Ventilator- Associated Pneumonia (Research Paper Sample)

Ventilator- Associated Pneumonia (VAP)
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Ventilator- associated pneumonia (VAP)
Selective decontamination of the digestive tract (SDD) is a strategy, which is applied to prevent Ventilator-associated Pneumonia. The SDD is centered on the use of antimicrobials to eradicating pathogenic microorganism, which might be present in the digestive tract. The selective decontamination of the digestive tract aims at eliminating pathogens from the oropharynx, stomach and gut without varying defensive micro- organisms.
Identification of PICO components
Population
A group of adult above 30 years on intensive care unit, at a risk of VAP, which occurs after five days of commencement of endotracheal intubation and the mechanical ventilation.
Intervention
The Selective Decontamination of the Digestive Tracts applying employing includes Non- absorbable antibiotics, which are applied through a nasogastric tube to the oropharynx. It is used along with antifungal, which are not absorbable/systematic antibiotics.
Comparators
The Selective Decontamination of the Digestive tract (SDD) will be compared to systematic antibiotic only or no antimicrobial. The comparison is not undertaken directly on Selective Decontamination of the Digestive tract (SDD) and other non-antimicrobial strategies concerning ventilator-associated pneumonia prevention.
Outcomes
Significant outcomes will include reduced length of stay in intensive care as the secondary outcome and the duration of mechanical ventilation. The primary outcome is the reduced incidence of Ventilator-associated pneumonia (Chao et.al, 2007).Other outcomes are the reduction of the emergence of microorganisms that are resistant to medications. Examples of this microorganism are the meticillin-resistant staphylococcus aureus, aerobic gram-negative bacilli, and vancomycin-resistant enterococci. Finally, there are adverse events like Clostridium difficile associated diarrhea which is associated with Selective Decontamination of the Digestive Tract.
PICO question/statement
For a mixed group of adults in ICU , 18 years and below (P), is the Selective Decontamination of the Digestive tract (SDD) (I) cost effective as compared to either no antimicrobial or systematic antibiotic only (C) in the prevention of Ventilator-associated Pneumonia (VAP) (0)?
Developing an Implementation Plan
Organizations main committees should be involved when implementing any health policy or plan within the healthcare facility. The first steps should be taken by the team involved in an evidence-based program to gain approval in terms of sets, protocols and established guidelines of data that are not standardized within the category setting or department. Considering different committees, such as respiratory, cardiovascular and women’s health departments, the initial steps of analysing ventilator-associated should be taken seriously.
Ventilator- Associated Pneumonia (VAP)
Ventilator-Associated Pneumonia (VAP) has been characterized by high morbidity, mortality and extra cost burdens for patients and hospital at large. It has a greater effect on morbidity hence one of the leading causes of mortality in hospitals with people in the ICU. Analyzing this condition is pivotal in the implementation and provision of measures to patients who are under mechanical ventilation in the hospitals.
There is a significant correlation between complications in patients with ventilator-associated pneumonia and those under mechanical ventilation (Babcock, et.al, 2004) the condition has been associated with increased hospital cost. Ventilator-Associated Pneumonia is the second largest condition after urinary infections keeping patients in the hospital for long. It is commonly known as a complication associated with mechanically ventilated patients hence contributing to patient’s death more than any other hospital-acquired infections. Considering the costs to the hospital, VAP requires concrete preventive strategies because it is attributed to high mortality, excess of stay and ICU utilization in respect of physical costs, antibiotic costs and bed cost.
Implementation and recommendation that reduces microbial colonization is the basic strategy in reducing its prevalence. Prevention of microbial aspiration and staff education is another strategy in reducing VAP prevalence. Changes in staff behavior are paramount in reducing of ventilator-associated pneumonia in ICU. Best programs lead to the reduction of oropharyngeal colonization, and aspiration hence education reinforcement is necessary for staff. Healthcare staff should be well trained and competent in any health procedures and care processes that are in line with health care policies.
The nosocomial pneumonia, VAP requires a unique approaching the caring and handling critically ill patients, safety being a priority. The American Association of Critical- Care Nurses (AACN) has established some mechanisms that are critical in handling cases of VAP. This mechanism has been important for health care providers and those who are undergoing mechanical ventilation. The mechanisms have been found to be cost-effective, feasible, and safe. They include the following: constant subglottic elimination, elevation of the patient to 30 to 45 degrees unless medically indicated, and change or modification of ventilator circuit after every two days. Furthermore, safety procedures presume stress prophylaxis and DVT, consistent oral care and hand cleaning before and after contact with the patient.
The selective decontamination of the selective tract is a solution to solve the research problem because it is the strategy that can be applied to prevent ventilator-associated pneumonia. The theory consists of the suppression of pathogenic microorganisms by applying the antimicrobials. The objective of selective decontamination of the digestive tract is to abolish the pathogens in the stomach, gut and oropharynx without altering protective microorganisms. The theory is important to solve the reduction of the onsets of resistance of mortality and bloodstream infections and pneumonia in case the full regimen is employed well. The selective decontamination of digestive tract can lower the effects of gram-negative bacteria that resist the medication. It is significant to prevent the colonization of the stomach, intestine, throat and oral cavity of the patients.
Rationale
The rationale for selecting this method is that, there are different randomized trials has based its clinical studies on it. This study suggests a strategy that deals with both gram-positive and gram- negative bacteria, and yeast that colonizes the stomach and intestines of patients who are critically ill. Respiratory infections reduction could significantly reduce the incidence of ventilator-associated pneumonia. This strategy is best suited for intensive care unit and a dynamic environment when incorporating organizational climate, multidisciplinary team, and the ICU culture. The theory should provide a framework by which change process could be initiated. Pneumonia is associated with almost 10% to 15% of the hospitalized associated infections and causes about 24% to 27% of the entire infections acquired in medical intensive care unit (MICU), the coronary care unit, and (CCU) respectively. The strategy is aiming at providing a possible solution to eliminate and reduce ventilator-associated pneumonia (VAP). The analysis of the proposed solution is to identify the problem when proposing solutions, how to implement and evaluate the desired solution. The primary risk factors in the incidence and development of ventilator-associated pneumonia is the mechanical ventilation and the requisite enndotracheal intubation. The rates of VAP range from 0-16 per ventilator days based on the type of ICU, which was the leading rates, received from the trauma ICUs.
Literature Review
According to Babcock (2004), Ventilator associated pneumonia is a preventable diseases, which may contribute to an increased morbidity, health care cost and mortality. The major solution to the patients is the prevention of ventilator-associated pneumonia and particularly those patients who are getting mechanical ventilation. The care concept of SDD was employed to prevent the difficulty as propose...