NRS 433V Assignment Preventing ventilator-associated pneumonia 

NRS 433V Assignment Preventing ventilator-associated pneumonia 

A majority of the patients receiving their care in the intensive care unit have to grapple with different adverse outcomes which affect their well-being. Due to their conditions, these individuals have to be assisted with their daily living activities. Since most of these patients face difficulties with their breathing, they need to be provided with aids which will improve this process. Thus, fitting these individuals with mechanical ventilators has long been used as a strategy for facilitating the proper breathing. 

 However, due to improper handling of these ventilators, a medium for bacteria growth is created resulting in the patient developing ventilator-associated pneumonia (Bassi, Ferrer, Marti, Comaru & Torres, 2014). In most cases, this condition arises as a result of the tracheostomy tubes allowing bacteria into the lower lung regions. In case the immune system of the patient is weak, they carry a higher risk of having to battle with the adverse effects associated with the condition. 

  The various bacteria responsible for the development of this condition include Hemophilus influenza, Streptococcus pneumonia and Staphylococcus aureus (Lewnard et al., 2015). Thus, the evidence-based practice plan which may be used to address this problem is the use of ventilator bundles. These bundles comprise oral hygiene using chlorhexidine, an elevation of the patient’s bed to between 30 degrees and 45 degrees, provision of deep venous thrombosis, daily sedation holds and stress ulcer prophylaxis. 

PICOT Statement 

For intubated patients in the intensive care unit, is the use of ventilator bundles more effective than standard care (use of antibiotics) in preventing ventilator-associated pneumonia during hospitalization? 

1. Type of Research Study: Quantitative  

Literature search 

Talbot, T. R., Carr, D., Parmley, C. L., Martin, B. J., Gray, B., Ambrose, A., & Starmer, J. (2015). Sustained reduction of ventilator-associated pneumonia rates using real-time course correction with a ventilator bundle compliance dashboard. infection control & hospital epidemiology, 36(11), 1261-1267. 

Abstract 

Background: The effectiveness of practice bundles on reducing ventilator-associated pneumonia (VAP) has been questioned. Objective: To implement a comprehensive program that included a real-time bundle compliance dashboard to improve compliance and reduce ventilator-associated complications. DESIGN Before-and-after quasi-experimental study with interrupted time-series analysis. SETTING Academic medical center. Methods: In 2007 a comprehensive institutional ventilator bundle program was developed. To assess bundle compliance and stimulate instant course correction of noncompliant parameters, a real-time computerized dashboard was developed. Program impact in 6 adult intensive care units (ICUs) was assessed. Bundle compliance was noted as an overall cumulative bundle adherence assessment, reflecting the percentage of time all elements were concurrently in compliance for all patients. Results: The VAP rate in all ICUs combined decreased from 19.5 to 9.2 VAPs per 1,000 ventilator-days following program implementation (P<.001). Bundle compliance significantly increased (Z100 score of 23% in August 2007 to 83% in June 2011 [P<.001]). The implementation resulted in a significant monthly decrease in the overall ICU VAP rate of 3.28/1,000 ventilator-days (95% CI, 2.64-3.92/1,000 ventilator-days). Following the intervention, the VAP rate decreased significantly at a rate of 0.20/1,000 ventilator-days per month (95% CI, 0.14-0.30/1,000 ventilator-days per month). Among all adult ICUs combined, improved bundle compliance was moderately correlated with monthly VAP rate reductions (Pearson correlation coefficient, -0.32). Conclusion: A prevention program using a real-time bundle adherence dashboard was associated with significant sustained decreases in VAP rates and an increase in bundle compliance among adult ICU patients. 

2. Type of Research Study: Quantitative 

Jansson, M., Ala-Kokko, T., Ylipalosaari, P., Syrjälä, H., & Kyngäs, H. (2013). Critical care nurses’ knowledge of, adherence to and barriers towards evidence-based