...Ventilator-Associated Pneumonia In general, Healthcare acquired infections are caused by a viral, bacterial, or fungal pathogen that is not present at the time of admission to a hospital or other healthcare setting. These infections can result in an extended stay for patients, mortality, and increased healthcare costs. They can also occur in pediatric and adult patients of either sex, but are more common in critically ill patients. Healthcare acquired infections are a huge concern in the medical field, because they can be associated with medical equipment and involve any system of the body. The most common HAI’s are pneumonia, bloodstream, and urinary tract infections (Custodio, 2015). Ventilator-associated pneumonia or VAP is pneumonia that occurs longer than forty-eight hours after a patient has been intubated and receiving mechanical ventilation. This illness is the second most common hospital acquired infection in critically ill patients. Around eighty-six percent of healthcare acquired pneumonias are due to mechanical ventilation. Every year in the United...
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...HAI’s, 157,500 were caused by Pneumonia (CDC.gov, 2015). Ventilator Associated Pneumonia (VAP), a sub-category of Pneumonia, is a worldwide, challenging complication in the Intensive Care Unit (ICU) setting of many hospitals. VAP often leads to not only increased mortality rates, but also an increase in comorbidity, and healthcare costs in the affected population. It has been estimated that VAP As of 2013, Ventilator Associated Pneumonia has been renamed under the umbrella term Ventilator Associated Events (VAE), making it difficult to find statistics that specifically represent VAP incidences and...
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.......................................................................…...8 Data collection ……………………………………..………….……………………………8 Statistics and data analysis …………………………………………………………….…...9 Expected results …………………………………………………………………………………..9 References cited………………………………………………………………………………….10 Appendix A………………………………………………………………………………………13 Appendix B………………………………………………………………………………………14 Appendix C………………………………………………………………………………………15 Appendix D………………………………………………………………………………………16 Ventilator associated pneumonia and chlorhexidine use in the traumatic brain injured patient Ventilator associated pneumonia (VAP), is defined as, a nosocomial pneumonia that develops more than 48 hours following endotrachial intubation and mechanical ventilation, and is a common and serious intensive care unit (ICU) complication. VAP causes noteworthy morbidity, mortality, amplified hospital costs, and increased utilization of healthcare resources, prolonged time for ventilator support, as well as lengthened ICU and hospital stay (Caruso, 2009). Antibiotics (ATBs) have traditionally been used to treat VAP, but the occurrence of resistance...
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...Journal of Intensive Care Medicine http://jic.sagepub.com/ The Impact of a Simple, Low-cost Oral Care Protocol on Ventilator-associated Pneumonia Rates in a Surgical Intensive Care Unit Carrie S. Sona, Jeanne E. Zack, Marilyn E. Schallom, Maryellen McSweeney, Kathleen McMullen, James Thomas, Craig M. Coopersmith, Walter A. Boyle, Timothy G. Buchman, John E. Mazuski and Douglas J. E. Schuerer J Intensive Care Med 2009 24: 54 originally published online 17 November 2008 DOI: 10.1177/0885066608326972 The online version of this article can be found at: http://jic.sagepub.com/content/24/1/54 Published by: http://www.sagepublications.com Additional services and information for Journal of Intensive Care Medicine can be found at: Email Alerts: http://jic.sagepub.com/cgi/alerts Subscriptions: http://jic.sagepub.com/subscriptions Reprints: http://www.sagepub.com/journalsReprints.nav Permissions: http://www.sagepub.com/journalsPermissions.nav Citations: http://jic.sagepub.com/content/24/1/54.refs.html >> Version of Record - Jan 14, 2009 OnlineFirst Version of Record - Nov 17, 2008 What is This? Downloaded from jic.sagepub.com at UNIV OF THE INCARNATE WORD on April 15, 2013 Original Research The Impact of a Simple, Low-cost Oral Care Protocol on Ventilator-associated Pneumonia Rates in a Surgical Intensive Care Unit Journal of Intensive Care Medicine Volume 24 Number 1 January/February 2009 54-62 # 2009 SAGE Publications 10.1177/0885066608326972 http://jicm.sagepub...
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...Decreased oropharyngeal pathogen colonization reduces number of VAPs and lowering intubation time, hospital stay, and mortality rate Does the use of chlorhexidine oral care reduce the number of ventilator-acquired pneumonias? More specifically, determine the efficay of chlorhexidine in decontamminating the oral cavity of pathogens in mechanically ventilated intensive care patients based on published scientific literature. Significance of the Problem Pneumonia is the second most common nosocomial infection in the United States and the leading cause of death from nosocomial infections. Critically ill patients are a vulnerable population that is more susceptible to developing nosocomial infections. Ventilator-associated pneumonia (VAP) occurs in patients treated with mechanical ventilation, and is associated with a higher incidence in patients treated with continuous ventilatory support. These patients have 8% to 25% risk of developing VAP, and the risk increases by as much as 1% per ventilator day (CDC, 2015). VAP is considered a serious problem, because it extends hospital stay by 6 days or more, has substantial cost implications of up to $40,000 per patient episode, and is associated with significant morbidity and mortality rates (CDC, 2015). Strategies for the reduction and prevention of VAP are urgently needed to help reduce hospitalization costs, incidence of mortality and improve patient outcome. Evidence identifies that VAP occurs 48 hours after intubation and because...
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...Ventilator associated pneumonia (VAP) is a pneumonia occurring approximately 48 hours after a patient is intubated and placed on a mechanical ventilator. VAP is of major concern as it is directly caused by the use of a medical device. This pneumonia occurs when secretions from the oropharyngeal area move into the lungs (VAP, 2006). VAP accounts for 6 of every 10 deaths attributed to healthcare-associated infections (Doyle, Fletcher, Carter, Blunt, & Young, 2011). VAP extends the time a patient is in the intensive care unit by approximately a week and increases cost by $10000 per episode (Doyle et al., 2011). BioMed Central, a peer research group, performed a quantitative research study on VAP and the PneuX System addresses issues surrounding the prevention of VAP. This device incorporates and proprietary endotracheal tube and tracheal cuff seal monitor which is not used with traditional endotracheal intubation. When selecting the sample study, each patient was over the age of 18 years and intubation was required within their plan of care. PneuX System was implemented only of patients expected to be intubated over 24 hours (Doyle et al., 2011). For all patients included in the study, the PneuX System was used and intubation time was at least 48 hours. All patients intubated using the PneuX System were included in study results. First to review VAP and the role the PneuX system plays in VAP prevention. Often when placed on a ventilator a patient is sedated. Bacteria...
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...knowledge for synthesis into the best research evidence needed for practice. This research evidence might be synthesized to develop guidelines, standards, protocols, or policies to direct the implementation of a variety of nursing interventions (Burns & Grove, 2011). One example of nursing research that has improved patient outcomes is through the use of VAP (ventilator associated pneumonia) bundles in an intensive care unit setting for patients that are intubated for more than twenty four hours. VAP is pneumonia that occurs in a patient who was intubated and ventilated at the time of or within 48 hours before the onset of event (Centers for Disease Control and Prevention, n.d.) The Institute of Health Improvement (IHI) developed a ventilator bundle that incorporates several strategies to prevent morbidity associated with being on a ventilator. These strategies included: elevation head of bed to 30-45 degrees (prevents aspiration), daily sedation vacation and assessment of readiness to wean (can lead to a more rapid weaning of the patient off the ventilator), peptic ulcer disease (PUD) and deep vein thrombosis (DVT) prevention. Through the use of the VAP bundle and collaborative care with regular daily rounds on all ventilated patients regarding the progress,...
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...infection control and hospital epidemiology march 2014, vol. 35, no. 3 original article Ventilator-Associated Pneumonia: Overdiagnosis and Treatment Are Common in Medical and Surgical Intensive Care Units Veronique Nussenblatt, MD, MHS;1 Edina Avdic, PharmD, MBA;2 Sean Berenholtz, MD, MHS;3,4 Elizabeth Daugherty, MD, MPH;5 Eric Hadhazy, MS;1 Pamela A. Lipsett, MD, MHPE;3,4 Lisa L. Maragakis, MD, MPH;1 Trish M. Perl, MD, MSc;1 Kathleen Speck, MPH;3 Sandra M. Swoboda, RN, MS;3 Wendy Ziai, MD;3,6 Sara E. Cosgrove, MD, MS1 objective. Diagnosing ventilator-associated pneumonia (VAP) is difficult, and misdiagnosis can lead to unnecessary and prolonged antibiotic treatment. We sought to quantify and characterize unjustified antimicrobial use for VAP and identify risk factors for continuation of antibiotics in patients without VAP after 3 days. methods. Patients suspected of having VAP were identified in 6 adult intensive care units (ICUs) over 1 year. A multidisciplinary adjudication committee determined whether the ICU team’s VAP diagnosis and therapy were justified, using clinical, microbiologic, and radiographic data at diagnosis and on day 3. Outcomes included the proportion of VAP events misdiagnosed as and treated for VAP on days 1 and 3 and risk factors for the continuation of antibiotics in patients without VAP after day 3. results. Two hundred thirty-one events were identified as possible VAP by the ICUs. On day 1, 135 (58.4%) of them were determined to not have VAP...
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...respiratory insufficiency. But this can profoundly impair the defensive mechanisms which keep the lower respiratory tract sterile, increasing the risk of bacterial colonization and ventilator-associated pneumonia. Although endotracheal suctioning is a standard of care in all mechanically ventilated patients, clear guidelines regarding the technique and timing of suctioning are lacking. The applicable American Association for Respiratory Care (AARC) guideline suggests that endotracheal suctioning should be performed at some minimum frequency or when clinically indicated. Since endotracheal suctioning can cause hypoxemia, mechanical trauma, bronchospasm, and hemodynamic instability, an accurate assessment of the need for suctioning might decrease the frequency of suctioning complications. TBA Care is a novel device designed to generate a signal when secretions are present in the respiratory tract of an intubated patient, indicating the need for endotracheal suctioning. This is the first prospective randomized trial to compare different indications for endotracheal suctioning. This study compares the efficacy of TBA Care in detecting the presence of secretions in the airways to standard indications, and tested the hypothesis that different suctioning indications could impact the incidence of ventilator-associated pneumonia and extubation rate (Lucchini et al., 2011). This is a quantitative research study with prospective randomized trial with 72 general intensive care unit patients randomized...
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...Running head: A QUALITATIVE ANALYSIS OF CLINICIANS' PERCEPTION OF A Qualitative Analysis of Clinicians' Perception of Head-of-Bed Elevation Jolly Abraham Grand Canyon University NRS-433V January 09, 2011 A Qualitative Analysis of Clinicians' Perception of Head-of-Bed Elevation Ventilator - associated pneumonia (VAP) is the second most common hospital acquired infection (HAI) and is associated with high morbidity and mortality rates for ventilated patients in intensive care units (Bingham, Ashley, Jong, & Swift, 2010). The VAP increases patients’ mortality rates, length of stay and hospital costs (Hiner, Kasuya, Cottingham, & Whitney, 2010). The VAP is the leading causes of death due to nosocomial infections and the second most common nosocomial infection in the United States (Hiner et al., p. 164). The VAP is a serious and life threatening infection to critically ill patients and prevention of VAP is an ongoing challenge to critical care nurses. The purpose of this research was to investigate clinicians’ ability to estimate the head of the bed elevation (HOB) levels, assess their knowledge regarding the recommended guidelines of head of the bed elevations and to find out how they determine angle of the HOB in their practice (Hiner et al.). The study suggests that clinicians’ perception of head of the bed elevation play a significant role in helping to achieve the goal of elevating the HOB to 300 to 450(Hiner et al., 2010, p. 165). The study design and methods...
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...Change in Practice: Preventing Hospital Associated Infections April Shannon Walden University NURS 4000 Section 04, Research and Scholarship for Evidence-Based Practice November 18, 2012 Change in Practice: Preventing Hospital Associated Infections Benjamin Franklin was quoted as saying “an ounce of prevention is worth a pound of cure.” With the increasing costs of healthcare and the emergence of multi-drug resistant organisms this truth still resonates today. Hospital associated infections (HAIs), have been a complication in hospitals for many years. The purpose of this assignment is to address this problem in nursing practice, and discuss evidence on practices that will address this issue. The problem Hospital associated infections (HAIs) can be defined as an infection acquired in hospital by a patient who was admitted for a reason other than that infection. An infection occurring in a patient in a hospital or other healthcare facility in whom the infection was not present or incubating at the time of admission. This includes infections acquired in the hospital but appearing after discharge, and also occupational infections among staff of the facility (central line associated bloodstream infections, catheter associated urinary tract infections, surgical site infections, ventilator associated pneumonia, etc.) (World Health Organization, 2002). HAI’s have become one of the leading caused of hospital related deaths in the United States. However, these infections...
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...Australasian Medical Journal [AMJ 2012, 5, 2, 135-140] Outcome of ventilator-associated pneumonia: Impact of antibiotic therapy and other factors Noyal Mariya Joseph1, Sujatha Sistla1, Tarun Kumar Dutta2, Ashok Shankar Badhe3, Desdemona Rasitha1, Subhash Chandra Parija1 1. Department of Microbiology, 2. Department of Medicine, 3. Department of Anaesthesiology and Critical Care Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry - 605006, India RESEARCH Please cite this paper as: Joseph NM, Sistla S, Dutta TK, Badhe AS, Rasitha D, Parija SC. Outcome of ventilatorassociated pneumonia: impact of appropriate therapy and other factors. AMJ 2012, 5, 2, 135-140. http//dx.doi.org/10.4066/AMJ.2012.1004. Corresponding Author: Dr. Noyal Mariya Joseph, Assistant Professor, Department of Microbiology, Mahatma Gandhi Medical College and Research Institute, Pillaiyarkuppam, Pondicherry – 607 402 (India) Email: noyaljoseph@yahoo.com Please use these fonts and font sizes only. Abstract inappropriate therapy (defined as lack of coverage of one or all the significant VAP pathogens) were at significantly high risk for death (Relative risk, 2.00; 95% confidence interval, 1.14 to 3.52; P 0.0008). A delay of > 2 days in administering the first dose of appropriate antibiotic therapy significantly prolonged the duration of ventilation (P < 0.0001). Infection by multi-drug resistant pathogens, polymicrobial infection and time of onset of VAP did not...
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...The Centers for Disease Control and Prevention estimate that approximately 1.7 million hospitalized patients acquire infections while being treated for other medical conditions. In 2011, there were an estimated 722,000 hospital acquired infections (HAIs) in United States Acute Care Hospitals. Additionally, about 75,000 patients with hospital acquired infections died during their hospitalization (CDC, 2018). (Note: To ensure consistency, we will use HAIs when referring to nosocomial infections, please refer to the definition section for further understanding of the terms) More than half of all the incidents occurred within the intensive care unit. HAIs can be associated with the devices used in medical procedures, such as central line-associated...
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...Tanner Medical Center's ICU Organizational Assessment Scott Willard Franklin The University of Alabama Capstone College of Nursing NUR 522: Organizational Assessments for Clinical Nurse Leaders Fall, 2010 Tanner Medical Center's ICU Organizational Assessment Tanner Health System is a nonprofit regional health system serving a nine county area of West Georgia and East Alabama. Tanner facilities include: a 202-bed acute care Tanner Medical Center/Carrollton, a 40-bed acute care Tanner Medical Center/Villa Rica, a 25-bed critical access Higgins General Hospital in Bremen, and a 52-bed behavioral health facility Willow Brooke in Villa Rica (Retrieved from http://www.tanner.org) The micro system that I am going to describe consists of the Intensive Care Unit (ICU) located in Carrollton, Georgia. The purpose of this paper is to describe the current microsystem in the ICU and how Clinical Nurse Leader can help the ICU can run more efficiently. The critical care department is composed of a joint eight bed intensive care unit (ICU) and a four bed coronary care unit (CCU) in a horse shoe design. Because Tanner’s provides highly complex medical care requiring precision, synchronization, and coordination of multiple services and personnel, the ICU functions as a closed unit that is self sufficiently ran. Because we are a closed unit, our nursing staff is required to take 36 hours of call every 6 weeks and work every other weekend. The nurse to patient ratio is 2:1. Patients that...
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...for bloodstream infections, and 6.8 to 30 days for pneumonia. The estimated mortalities associated with nosocomial bloodstream infections and pneumonia are 23.8% to 50% and 14.8% to 71% (overall), or 16.3% to 35% and 6.8% to 30% (attributable), respectively. The estimated average costs of...
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