Running head: Ventilator-associated-pneumonia 1 Decrease of Ventilator-Associated-Pneumonia in ICU Patients Quanzette Chevalier Grand Canyon University
Decrease of Ventilator-Associated-Pneumonia in ICU Patients 2 Decrease of Ventilator-Associated-Pneumonia in ICU Patients Ventilator-associated pneumonia (VAP) is defined as pneumonia that occurs 48-72 hours or thereafter following endotracheal intubation, characterized by the presence of a new or progressive infiltrate, signs of systemic infection (fever, altered white blood cell count), changes in sputum characteristics, and detection of a causative agent(Kalanuria,2014). It is the second most common nosocomial infection in the intensive care unit (ICU) and the most common in mechanically ventilated patients(Kalanuria, 2014). PICOT is a mnemonic used to describe the four elements of a good clinical question. It stands for: P--Patient/Problem, I--Intervention, C--Comparison, O--Outcome, T--Time. The nursing practice problem identified is ICU nurses do not always perform proper oral care on their ventilated patients.The PICOT statement that I am formulating is based on the nursing practice problem and will focus on oral hygiene in relationship to the prevention of VAP in patients who are mechanically ventilated. PICOT Statement: Is the incidence of ventilator-associated-pneumonia (O) in patients requiring mechanical ventilation(P) decreased by utilizing proper oral hygiene care(I) during the ICU stay (T)? After choosing this area of focus I was able to identify reference articles to the selected nursing practice problem. The list of the articles and abstracts will be cited in this paper. Research Articles: Reduction in the Incidence of Ventilator-Associated Pneumonia: A Multidisciplinary Approach.
Decrease of Ventilator-Associated-Pneumonia in ICU Patients 3 Abstract: BACKGROUND: We report the process implemented in our institution by a task force focused on the reduction of ventilator-associated pneumonia (VAP). METHOD: Retrospective cohort study of all adults admitted to one of our 4 adult ICUs, intubated on invasive mechanical ventilation. We implemented a ventilator bundle in April of 2007; we report the incidence of VAP in 2008, and, after adjustment in the process (oral care performed by respiratory therapists), the incidence in 2009. The primary outcome was reduction of the microbiologically confirmed VAP rate over a 2 year period. Other outcomes were duration of mechanical ventilation, antibiotic days, ICU and hospital stay, and mortality. RESULTS: During the study period, 2,588 patients received invasive mechanical ventilation in the adult ICUs. The VAP rate during 2008 was 4.3/1,000 ventilator days, and the 2009 rate was 1.2/1,000 ventilator days. The 2008 to 2009 VAP rate ratio was significantly greater than 1 (rate ratio 3.6, 95% CI 1.8-8.0, P < .001). Antibiotic days were less in 2009 versus 2008 (Hodges-Lehmann estimate of difference between 2008 and 2009, 1.0, 95% CI 0.0 -1.0, P = .002). The median stay in the ICU was unchanged, and in the hospital was decreased in 2009 (Hodges- Lehmann estimate of difference between 2008 and 2009, 1.0, 95% CI 0.0 -1.0, P < .001). The hospital mortality was 26.1%, and there was no
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- Fall '15
- Nursing, Intensive care medicine, ventilator-associated pneumonia