ventilator-associated-pneumonia - Running head...

Running head: Ventilator-associated-pneumonia
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Decrease of Ventilator-Associated-Pneumonia in ICU Patients
Quanzette Chevalier
Grand Canyon University

Decrease of Ventilator-Associated-Pneumonia in ICU Patients
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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
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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