Ventilator Assisted Pneumonia
Ventilator Assisted Pneumonia
- 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.xSummary of Article: In an effort to create care practices and a ventilator bundle to reduce ventilator-induced pneumonia, the study started with a compliance audit by quality control to determine baseline information.
- Research Elements: The design included education of staff, placement of reminder signage, and collecting data from the period of October 2008 to December 2009. The quality department conducted compliance audits. Specific objectives were determined, striving for 100% compliance and reduction of VAP to 0 within one year. ICUs at one hospital with 105 staff nurses and 4709 ventilator days for the prior period studied were used. The population was patients receiving treatment with ventilators in the ICU units of one Pennsylvania hospital. Strengths of the study were the implementation of bundled services that included oral care as of 2002s, the use of an interdisciplinary team, using real-time feedback, and having independent audits for compliance.
- Outcomes/ Research Results: Compliance rates increased with a resultant decrease of pneumonia from 9.47 to 1.9 cases per 1000 days of ventilation; also, savings were estimated at about $1.5 million.
- Significance to Nursing and Patient Care: Compliance by primary care-givers to expanded ventilator bundles substantially reduced mortality and morbidity and resulted in impressive monetary savings.
- Andrews, T., & Steen, C. (2013). A review of oral preventative strategies to reduce ventilator-associated pneumonia. Nursing In Critical Care, 18(3), 116-122. doi:10.1111/nicc.12002. NOTE: access to the full article online was only available with purchase.
- Summary of Article: Evaluates evidence for mechanical hygiene and chlorhexidine for prevention of VAP.
- Research Element: not supplied
- Outcome/ Research Results: Inconclusive
- Significance to Nursing and Patient Care: not discussed
- Guterres da Silva, S., Pereira do Nascimento, E., Kuerten de Salles, R., Enfermagem, T., & Enfermagem, C. (2012). BUNDLE TO PREVENT VENTILATOR-ASSOCIATED PNEUMONIA: A COLLECTIVE CONSTRUCTION, 4, 837-44.
- Summary of Article: Research focused on at constructing a bundle to present VAP with the assistance of professionals. Results were coordinated with information gained from interviews with healthcare providers.
- Research Elements: Healthcare professionals meeting the criteria of the study were given private interviews, then participated in group discussions. Analysis of data used the framework by Morse and Field. The bundle construction consisted of oral hygiene, elevated headboards, tracheal secretion aspirations, and specific inflation of endotracheal cuff.
- Outcome/ Research Results: not discussed
- Significance to Nursing and Patient Care: Use of the recommendations produced in the study for bundled care contributes to reduction of VAP.
- Lawrence, P., & Fulbrook, P. (2011). The ventilator care bundle and its impact on ventilator-associated pneumonia: a review of the evidence. Nursing In Critical Care, 16(5), 222-234. doi:10.1111/j.1478-5153.2010.00430.x
- Summary of Article: Investigating VCB use to critically analyze effect on VAP outcomes, research reviews from 2004 to 2009 was performed.
- Research Elements: Ten research studies and two literature reviews were used. Studies without measured clinical outcomes were excluded. The populations were adult patients in the ICU on ventilators. There are limitations of the observational designs in previous studies. It is difficult to determine the elements responsible for the outcomes.
- Outcome/ Research Results: With VCB use, the incidence of VAP is reduced.
- Significance to Nursing and Patient Care: While research is not at the highest experimental level yet, evidence suggest use of VCB for all appropriate patients in ICU is best practice.
- Cutler, L., & Sluman, P. (2014). Reducing ventilator associated pneumonia in adult patients through high standards of oral care: A historical control study. Intensive And Critical Care Nursing, 30(2), 61-68. doi:10.1016/j.iccn.2013.08.005
- Summary of Article: To evaluate the implementation of oral hygiene measures on VAP incidence and costs.
- Research Elements: 1087 patients on ventilators for at least 48 hours between July 2009 and December 2011 in a 22 bed ICO and high dependency unit. Comparison was made before and after a practice change. Compliance was reviewed with a clinical audit cycle. Costs were calculated. Limitations relate to generalization of findings due to lack of agreement in severity of illness and other variables.
- Outcome/ Research Results: With 91% compliance with the practice change, there was a significant reduction in VAP and associated costs.
- Significance to Nursing and Patient Care: Compliance with the use of an oral care bundle enhanced with 1% Chlorhexidine Gluconate results in decreased costs to the facility and the patient and lessened significant of VAP.
- Roberts, N., & Moule, P. (2011). Chlorhexidine and tooth-brushing as prevention strategies in reducing ventilator-associated pneumonia rates. Nursing In Critical Care, 16(6), 295-302. doi:10.1111/j.1478-5153.2011.00465.x
- Summary of Article: The reduction in the incidence of VAP as a result of tooth-brushing and use of chlorhexidine needs appraising.
- Research Elements: Population is adults patients in ICU setting that are mechanically ventilated. Eight papers meeting criteria were assessed. There were limitations in the design of the study and inconsistent results suggested further research.
- Outcome/ Research Results: CHX reduced VAP rate and in conjunction with colistine there was better decontamination.
- Significance to Nursing and Patient Care: There is some value in reducing VAP with the use of chlorhexidine, but effectiveness may be improved with the addition of a solution targeting gram-negative bacteria.
- Nicolosi, L., del Carmen Rubio, M., Martinez, C., Gonzalez, N., & Cruz, M. (2013). Effect of Oral Hygiene and 0.12% Chlorhexidine Gluconate Oral Rinse in Preventing Ventilator-Associated Pneumonia After Cardiovascular Surgery. Respiratory Care, 59(4), 504-509. doi:10.4187/respcare.02666.
- Summary of Article: To determine if tooth-brushing plus 0.12% chlorhexidine gluconate oral rinse prevents VAP following cardiovascular surgery, Group 1 patients were enrolled in a regime to prevent biofilm and compared with a Group 2 who did not receive the same care.
- Research Elements: the population was 150 patients. Statistical analysis used Chi square test and Fisher’s test. The fact that the population was not prospective randomized case control was a limitation.
- Outcome/ Research Results: The risk of develop VAP was three-fold higher in Group 2 patients.
- Significance to Nursing and Patient Care: Use of chlorhexidine in oral hygiene and mouth rinses preventatively reduced the incidence of VAP, reinforcing nursing care utilization in patients undergoing elective cardiovascular surgery.
- Oshodi, T., & Bench, S. (2013). Ventilator-associated pneumonia, liver disease and oral chlorhexidine. Br J Nursing, 22(13), 751-758. doi:10.12968/bjon.2013.22.13.751
- Summary of Article: Due to the heterogeneous nature of ICU patients on mechanical ventilation, recommendations for using CHX for oral care for specific groups should be considered. This article focuses on patient with liver dysfunction meeting the other criteria.
- Research Elements: Research review of eight studies did not specify patients with liver dysfunction, although the records were reviewed to ascertain if it was present. However, the research was discussed as to the application to this patient population.
- Outcome/ Research Results: While there is no specific data on the use of CHX on patients with liver dysfunction, there is no reason to suspect it would be contraindicated. Research reviews indicates oral hygiene including CHX rinses decreases the incidence of VAP.
- Significance to Nursing and Patient Care: Nurses continue to see oral care as a comfort measure despite efforts at education and enforcement of guidelines.
- Feider, L., Mitchell, P., & Bridges, E. (2010). Oral Care Practices for Orally Intubated Critically Ill Adults. American Journal Of Critical Care, 19(2), 175-183. doi:10.4037/ajcc2010816
- Summary of Article: The study compares oral care as a nursing practice with recommendation in a 2005 manual and CDCP guidelines.
- Research Elements: Recommendations for oral care were included in the AACN Procedure manual for Critical Care in 2005 and guidelines were supplied from the center for Disease Control and Prevention. Oral care performed by nurses in critical care units caring for critically ill orally intubated patients were surveyed. 347 randomly selected members of the American Association of Critical-Care Nurses used a cross-sectional, descriptive design with a 31-item survey that was Web-based. Care was performed every 2 or every 4 hours.
- Outcome/ Research Results: There are discrepancies between policies and reported practices. Policies are present, but not well used. Nursing staff more experienced performed care more often than less experienced. Those with a BA in nursing also suctioned before and after care.
- Significance to Nursing and Patient Care: Nurses with more experience appear to understand the importance of oral care in the prevention of VAP better than less experienced ones, and those with a higher education employ additional techniques to combat biofilm. Nurses should be aware regardless of educational level or experience of the importance of oral care procedures.
- Soh, K., Soh, K., Japar, S., Raman, R., & Davidson, P. (2011). A cross-sectional study on nurses’ oral care practice for mechanically ventilated patients in Malaysia. Journal Of Clinical Nursing, 20(5-6), 733-742. doi:10.1111/j.1365-2702.2010.03579.x
- Summary of Article: There is a gap between nurses acknowledging the importance of oral care and the practice of doing to. The study directly evaluates Iranian nurses concerning oral care of patient in ICU with mechanical ventilation.
- Research Elements: Nurses meeting criteria were used in a descriptive cross-sectional study. The 130 nurses were randomly selected. A questionnaire was administered.
- Outcome/ Research Results: Only 21% of the nurses rated prevention of VAP as the reason for oral care. Only 21.5% stated they gave oral care with toothbrushes only used 14.6% of the time.
- Significance to Nursing and Patient Care: The importance of education for nurses in regards to oral care, particularly for prevention of VAP and how to perform oral care, is critical in the performance of it at the bedside.
- Arroliga, A., Pollard, C., Wilde, C., Pellizzari, S., Chebbo, A., & Song, J. et al. (2011). Reduction in the Incidence of Ventilator-Associated Pneumonia (VAP): A Multidisciplinary Approach. Respiratory Care. doi:10.4187/respcare.01392http://rc.rcjournal.com/content/57/5/688.full.pdf+html
- Summary of Article: In an attempt to decrease incidence of VAP, a study was done to compare incidence after a VBA was introduced, and then after the care was performed by respiratory therapists.
- Research Elements: The method was a retrospective study of adult admittances intubated on mechanical ventilations. A constructed ventilator bundle was implemented in April 2007, VAP incidence reported in 2008, and changing care by RTs influencing incidence of 2009. The population was all adult ICU patients with mechanical ventilation.
- Outcome/ Research Results: Over a 2-year period, VAP rate decreased.
- Significance to Nursing and Patient Care: When respiratory therapists perform oral care, there may be reduction in VAP. Regular ventilation treatments promote consistent care, and a decreased workload may contribute to more time for the care.
- Johnson, K., Domb, A., & Johnson, R. (2012). One evidence based protocol doesn’t fit all: Brushing away ventilator associated pneumonia in trauma patients. Intensive And Critical Care Nursing, 28(5), 280-287. doi:10.1016/j.iccn.2012.02.005. NOTE: access to the full article online was only available with purchase.
- Summary of Article: The attitudes and performance of nurses in application of oral care techniques in trauma patients in critical care units effect the incidence of VAP rates.
- Research Elements: Descriptive pre- and post-designs in two critical care units of a trauma hospital. Data was analyzed for comparison between medical/surgical and trauma patients.
- Outcome/ Research Results: Patients requiring mechanical ventilation require specific attention if they experienced trauma, as it may compromise oral care. Risk factors, prognosis, transmission mechanism and imflammatory responses are important to consider.
- Significance to Nursing and Patient Care: The attitudes and beliefs of nurses are important to promote staff compliance with EBP changes.
- Prendergast, V., Kleiman, C., & King, M. (2013). The Bedside Oral Exam and the Barrow Oral Care Protocol: Translating evidence-based oral care into practice. Intensive And Critical Care Nursing, 29(5), 282-290. doi:10.1016/j.iccn.2013.04.001. NOTE: access to the full article online was only available with purchase.
- Summary of Article: Addressing the cost effectiveness for use of oral hygiene supplies, response of staff to practice change, and introduce the Bedside Oral Exam (BOE) and Barrow Oral Care Protocol (BOCP) for ICU patients.
- Research Elements: Method was a case design to implement and evaluate oral assessments and hygiene. Comparison of cost of supplies and incidence of VAP were compared before and after. Responses of staff were also elicited before and after.
- Outcome/ Research Results: VAP incidence fell significantly. Cost saving was 65% monthly. Increased satisfaction was reported by staff.
- Significance to Nursing and Patient Care: The impact on patient comfort and oral health was not addressed, but BOE orals care was cost effective in reducing VAP incidence. This may have been due to the high expense of treating VAP compared with the relatively low-cost of supplies.
- Berry, A. (2013). A comparison of Listerine® and sodium bicarbonate oral cleansing solutions on dental plaque colonisation and incidence of ventilator associated pneumonia in mechanically ventilated patients: A randomised control trial. Intensive And Critical Care Nursing, 29(5), 275-281. doi:10.1016/j.iccn.2013.01.002NOTE: access to the full article online was only available with purchase.
- Summary of Article: Determination of the possibility of improved effectiveness in use of sterile water, Listerine, or baking soda in oral care was correlated with incidence of VAP.
- Research Elements: Baseline characteristics were the same for the members of each of 3 groups for a total of 398 randomly selected patients. The differences were oral care with Listerine, sodium bicarbonate, or sterile water.
- Outcome/ Research Results: No group proved more effective in lower incidence of VAP.
- Significance to Nursing and Patient Care: Use of oral rinses should follow the protocol policy of the facility.
- C., Angus, J., Sinuff, T., & Mykhalovskiy, E. (2013). Mouth care for orally intubated patients: A critical ethnographic review of the nursing literature. Intensive And Critical Care Nursing, 29(5), 266-274. doi:10.1016/j.iccn.2012.09.003. NOTE: access to the full article online was only available with purchase.
- Summary of Article: Articles written for nurses between 1960 and 2011 addressing oral hygiene for mechanically ventilated patients are researched and criticized for content.
- Research Elements: Peer-reviewed journals for nurses were used; articles not discussing oral care of intubated adult patients were excluded. Articles that met the criteria were reviewed chronologically to language changes and focus. 469 articles and 84 papers were reviewed.
- Outcome/ Research Results: Nursing discussions became more scientific as time progressed. Originally focusing on patient comfort, it now addresses infection control for VAP.
- Significance to Nursing and Patient Care: Articles for nurses are informative for current VAP prevention through oral care. Nurses need to avail themselves of this information through periodicals and/or online access.
My Theory
- My theory is the VCB that includes oral hygiene measures reduce VCP rates better than a VCB defaulting on oral hygiene measures in adult patient in ICU settings with mechanical ventilation. The rationale for this theory is based on the various types of studies in the research review addressing variable involved in VAP rates.
- My solution is to conduct a study comparing historical patients without oral hygiene versus those with it. The challenge comes with finding historically pertinent cases with the same VCB as the one proposed for use in the study.
- Explain how you will incorporate the theory into your project.
