence ventilator-associated pneumonia in the neurologic intensive care unit. Journal of Neuroscience Nursing, 40(5), 291-298. http://www.ncbi.nlm.nih.gov/pubmed/18856250 The study involved investigation of the effectiveness of oral hygiene in VAP prevention among ICU patients. The study was carried out in 200 twenty four hours bed ridden ICU patients. The study involved a randomized controlled group and an intervention sample group who brushed their teeth in 8 hours intervals. It was found that the VAP cases dropped to zero within a week of oral hygiene in intubated patients. Therefore, the study illustrated the effectiveness of oral hygiene in VAP prevention as intended (Rello et al., 2010). Keeley, L. (2007). Reducing the risk of ventilator-acquired pneumonia through head of bed elevation. Nursing in Critical Care, 12 (6), 287-94. Accessed http://www.ncbi.nlm.nih.gov/pubmed/17983363 The study investigated the effectiveness of bed elevation 45 degrees in reducing VAP. The study involved a sample of 30 patients; the sample had 17 participants in the treatment group, while 13 were in the control group in a randomized trial, with beds raised at 45 and 25 degrees respectively. 29% (5) of treatment group participants, in addition to 54% (7) of the control group patients contracted VAP. However, the sample population was too small to be of any statistical significance; a larger sample size is required in such a randomized trail (Sibbald, 1998). However, the change observed authenticates the study in reducing VAP cases. Efrati, S., Deutsch, I., Antonelli, M., & Hockey, M. P. (2010). Ventilator-associated Pneumonia: Current status and future recommendations. Journal of Clinical Monitoring and Computing, 24(2), 161-168,  doi: 10.1007/s10877-010-9228-2. Epub The study involved a critical review of evidence based studies on VAP, and new technologies in VAP prevention. It was revealed that VAP is a serious illness in intensive care units, having a risk of between 9 and 27 % and a mortality rate of 25 to 50%, and accounts of about $ 40,000 in hospital admission. It was reported that various evidence based practice guidelines as outlined in VAP bundles and the endotracheal tube (ETT) technology optimization have to be integrated in VAP prevention. The review illustrated the various VAP bundle elements and technologies in use and their effectiveness in reducing VAP cases and hospital admission costs. O'Keefe-McCarthy, S., Santiago, C., & Lau, G. (2008). Ventilator-associated pneumonia bundled strategies: An evidence-based practice. Worldviews on Evidence- Based Nursing, 5 (4), 193-204. doi: 10.1111/j.1741-6787.2008.00140.x. The study reviewed literature in VAP bundle practices, defined the risk factors and practices, demonstrated the framework leading to imparting knowledge about VAP bundles in clinical settings, and suggesting areas of possible research on the issue. The article portrayed that VAP accounts for more than 90% of all nosocomial infections and greatly increases hospitalization costs. The review portrays that the more nurses adhered to VAP bundle care, the greater the reduction in VAP infections. The article also suggests and aids in more research work on the issue in improving ICU conditions related to VAP prevention (Efrati et al, 2010). Pattanshetty, R., & Gaude, G. (2010). Effect of multimodality chest physiotherapy in prevention of ventilator-associated pneumonia: A randomized clinical trial. Indian Journal of Critical Care Medicine. 14(2), 70-76. DOI: 10.4103/0972-5229.68218 The article investigated the causes of multimodality chest physiotherapy in mechanically ventilated and intubated patients in intensive care units (ICU) in VAP prevention. Which include suctioning, patient poisoning, among others. The study in a statistical analysis portrayed VAP cases reductions of the above multimodality interventions, with the mortality rate being higher in the control (49%) compared to the study group (24%) (Efrati et al., 2010). The findings therefore supported the changes intended in the study. Klompas, M. (2010). Prevention of ventilator-associated pneumonia. Expert Review of Anti Infective Therapy 8(7):791-800. doi: 10.1586/eri.10.59. The study design involved review of selected approaches in VAP prevention, and found that VAP was a major cause of morbidity and mortality in ICUs, with the mortality rates being between 30 and 50%. In the article reviews, the study found that effective compliance with the VAP bundles resulted in significant reduction of VAP cases in ICUs. The study as well suggested and advocated for implementation of new approaches in VAP reduction (Rello et al., 2010). Rivera, S. J., & Meyer, P. (2007). Reduction of VAP (Ventilator-Associated Pneumonia) to Implementation of known strategies to Reduce VAP at a 350 Bed Metro-Suburban Midwest Community Hospital: Publication Number 5-60. American Journal of Infection Control, 35 (5), 64-65 http://dx.doi.org.lcproxy.shu.ac.uk/10.1016/j.ajic.2007.04.066 The study involved a multidisciplinary review involving a number of healthcare practitioners in designing and implementing the Institute Healthcare Improvement (IHI) VAP bundle elements, and integrating an oral care product for VAP prevention in patients. The study indicated application of VAP bundle will drastically reduce VAP infections with hospital bills drastically reducing. The study portrayed that a hospital bill could reduce from 481, 536 dollars to 160, 512 dollars after the intervention; the intervention could as well reduce VAP cases to zero. The results were therefore in line with the change intended (O'Keefe-McCarthy, Santiago and Lau, 2008). Standring, D., & Oddie, D. (2011). Prevention of ventilator-associated pneumonia. British Journal of Cardiac Nursing. 6(6), 286-290 Retrieved from http://www.internurse.com/cgi-bin/go.pl/library The article investigates the extent of VAP problems by reviewing current research evidence and integrating some key aspects towards the prevention of VAP. The study noted that VAP complication rates ranged from 8 to 28% in patients under mechanical ventilation. The study reiterated on the need to ensure tracheostomy and endotracheal cuff pressures were maintained in the required ranges, in preventing possible secretions around the cuff covering in all VAP bundle care prevention strategies (O'Keefe-McCarthy, Santaigo & Lau, 2008) Blot, S. I., Labeau, S., Vandijck, D., Van Aken, P., & Claes, B. (2007). Evidence-based guidelines for the prevention of ventilator-associated pneumonia: Results of a knowledge test among intensive care nurses. Intensive Care Med. 28(5), 531-536 Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/1746491 The research design involved the use of a questionnaire in survey aimed at evaluating the knowledge of nurses with regard to VAP prevention. The study involved a total of 638 questionnaires, a repose rate of 74.6%. The study indicated that the average knowledge of VAP prevention strategies was greater in experienced nurses with more than one year of experience, and those with qualifications in emergency and special care studies. It was noted that most nurse lack the required knowledge to deal with VAP cases; the only commonly known VAP prevention measure was bed positioning at 90% of respondents. The study was effective in portraying its intended aim of testing knowledge among intensive care nurse (Tolentino-DelosReyes et al, 2008). Al-Tawfiq, J. A., & Abed, S. M. (2010). Decreasing ventilator-associated pneumonia in adult ICU using the institute for healthcare improvement bundle. American Journal of Infection Control. 38(7):552-6. doi: 10.1016/j.ajic.2010.01.008 The study involved implementation of VAP bundles in reducing VAP infections in adult ICUs in a post and pre intervention trails starting from 2006 using the Institute of Health Improvement (IHI) bundles. The study was carried in a two years period and showed great reduction in VAP cases with intervention. The study showed that VAP bundle implementation greatly reduced VAP cases from 9.3 to about 2.3 reported cases per every 1000 ventilator days between 2006 and 2007, falling down to 2.2 by the end of 2008. The study also indicated the reduction of hospitalization cost by about $ 780,000 annually. The results supported the intended change (Pattanshetty & Gaude, 2010). References Al-Tawfiq, J. A., & Abed, S. M. (2010). Decreasing ventilator-associated pneumonia in adult ICU using the institute for healthcare improvement bundle. American Journal of Infection Control. Blot, S. I., Labeau, S., Vandijck, D., Van Aken, P., & Claes, B. (2007). Evidence-based guidelines for the prevention of ventilator-associated pneumonia: Results of a knowledge test among intensive care nurses. Intensive Care Med. Efrati, S., Deutsch, I., Antonelli, M., & Hockey, M. P. (2010). Ventilator-associated Pneumonia: Current status and future recommendations. Journal of Clinical Monitoring and Computing. Fields, B. L. (2008). Oral care intervention to reduce incidence of ventilator-associated pneumonia in the neurologic intensive care unit. Journal of Neuroscience Nursing. Hawe, S. C., Ellis, S. K., Cairns, S. C., & Longmate, A. (2009). Reduction of ventilator associated pneumonia: Active versus passive guideline implementation. Intensive Care Med. Hunter, J.D., Ventilator Associated Pneumonia BMJ 2012; 344 doi: http://dx.doi.org/10.1136/bmj.e3325 Keeley, L. (2007). Reducing the risk of ventilator-acquired pneumonia through head of bed elevation. Nursing in Critical Care, 12 (6), 287-94 Klompas, M. (2010). Prevention of ventilator-associated pneumonia. Expert Review of Anti- Infective Therapy. O'Keefe-McCarthy, S., Santiago, C., & Lau, G. (2008). Ventilator-associated pneumonia bundled strategies: An evidence-based practice. Worldviews on Evidence- Based Nursing, 5 (4), 193-204. Pattanshetty, R., & Gaude, G. (2010). Effect of multimodality chest physiotherapy in prevention of ventilator-associated pneumonia: A randomized clinical trial. Indian Journal of Critical Care Medicine. Rello, J., Lode, H., Cornaglia, G., & Masterton, R. (2010). A European care bundle for prevention of ventilator-associated pneumonia. Intensive Care Medicine, 36,773–780. Rivera, S. J., & Meyer, P. (2007). Reduction of VAP (Ventilator-Associated Pneumonia) to Implementation of known strategies to Reduce VAP at a 350 Bed Metro-Suburban Midwest Community Hospital: Publication Number 5-60. American Journal of Infection Control, 35 (5), 64-65 Sibbald, B., (1998). Understanding Controlled Trials: Why are Randomized Controlled Trials Important, BMJ,316; 201 Standring, D., & Oddie, D. (2011). Prevention of ventilator-associated pneumonia. British Journal of Cardiac Nursing. Tolentino-DelosReyes, F. A., Ruppert, D. S., & Pamela, K. S. (2007). Evidence-based practice: Use of the ventilator bundle to prevent ventilator associated pneumonia. American Journal of Critical Care, 3 (4), 12-13. Wip C.,& Napolitano, L., (2009). Bundles to prevent ventilator-associated pneumonia: how valuable are they? Current Opinion in Infectious Diseases 22:159–166 Zambuto, A. et al. (2010). Adherence to ventilator-associated pneumonia bundle and incidence of ventilator-associated pneumonia in the surgical intensive care unit. Archives of Surgery, 145 (5), 465-470. Zaydfudim, V. et al. (2009). Implementation of a real-time compliance dashboard to help reduce SICU ventilator-associated pneumonia with the ventilator bundle. Archives of Surgery. Read More