Paper Example on Ventilator-Associated Pneumonia: Risk and Prevalence

Introduction

Ventilator-Associated Pneumonia (VAP) refers to a parenchyma lung complication that occurs in not less than 48 hours after the introduction of mechanical ventilation. For patients requiring mechanical ventilation, the estimated risk of developing VAP stands at 9 per cent- 27 per cent ((Timsit et al., 2017). In the US, the incidences of VAP cases vary from 2 to 16 incidents per 1000 ventilation-days (Timsit et al., 2017). The VAP is detrimental since it increases ICU and hospital time of stay and escalates the cost of healthcare. Several evidence-based approaches in the avoidance of VAP have been established. VAP bundle is one of the evidence-based approaches. A bundle is a planned way of improving the practice of care and patient outcome. Some aspects of VAP bundle target head-bed elevation, daily sedation vacation and deep vein thrombosis, among others. The PICOT question for this question is; For patients admitted to the high dependency unit (P) does t subjected to a VAP bundle (I) mitigate the effect of VAP (O) in comparison to other evidence-based approaches (C) in an evaluation of 12 months' period (T). This paper seeks to examine whether the use of the VAP bundle is well-informed evidence-based practice.

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Literature Review

Rodrigues et al. (2016) examined the factors and impacts of VAP bundles. Their study was conducted in a public teaching hospital and involved patients in the ICU with VAP. The outcomes from the study indicated that there was a rise in the incidences of VAP after the implementation of the bundle. The study further noted that frequencies of death were equal to or greater to 50 per cent. The study identified the lack of necessities such as the 0.12 per cent chlorhexidine for oral disinfection, which, might have heightened the incidences. Another factor identified in the study was age, especially among older patients.

Another crucial factor in the efficient delivery of the VAP is the competence of support nurse. A study by Shahnaz et al. (2018) sought to examine the level of competency among ICU nurses. The study compared 30 nurses from government hospital with another 30 from private hospitals through quantitative research approach, observation, and comparative approach. In the study, the authors did not find any significant link between knowledge and skills in the practice of VAP bundles among nurses. The study, however, notes that there is a need for retention of knowledge if incidences of VAP are to decrease. In a similar survey by Osti et al. (2017), the authors note that nurses play a significant role in the avoidance of VAP as evaluators, coordinators, managers, educators, and providers. The article identified various practices essential for VAP prevention such as active surveillance, proper hand hygiene, appropriate antibiotic use, minimized the duration of mechanical ventilation, through suction of oropharynx and avoiding of saline lavage with suctioning. The study emphasizes on the role of a nurse by noting they should practice prevention strategies to protect patients from infections. The authors agree with Shahnaz et al. (2018) by arguing a shortage of knowledge among nurses is an obstacle to the observance of evidence-based VAP bundle interventions.

The VAP bundle consist of multiple interventions with no particular format and varies from hospital to hospital and even country. The objective of the research by Speck et al. (2016) was to cultivate a new VAP deterrence bundle in a methodical approach. The authors reviewed existing interventions and literature and applied them in a 2-step adjusted Delphi technique to come up with the concluding method of interventions. In a 171 interdisciplinary member study, the team reviewed 65 recommendations and came up with 19 interventions, of which 5 are bedside care practices that are evidence-based and convenient. The new VAP prevention bundle is limited by several factors such as misclassification, lack of an evaluated performance and cost associated with the intervention.

All the researches acknowledge that VAP bundle as an evidence-based approach on preventing VAP suffers from various shortcoming which can be rectified.

Search Strategy

Researching an article was crucial in identifying coming up with the information required on the VAP bundle and its effectiveness. The database used was ResearchGate and ScienceDirect. The reason for using these databases is that they give the peer-review information concerning the article. Moreover, they give the article metrics such as the number of downloads as well as information on the credibility of the author. The PICOT question sought for the effectiveness of VAP bundle use. In searching for related articles, the key search terms were; VAP, VAP bundle, VAP evidence-based approach. In the first search, the databases provided 140 articles. The articles that were narrow such as concentrating on a single VAP bundle intervention were eliminated, and only 20 remained. These were further reduced to 4 since depending on the currency. The articles chosen are not older than three years.

Two articles that will be relevant in my next discussion are those of Shahnaz et al. (2018) and Rodrigues et al. (2016). This articles identified barriers to evidence-based approach as well as a new combination of VAP bundles for successful implementation.

References

Osti, C., Wosti, D., Pandey, B., & Zhao, Q. (2017). Ventilator-Associated Pneumonia and Role of Nurses in Its Prevention. Journal of Nepal Medical Association, 56(208), 461-8. doi:10.31729/jnma.3270

Rodrigues, A., Fragoso, L., Beserra, F., & Ramos, I. (2016). Determining impacts and factors in ventilator-associated pneumonia bundle. Rev Bras Enferm, 69(6), 1045-51. Retrieved from http://dx.doi.org/10.1590/0034-7167-2016-0253

Shahnaz, A., Bhardwaj, U., Tamang, E. K., & Dwivedi, S. (2018). A comparative study to assess the competency among ICU nurses in using ventilator-associated pneumonia bundle to prevent ventilator-associated pneumonia in selected government and private hospitals of New Delhi. International Journal of Nursing Education, 10(3), 6. doi:10.5958/0974-9357.2018.00057.0

Speck, K., Rawat, N., Weiner, N. C., Tujuba, H. G., Farley, D., & Berenholtz, S. (2016). A systematic approach for developing a ventilator-associated pneumonia prevention bundle. American Journal of Infection Control, 44(6), 652-656. doi:10.1016/j.ajic.2015.12.020

Timsit, J., Esaied, W., Neuville, M., Bouadma, L., & Mourvillier, B. (2017). Update on ventilator-associated pneumonia. F1000research, 6, 2061. doi: 10.12688/f1000research.12222.1