Respiratory Ñare: Ventilator-Associated Pneumonia (VAP) (Essay Sample)

Annotated Bibliography: Respiratory care
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O’Grady, N. P., Murray, P. R., & Ames, N. (2012). Preventing ventilator-associated pneumonia: does the evidence support the practice? JAMA, 307(23), 2534-2539.
This article defines Ventilator-associated pneumonia (VAP) as one of the joint infection in patients and that it requires endotracheal tubes with ventilation. The author characterizes VAP with long ICU hospitalization days, high hospital bills, high mortality, and a wide duration of mechanical ventilation (O’Grady et al.,2012). This paper clearly points out how difficult it is to diagnose VAP, its risk, and prevention strategies.
The author describes the difficulty of diagnosing VAP by highlighting a case in the National Institute of Health Clinical Centre, where a woman was admitted. The woman was admitted due to worsening diarrhea and abdominal pains. A CT scan was performed on the chest and abdomen. She was intubated and extubated after eight days of improvement. Later on, her health failed again and was re-intubated but this time she did not survive death. There was difficulty in recognizing that the woman had a VAP infection.
The article explores on prevention strategies of VAP and dwells on the bundle strategy (O’Grady et al.,2012). He describes bundles as a set of processes that when issued as a group give more appealing results than when they are published individually. The author also notes that there is no reported information of reduced VAP cases because of using the bundles strategy. VAP is, therefore, an infection whose diagnosis process is complicated and its prevention strategies have not been fully established.
Azab, S. F., Sherbiny, H. S., Saleh, S. H., Elsaeed, W. F., Elshafiey, M. M., Siam, A. G., ... & Gheith, T. (2015). Reducing ventilator-associated pneumonia in the neonatal intensive care unit using "VAP prevention Bundle”: a cohort study. BMC infectious diseases, 15(1), 314.
This paper dwells on the use of bundles approach to prevent VAP. VAP is a persistent radiographic infiltrates and in infants is worsening gas exchange for those infants ventilated for more than forty-eight hours (Azab et al., 2015). The authors base their arguments on a study that was conducted in the neonatal intensive care unit (NICU) at Zagazig University in Egypt.
The paper describes in detail how the study was conducted. The study took place in three periods; phase 1, the intermediate phase, and phase 2. The first took place for six months and involved a detailed summary of health institutes on the bundles approach. The intermediate took place for three months and involved the signing of documents by health providers. The last phase took place for six months that were used to access the efficiency of the bundles approaches (Azab et al., 2015).
The researchers discovered that there was no difference in the mortality rates in phase 1 and phase 2 (Azab et al., 2015). They also found out the main infection-causing organism was known as Klebsiella pneumonia. The researchers also discovered that there was a reduction in VAP rates in NICU after application of the preventive bundles. The bundle included head elevation of a patient, hand hygiene, proper sterilization of respiratory care equipment, and using sterile water in the humidification system. The researchers also found out that there was a greater desired outcome when the bundles are applied together. The end research results show that there is reduced VAP infection during neonatal ventilation (Azab et al., 2015). Evidently, VAP will reduce when the bundles are applied in the right manner and adhered to strictly.
Alsadat, R., Al-Bardan, H., Mazloum, M. N., Shamah, A. A., Eltayeb, M. F., Marie, A., ... & Kherallah, M. (2012). Use of ventilator associated pneumonia bundle and statistical process control chart to decrease VAP rate in Syria. Avicenna journal of medicine, 2(4), 79.
The author of this article acknowledges the high costs, long hospitalization days, and high mortality that is associated with VAP. This editorial evaluates the implementation the VAP bundle in intensive care units for the mechanically ventilated patients to decrease VAP rates. The paper dwells on an eight-month study research.
According to this article, the study was conducted in four teaching hospitals in Damascus. Compliance rates and VAP rates were observed in control charts. In hospital 1, the compliance rates increased from 33% to 91%, whereas the VAP rate decreased from 30 to 6.4 per 1000ventilator days. In hospital 2, the rate of conformity rose from 33% to 86% and the VAP rate increased 13 to 24 per 1000 ventilator days. In hospital 3, the compliance rate increased from 83% to 100% and the VAP rate decreased from 12 4.9 per 1000 ventilator days (Alsadat et al.,2012). There were no results in hospital four since the VAP bundle was not applied here (Alsadat et al.,2012).
The author points out that studies that show that reduced VAP rates using VAP bundles are related to improvements in clinical outcomes. However, it is evident that where the bundle has not been implemented, then there will be no reduction rates in VAP as was in hospital 4. The difference in the results was due to several factors such as lack of nursing leadership, and lack of structured competency skills testing (Alsadat et al.,2012). The VAP bundle prevention method is, therefore, reliable in the prevention of VAP. Its success depends on the corporation of the hospital administration, physicians and the ICU personnel.
Gu, W. J., Gong, Y. Z., Pan, L., Ni, Y. X., & Liu, J. C. (2012). The impact of oral care with versus without tooth brushing for the prevention of ventilator-associated pneumonia: a systematic review and meta-analysis of randomized controlled trials. Crit Care, 16(5), R190.
In this article, the writer tries to establish whether oral care with tooth brushing can reduce VAP rates. The oral cavity provides a breeding site for microorganisms responsible for VAP (Gu et al., 2012). The author criticizes previous attempts by researchers to establish the role of tooth brushing on VAP on ill patients receiving mechanical ventilation.
The author goes into detail and discusses how he conducted his research. He says that the study was conducted by use of search engines such as Google Scholar to key out major points on tooth brushing or dental. The research evaluated the relevance of randomized controlled trials.
According to the paper, the search produced 148 relevant works. In four studies, composing of 828 patients, the tooth brushing did not reduce the VAP rates on patients, neither did it reduce the mortality rates (Gu et al., 2012). The research also looked into a nonrandomized study that showed an association of tooth brushing with some reduced level of VAP. This research is not reliable since the results are obtained from a non-randomized study.
The author finally acknowledges that oral care with or without tooth brushing does not significantly impact on the incident of VAP on ill patients that have been mechanically ventilated. However, this remains unclear since the research control trials were small scale and not well designed.
Lawrence, P., & Fulbrook, P. (2011). The ventilator care bundle and its impact on ventilator‐associated pneumonia: a review of the evidence. Nursing in Critical care, 16(5), 222-234.
This article attempts to show the relationship between care bundles and VAP reduction. The author starts by defining a bundle as more than two interventions that are grouped together. The Ventilator care bundle comprises four measures that are grouped together. The author attempts to establish other the relationship between VAP and VCB through research for related articles (Lawrence & Fulbrook, 2011).
From the editorial, the research was conducted using Medline and PubMed databases. The research produced ten research results (Lawrence & Fulbrook, 2011). From the results, effects of VCB were mostly on VAP rates, mortality, and ICU and ventilator days. However, the ten research findings were limited in their designs since they did not have control, groups. The author puts it out that the relationship between VCB and VAP is not definite.
According to the author, in clinical practice VCB relates to reduced VAP rates, though the evidence is not clear enough. Further and detailed research in VCB still needs to be established. Evidence-based practice is required to implement the research and ensure its compliance. This article did not secure the proof of its research, but still depicts that VCB causes a reduction in VAP rates.
BIBLIOGRAPHY \l 1033 Rello, J. (2012). clinical microbiology and infection. ps vall d'Hebron: online.
This paper explores the advantage of implementing care bundles to ICU patients. According to (Rello, 2012) the care bundles improves the patient health outcome by promoting changes in patient care and encouraging guidelines compliance. The bundles help in the prevention of Ventilated-Associated Pneumonia (VAP).
The objectives of the care bundles are to determine the impact of implementing a care bundle for VAP prevention on VAP rates and duration of mechanical ventilation. In addition, it determines any existing relationship between care bundles compliance and other outcomes and assessment of compliance level.
The idea to promote patient safety in the ICU was developed by Catalonian quality improvement collaborative strategy. The strategies included; not implementing ventilator circuit changes unless clinically indicated and the incorporation of sedation into control patient care. Also, it involved the use of strict hand hygiene using alcohol-based antiseptic before manipulating the air ways, oral care and intra-cuff pressure control. Hand washing and intra-cuff pressure reduced the risk of developing VAP.