Ventilator Associated Pneumonia in the Icu

breathing device associated pneumonia (VAP) is a nosocomial infection occurring in hospitalized patients who atomic number 18 mechanically vent. These infections are common in ICU settings, difficult to diagnose early, and unfortunately have a high set of mortality and morbidity. VAP accounts for al virtually half of infections in ICU settings, up to 28% of mechanically ventilated patients impart develop VAP and of these patients the mortality crop is between 20% and 70% (Craven & Steger, 1998). A patient that develops VAP while mechanically ventilated adds days to his recovery as healthy as thousands of dollars to the business concern costs.Numerous studies have been conducted crosswise the county in an effort to understand VAP, however very few of those studies focus on the nursing interventions that bottom of the inning prevent this deadly and costly nosocomial infection. Many of these studies focus on the bundling of certain interventions, so the question is does the imple mentation of a VAP bundle compared with the use of non-bundled interventions decrease the incidence of VAP in ventilated patients. The enquiry that was found in nursing daybooks along with a related study from a medical journal follows.Cason, Tyner, Saunders and Broome (2007) conducted a study of 1200 critical 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 improvement to comply with the CDC recommendations for legal community of VAP. The study consisted of a questionnaire distributed to nurses who attended the 2005 American Association of slender Care Nurses National Teaching Institute, with the findings demonstrating a need for more education and look for in the area of preventing ventilator associated pneumonia.Ferrer and Artigas (2001) also annotatingd the lack of compliance in even the most basic of preventative measures. The study focuses on non-antibio tic preventative strategies for VAP they signify the use of antimicrobial hand soap, clorahexidine literal rinses, stress ulcer prophylaxis, prevention of gastric over distension, providing adequate nutritional support as well as frequent position changes. The research also suggests that endotracheal tubes with an extra lumen designed to continuously suction secretions pooled above the endotracheal tube cuff would lower the incidence of VAP by reventing these secretions from being aspirated into the lower airway. The authors also suggest more research be done to further limit the number of patients who develop VAP. Siempos, Vardakas and Falagas (2008) found that later meta-analysis of nine published randomized controlled trials that a unsympathetic tracheal suction system has no get in reducing the incidence of VAP compared with an open tracheal suction system. The preliminary data suggests that a closed circuit would debase the incidence of VAP, however the data and trials t hat 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 entirely needs to be changed every 24 hours, it does tend to be more cost effective. Also of note, in two separate trials, a closed system was found to increase colonization of both 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, Vandijck, 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 suit that VAP is still so prevalent in the intubated patient. The research points to the idea that because many nurses are not creditworthy for the ventilator circuit they rely on the respiratory therapist to manage the v entilator, they may be little informed than if they had more control and nurture 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 Medicine has shown a decrease in the incidence of VAP in its ten bed surgical ICU by implementing a FASTHUG 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, head of bed elevation, ulcer prophylaxis, and glucose control in critically ill intubated patients. The FASTHUG protocol was emphasized at morning and by and bynoon rounds and after a 2 year esearch period the incidence of VAP declined to 7. 3 VAPs/1000 ventilator days mickle from a historical rate of 19. 3 VAPs/1000 ventilator days. Of note, in 2007 the surgical ICU that utilis e 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 reduce 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 assess the nurses savvy 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 detention 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 demo an increase in complian ce 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 spanking 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 indisposition Control and Prevention. American journal of hypercritical 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. Critical Care 2002, 6, 45-51.Hunter, J. D. (2006) Ventilator associated pneumonia. Postgraduate Medical Journal, 82, 172-178. doi10. 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. , Vardakas, K. Z. & Falagas, M. E. (2008) Closed tracheal suction system for prevention of ventilator-associated pneumonia. Bri tish 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