Ventilator Associated Pneumonia in the Icu

Ventilator associated pneumonia (VAP) is a nosocomial infection occurring in hospitalized patients who are mechanically ventilate. These infections are common in intensive care unit settings, difficult to diagnose early, and unfortunately have a high govern of mortality and morbidity. VAP accounts for almost half of infections in ICU settings, up to 28% of mechanically ventilated patients will develop VAP and of these patients the mortality rate is amid 20% and 70% (Craven & Steger, 1998). A patient that develops VAP while mechanically ventilated adds age to his reco rattling as well as thousands of dollars to the care costs. legion(predicate) studies have been conducted across the county in an effort to understand VAP, however very few of those studies focus on the hold back interventions that base prevent this acrid and costly nosocomial infection. Many of these studies focus on the bundling of current interventions, so the question is does the implementation of a VAP b unch up compared with the use of non- napd interventions reducing the relative incidence of VAP in ventilated patients. The research that was found in nursing diarys along with a related study from a medical journal follows.Cason, Tyner, Saunders and Broome (2007) conducted a study of 1200 circumstantial care nurses and the results demonstrate the variability in the recommended and reported care of the ventilated patient. Their study aims to identify the areas of needed amelioration to comply with the CDC recommendations for prevention of VAP. The study consisted of a questionnaire distributed to nurses who attended the 2005 American familiarity of overcritical Care Nurses National Teaching Institute, with the findings demonstrating a need for to a greater extent(prenominal) education and research in the area of preventing breathing machine associated pneumonia.Ferrer and Artigas (2001) also celebrated the pretermit of compliance in even the most basic of cautionary mea sures. The study focuses on non-antibiotic preventative strategies for VAP they suggest the use of antimicrobial strive soap, clorahexidine oral rinses, stress ulcer prophylaxis, prevention of gastric over distension, providing sufficient nutritional support as well as frequent redact changes. The research also suggests that endotracheal tubes with an extra lumen designed to continuously sucking secretions pooled above the endotracheal tube cuff would lower the incidence of VAP by reventing these secretions from beingness aspirated into the lower airway. The authors also suggest to a greater extent research be through with(p) to but limit the number of patients who develop VAP. Siempos, Vardakas and Falagas (2008) found that later on meta-analysis of ball club published randomized findled trials that a closed tracheal suction carcass has no benefit in reducing the incidence of VAP compared with an open tracheal suction system. The preliminary data suggests that a closed ci rcuit would recoil the incidence of VAP, however the data and trials that were reviewed showed that there was no decrease in the rate of infection.Due to the fact that a closed system can be used more than once, and only needs to be changed every(prenominal) 24 hours, it does tend to be more cost effective. Also of note, in two separate trials, a closed system was found to plus colonization of both(prenominal) the respiratory tract and the ventilator tubing. Obviously more research is needed to determine the best intervention when endotracheal suctioning is necessary. Ventilator associated pneumonia is both common and unfamiliar to nurses in the critical care setting, according to Labeau, caravandijck, Claes, Van Acken & Blot (2007).They note that while nurses deal with VAP frequently their knowledge of the infection and preventative measures may be a reason that VAP is still so prevalent in the intubated patient. The research points to the idea that because many nurses are not responsible for the ventilator circuit they rely on the respiratory therapist to manage the ventilator, they may be less informed than if they had more control and education in the interventions necessary to prevent VAP. The research suggests more training and education for nurses who work with ventilated patients.Research done at the University of Toledo College of medical specialty has shown a decrease in the incidence of VAP in its ten bottomland surgical ICU by implementing a FASTHUG communications protocol. Papadimos, et al, (2008) explained the interventions that the college used as a tool to educate the critical care team. FASTHUG stands for daily evaluation of feeding, analgesia, sedation, thromboembolic prevention, enquiryman of bed elevation, ulcer prophylaxis, and glucose control in critically ill intubated patients. The FASTHUG protocol was emphasized at morning and afternoon rounds and after a 2 year esearch period the incidence of VAP declined to 7. 3 VAPs/1000 v entilator days down from a historical rate of 19. 3 VAPs/1000 ventilator days. Of note, in 2007 the surgical ICU that implemented this program actually had no incidence of VAP from January to May. The research suggests that the use of bundled care processes for ventilated patients may dress the rate of VAP. The nurses knowledge of the use of the ventilator bundle is crucial to the success of the protocol according to research done at the University of Texas.Education sessions were held with pre and posttests administered as well as observation to evaluate the nurses understanding of the bundles. The VAP bundle focused on the elevation of the head of the bed, continuous removal of subglottic secretions, change of the ventilator circuit no more often than every 48 hours, and washing of hands before and after contact with each patient. The research done by Tolentino-DelosReyes, Ruppert and Shiao (2007) suggests that a lack of understanding and knowledge of VAP leads to a higher rates of infection.Observation of the nurses in the study revealed that after the education sessions nurses demonstrated an increase in compliance with the established standards of care. Given the high mortality and morbidity of ventilator-associated pneumonia, compliance in the critical care unit is crucial to reducing the rate of VAP. The critical care nurse is vital to the prevention of VAP, and nurses need to initiate further research concentrating on education and prevention. References Cason, C. L. , Tyner, T. , Saunders, S. Broome, L. (2007) Nurses implementation of guidelines for ventilator-associated pneumonia from the Center for Disease give and Prevention. American daybook of Critical Care, 16, 28-37. Craven, D. E. , Steger, K. A. (1998) Ventilator-associated bacterial pneumonias Challenges in diagnosis, treatment, and prevention. New Horizons, 6(2). Ferrer, R. & Artigas, A. (2001) clinical Review Non-antibiotic strategies for preventing ventilator-associated pneumonia. Criti cal Care 2002, 6, 45-51.Hunter, J. D. (2006) Ventilator associated pneumonia. Postgraduate Medical Journal, 82, 172-178. inside10. 1136/pgmj. 2005. 036905. Labeau, S. , Vandijck, D. M. , Claes, B. , Van Aken, P. , Blot, S. I. & on behalf of the executive board of the Flemish Society for Critical Care Nurses (2007) Critical care nurses knowledge of evidence-based guidelines for preventing ventilator- associated pneumonia An evaluation questionnaire. American Journal of Critical Care, 16, 371-377. Morrow, L. E. Shorr, A. F. (2008) The seven deadly sins of ventilator-associated pneumonia. Chest, 134, 225-226. doi10. 1378/chest. 08-0860. Papadimos, T. J. , Hensley, S. J. , Duggan, J. M. , Khuder, S. A. , Borst, M. J. , Fath, J. J. , Oakes, L. R. , & Buchman, D. (2008, February) Implementation of the FASTHUG concept decreases the incidence of ventilator-associated pneumonia in the surgical intensive care unit. Patient Safety in Surgery 2(3). doi10. 1186/1754-9493-2-3. Siempos, I. I. , Va rdakas, K. Z. & Falagas, M. E. (2008) Closed tracheal suction system for prevention of ventilator-associated pneumonia. British Journal of Anasthesia 100(3), 299-306. doi10. 1093/bja/aem403. Tolentino-DelosReyes, A. F. , Ruppert, S. D. , Shiao, S. P. K. (2007) Evidence-based practice Use of the ventilator bundle to prevent ventilator-associated pneumonia. American Journal of Critical Care, 16, 20-27. Ventilator-associated pneumonia. (2008). Critical Care Nurse. Retrieved from http//ccn. aacnjournals. org