Ventilator_Associated_Pneumonia

Efficacy of an expanded ventilator bundle for the reduction of ventilator associated pneumonia Ventilator Associated pneumonia (VAP) is a serious hospital- acquired infection (HAI) and is an important cause of morbidity and mortality in hospitalized patients. Ventilator- associated pneumonia is a type of pneumonia in patients receiving mechanical ventilation that was not present at the time of intubation. The incidence of VAP ranges from 10% to 25%, with mortality of 10 % to 40 %( Al-Tawfiq & Abed, 2010, p. 552). Several interventions have been focused to help prevent the incidence of Ventilator associated pneumonia. The purpose of this study was intended to find the effectiveness of the new modified ventilator bundle for the prevention of VAP. The so called” ventilator bundle “(VB) represents a core group of maneuvers intended to decrease or eliminate VAP (Rella, Wojcik, Solis, & Khan, 2009). These VB includes combinations of head of the bed elevation, daily sedation vacation in addition to an assessment of weaning trial, gastric and deep vein thrombosis prophylaxis, frequent change of the ventilator circuit and hand washing (Rella et al., 2009). The study methods and design A quantitative method of research conducted in this study- that is, numeric information that results from some type of formal measurement and that is analyzed with statistical procedures (Polit & Beck, 2010). The study was conducted in the 18- bed adult MICU at St Joseph’s Regional Medical center in New Jersey (Rella et al., 2009). The study design was approved by the St Joseph’s Regional Medical Center Institutional Review Board. The researchers conducted a quantitative study, and mainly examined the rate of VAP in the MICU after initiation of the modified VB for the period of 18 month, and reporting the successful implementation of a method of a modified VB in that unit. All mechanically ventilated patients were included in this study (Rella et al., 2009). In this pre and post interventional study, the researchers compared the rates of VAP, on a quarterly basis, for 1.5 year period before the initiation of VB guidelines with the rates of VAP after the intervention (Rella et al., 2009). For the accuracy of the study result, the staff responsible for implementing VB was not informed that the data would be evaluated for a generalized study. The study Intervention In this study, in addition to routine infection control measures, a set of modified respiratory therapist –driven procedures, were also implemented to control the VAP (Rella et al., 2009). The expanded VB includes strict enforcement of infection control guidelines; which includes; every patient was screened for infection upon admission and monitored for signs of developing infection after admission (Rella et al.). The patients suspected for sepsis on admission or first spike of temperature >100.40 F are immediately tested for pathogens. The laboratory technician provides verbal alert on the recognition of any pathogens to the nurse caring the patient. The nurse, will notify the physician and the decision will be made regarding the initiation of treatment. The strict isolation techniques including the use personal protective equipment were implemented depending on the patient’s symptoms and suspected organisms. Other interventions are, strict hand washing before and after patient contact, use of alcohol-based gel and meticulous oral hygiene policy are also initiated and observed (Rella et al., 2009). The respiratory therapist –driven protocol also included in this study such as, trial of spontaneous breathing trial (SBT) after the use of sedation vacation every day by changing the ventilator mode to a pressure support setting, assess readiness for weaning every day, notification of physician when the patient is considered to have passed the SBT, early tracheostomy for patients frequently failing SBT, especially for patients expected to be ventilator dependent for an extended period and tracheostomy for all patients beyond 12 days(Rella et al., 2009). The study results The group wise comparison of VAP rate was done using the Mann-Whitney test and trend analysis was done using the X2 test for trends (Rella et al., 2009). Post hoc power analysis indicated that the study achieved a power of more than 95 % (Rella et al., p. 173). The study results shows by a near zero rate of VAP in a MICU and has been achieved over an 18 month period. The intervention effort for this study highlighted the fact that a modified VB immediately reduced VAP and, after 12 months of implementation, has kept the VAP rate near zero. In conclusion, VAP is an important clinical problem for all mechanically ventilated patients. The VAP cases are potentially preventable. Nursing research help nurses to educate each other, to provide safe quality care, and thus ultimately improve the patient outcome. The study clearly proven that, all VAP cases are preventable through the effective implementation of infection control protocols. The evidence based research findings alert the health care professionals to question traditional VB and encourage them to explore new VB care strategies. This study shows a strong correlation between compliance and VAP outcomes. Hence it is imperative to modify the VBs in order to reduce the VAP rates in our hospitals.