Ventilator-Associated Pneumonia and Nursing Awareness
Ventilator-associated pneumonia (VAP) is one of the most widespread hospital-acquired infections among American patients. VAP can cause increased mortality rates, length of stay, and health care costs both for the facility and the patient. However , there is no accurate reference definition of VAP, as it is usually suspected if the patient was intubated and ventilated within 48 hours before the onset of ventilation (Andrews & Steen, 2013).
Other radiological, clinical, and laboratory characteristics are used for the diagnosis of VAP. In the following literature review, seven articles from the nursing journals (including Nursing in Critical Care, Critical Care Nurse, and Intensive and Critical Care Nursing) will be reviewed. All of the articles are no older than five years and were published in peer-reviewed journals.
The focus of the Review
The focus of the review is the prevention of VAP by various methods, including high-quality oral care, nursing knowledge and awareness, and a training program. The review aims to examine the findings of the researches and indicate what strategies are effective and how they can be implemented in clinical care. Additional attention will be paid to VAP in children and strategies for its prevention, as Cooper and Haut (2013) provide an evidence-based protocol for the prevention of VAP in the pediatric population.
Student’s interest in VAP can be explained by the high prevalence of the infection in hospital patients and its severe and adverse influence on the health care costs for patients and hospital facilities. Furthermore, VAP can also lead to fatal outcomes in 46% of patients (Sedwick, Lance-Smith, Reeder, & Nardi, 2012). It is possible that the reimbursement for VAP in hospitals will be discontinued; in this case, hospitals will face severe financial losses (Sedwick et al., 2012). Therefore, future and current nursing professionals need in order to pay particular interest to VAP plus strategies of the prevention; if these types of strategies are adopted, you are able to significantly decrease the quantity of deadly outcomes in individuals with VAP plus hospital expenditures associated with those who obtain VAP during their own stay.
Sedwick ainsi que al. (2012) offered a particular “VAP bundle” to hospital personnel in which the research has been conducted and assessed the effectiveness of these surgery. Compliance of totally was reached with regard to PUD prophylaxis, DVT prophylaxis, HOB height, daily interruption associated with sedation, and evaluation of readiness with regard to extubation (Sedwick ainsi que al., 2012). The particular protocols for dental care were adopted less precisely plus never reached totally. Nevertheless, the use of the VAP bundle (strategies explained above) led to improved hospital savings plus better patient results.
Some other data is given by Andrews and Steen (2013), who argue that mechanical hygiene plus oral decontamination work well, whereas electronic teeth brushing is a lot more effective than the usual handbook one. Furthermore, the particular use of chlorhexidine can also be associated along with the reduced occurrence of VAP; the effect is the particular strongest in cardio patients. Andrews plus Steen (2013) discover that a 2% concentration from it is a lot more effective than lower ones.
Due to the particular lack of recognized guidelines in the particular prevention of VAP in children plus infants, Cooper plus Haut (2013) offer their VAP package. They argue that will after the execution of the package, “VAP rates reduced from 5. six to 0. a few infections per one thousand ventilator days” (Cooper & Haut, 2013, p. 26). The particular bundle includes dental hygiene, endotracheal suctioning, and circuit modifications; overall, it offers more than 15 interventions that may be implemented within a nursing device.
A few of the suggested interventions should be perform hand cleanliness before and right after contact with the individual or the ventilator, brush teeth each 12 hours (for kids <6>
A higher level of conformity (91%) and high-standard oral care triggered a reduction inside the incidents associated with VAP. Gatell ainsi que al. (2012) claim that to avoid ventilator-associated pneumonia within adults, nurses want to be mindful to the treatment routines and possess conformity with suggested methods. Nurses who went through additional training exhibited improved understanding of VAP-prevention techniques; additionally they utilized various strategies (use of chlorhexidine, hands washing, specific headboard positioning) more regularly right after the training system. The authors verify that not every healthcare professionals demonstrated compliance along with guidelines, possibly credited to high work load and time stress (Gatell et ing., 2012).
To boost adherence to recommendations, training activities plus evidence-based protocols are usually suggested as appropriate tools. Valuable info about the connection between guidelines faithfulness and VAP will be reported by Jansson, Ala-Kokko, Ylipalosaari, Syrjälä, and Kyngäs (2013). Nurses with a lot more ICU experience (> 5 years) have a tendency to adhere in order to guidelines more frequently than their much less experienced colleagues. Extra barriers incorporate a large workload, in addition to a lack of knowledge plus resources. Some associated with the nurses adhered to preventive techniques only if these people found them required (e. g., cleaned hands, use associated with protective gowns, and so on. ).
Akın Korhan, Hakverdioğlu Yönt, Parlotear Kılıç, and Uzelli (2014) provide results that support the particular arguments of Jansson et al. (2013) and Gatell ainsi que al. (2012). Absence of knowledge, insufficient training programs, plus lack of adequate home elevators VAP avoidance resulted in poor faithfulness to evidence-based recommendations among ICU healthcare professionals. Multifaceted educational applications are suggested while tools for the particular improvement of medical care.
Akın Korhan, E., Hakverdioğlu Yönt, G., Parlotear Kılıç, S., & Uzelli, D. (2014). Knowledge amounts of rigorous care nurses upon prevention of ventilator‐associated pneumonia. Nursing in Crucial Care , 19 (1), 26-33.
Andrews, T., & Steen, C. (2013). The review of dental preventative strategies in order to reduce ventilator‐associated pneumonia. Medical in Critical Treatment , 18 (3), 116-122.
Cooper, Sixth is v. B., & Haut, C. (2013). Avoiding ventilator-associated pneumonia within children: An evidence-based protocol. Critical Care Health professional , 33 (3), 21-29.
Cutler, T. R., & Sluman, P. (2014). Decreasing ventilator associated pneumonia in adult individuals through high requirements of oral treatment: A historical manage study. Intensive and Crucial Care Nursing , thirty (2), 61-68.
Gatell, J., Rosado, M., Santé Roig, M., Hernández Vian, Ó., Carrillo Santín, E., Turégano Duaso, C., & Vallés Daunis, J. (2012). Assessment of the teaching programme for that avoidance of ventilator‐associated pneumonia. Medical in Critical Treatment , 17 (6), 285-292.
Jansson, Meters., Ala-Kokko, T., Ylipalosaari, P., Syrjälä, They would., & Kyngäs, They would. (2013). Critical treatment nurses’ understanding of, faithfulness to and obstacles towards evidence-based recommendations for the avoidance of ventilator-associated pneumonia – A study study. Intensive and Crucial Care Nursing , twenty nine (4), 216-227.
Sedwick, M. W., Lance-Smith, M., Reeder, S. J., & Nardi, J. (2012). Using evidence-based exercise to prevent ventilator-associated pneumonia. Critical Care Health professional