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Prevention Of Ventilator Associated Pneumonia Essay

2122 words - 9 pages

Prevention of Ventilator-Associated Pneumonia

Prevention of Ventilator-Associated Pneumonia
Ventilator-Associated Pneumonia (VAP) is the most common nosocomial infection in Critical Care units. VAP is linked with high mortality rates, increased hospital stays, longer mechanical ventilation and increased costs to hospitals and patients (Rosa, Hernandez, Carillo, Fernandez, & Valles, 2012). Patients who have an endotracheal tube (ETT) with mechanical ventilation are more likely to develop VAP. These patients have a poor cough reflex due to a decreased level of consciousness and diminished movement of the respiratory tract mucocila, leading to the inability to clear secretions. These ...view middle of the document...

12% , prophylaxis of peptic ulcer disease and prevention of venous thromboembolism ("IHI," 2011). For a more standardized approach, the following studies researched followed the CDC’s standard definition of VAP. The CDC has created a detailed VAP algorithm to be followed in order to classify it as VAP (Magill et al., 2013). In general, it is identified by using an assortment of objective criteria: decline in respiratory status after a level of stability or improvement on the ventilator, indication of inflammation or infection, and laboratory confirmation of a respiratory infection. To be eligible for VAP, patients must be on mechanical ventilation for more than two days ("VAE," 2014).
A private general hospital in Saudi Arabia implemented a study using the Ventilator Bundle in attempt to decrease the rate of VAP. The study was performed in one of their 18 bed all-adult ICU over a two year period. They studied the rates and practices for one year pre-intervention and then compared those rates for one year after the intervention was applied. The outcome was measured using a ratio of VAP per 1000 ventilator days and investigation was done by a professional trained in infection control by the United States CDC definition. The pre-intervention results were 29 VAP events over the twelve month period or 9.3 events per 1000 ventilator days. Post Ventilator Bundle intervention was 2.5 events per 1000 ventilator days. It was also estimated that each patient who gets VAP will have an increased hospital stay of an additional ten days and an increase to hospital cost of $40,000 or $780,000 yearly. The Ventilator Bundle applied to this study showed a substantial decrease in the rate of VAP and a reduction of cost and hospital stay (Al-tawfiq & Abed, 2012).
Six Korean university hospitals with similar VAP rates conducted an experimental study using the Ventilator Bundle approach on patients on mechanical ventilation in the ICU setting. The bundle was implemented from March 2011-June 2011 and the results were then compared to the VAP rate from the previous eight months without the bundle. The results were conveyed as cases of VAP per 1000 ventilator days. The drawback to this study was that it was relatively short in time. However, the study was large in size including six university hospitals with a total of 196 ICU beds. Each patient was assessed daily by an infection control practitioner (using CDC guidelines) to make sure each bundle element was being applied properly with each patient. The study revealed a reduction in occurrence of VAP with putting the Ventilator Bundle into practice. In the eight month study prior to the initiation of the bundle, there were 4.08 events of VAP per 1000 ventilator days. Over the four month trial with the bundle, results improved to 1.16 events of VAP per 1000 ventilator days (Joong et al., 2013).
In Wynnewood, Pennsylvania, the Intensive Care units of the Lankenau Hospital system adopted the IHI’s Ventilator...

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