...…………………………..……………………………7 Power analysis …………………………………..…………….……………………………8 Instrumentation ...............................................................................................................…...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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...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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...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 contaminated secretions will then sit on top of the ETT cuff and eventually leak down and invade the lungs. Also aiding as a reservoir for microbes is a biofilm that can form on the ETT and enter the lungs causing infection (Mietto, Pinciroli, Patel, & Berra, 2013). Nurses are responsible for applying pharmacological and non-pharmacological measures to help prevent VAP which poses a very difficult challenge. Nurses must research and incorporate the use of evidence-based practice into their daily care of patients on mechanical ventilation (Sedwick, Lance-Smith, & Nardi, 2012). This paper will look closely at the evidence-based research and protocols implemented which best prevent ventilator-associated pneumonia. To help prevent further complications and improve outcomes in patients...
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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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...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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...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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...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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...Nursing Interventions for Reducing the Stresses Experienced by Mechanically Ventilated Patients Teresa Perkins McKendree University Nursing Interventions for Reducing the Stresses Experienced by Mechanically Ventilated Patients Mechanically ventilated patients may experience increased levels of stress due to various environmental factors in the ICU. These include equipment/alarm noise, invasive nature of treatments and the inability to communicate verbally. These stressors can cause non-favorable effects such as increased anxiety levels which can subsequently lead to somatic reactions such as tachycardia, dyspnea, increased blood pressure and patient-ventilator dyssynchrony. Prolonged anxiety levels can also induce psychological effects such as increased fear and inhibitions. This can ultimately affect the patient’s overall capacity to cope with difficult emotions and situations (Richart-Martinez & Perpina-Galvan, 2009). These effects can lead to the need for more sedation which can hinder weaning attempts. The longer a patient is mechanically ventilated the greater the risk of developing Ventilator Associated Pneumonia, (VAP), and Adult Respiratory Distress Syndrome (ARDS). VAP is a pneumonia that develops 48 hours or longer after mechanical ventilation. It results from the invasion of the lower respiratory tract and lung parenchyma by microorganisms. Intubation compromises the integrity of the oropharynx and trachea and allows oral and gastric...
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...PICO Question Population – Mechanically ventilated intensive care patients. Intervention – Oral care with chlorhexidine. Comparison – Oral care with other chlorhexidine. Outcome – 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...
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...ORAL CARE AND PNEUMONIA References Arroliga, A. C., Pollard, C. L., Wilde, C. D., Pellizzari, S. J., Chebbo, A., Song, J., & ... Meyer, T. (2012). Reduction in the Incidence of Ventilator-Associated Pneumonia: A Multidisciplinary Approach. Respiratory Care, 57(5), 688-696. Abstract BACKGROUND: We report the process implemented in our institution by a task force focused on the reduction of ventilator-associated pneumonia (VAP). METHODS: Retrospective cohort study of all adults admitted to one of our 4 adult ICUs, intubated on invasive mechanical ventilation. We implemented a ventilator bundle in April of 2007; we report the incidence of VAP in 2008, and, after adjustment in the process (oral care performed by respiratory therapists), the incidence in 2009. The primary outcome was reduction of the microbiologically confirmed VAP rate over a 2 year period. Other outcomes were duration of mechanical ventilation, antibiotic days, ICU and hospital stay, and mortality. RESULTS: During the study period, 2,588 patients received invasive mechanical ventilation in the adult ICUs. The VAP rate during 2008 was 4.3/1,000 ventilator days, and the 2009 rate was 1.2/1,000 ventilator days. The 2008 to 2009 VAP rate ratio was significantly greater than 1 (rate ratio 3.6, 95% CI 1.8-8.0, P < .001). Antibiotic days were less in 2009 versus 2008 (Hodges-Lehmann estimate of difference between 2008 and 2009, 1.0, 95% CI 0.0 -1.0, P = .002). The median stay in the ICU was unchanged, and...
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...com/EBT1-Evidence-Based-Practice-and-Applied-Nursing-Research-WGU-8906543.htm If You Face Any Problem E- Mail Us At JohnMate1122@gmail.com TASK 1 The research obtained in this particular study does support the conclusion. When all five area’s were studied, it verified that the incidence of ventilated associated pneumonia was decreased when oral care and dental care was performed onto these mechanically ventilated patients. The background information that was provided was direct, to the point and relevant to the impact of today’s heath care. Millions of dollars are being spent every year for incidences within hospitals that can be prevented and this study was set out to prove just that, that ventilator associated pneumonia can be prevented. The logic was simple. That logic was to clear the mouth and airway of any harboring microorganisms that can pool in the mouth and result into an infection. The test groups were relevantly the same size and the characteristics of age, sex, APACHE scores and reasons for admissions were comparable. The conclusion was predictable in verifying that strict oral cleaning did result in a lower incidence of ventilator associated pneumonia in patients. A.4. During the course of this research, ethics would be addressed. Before the study had begun, the Infection Control Department had meetings with nurses and doctors of the ICU, nurse educators, anesthesiologists, emergency room staff, Materials Management and the performance improvements...
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...com/EBT1-Evidence-Based-Practice-and-Applied-Nursing-Research-709077666.htm?categoryId=-1 If You Face Any Problem E- Mail Us At Contact.Hwnerd@Gmail.Com TASK 1 The research obtained in this particular study does support the conclusion. When all five area’s were studied, it verified that the incidence of ventilated associated pneumonia was decreased when oral care and dental care was performed onto these mechanically ventilated patients. The background information that was provided was direct, to the point and relevant to the impact of today’s heath care. Millions of dollars are being spent every year for incidences within hospitals that can be prevented and this study was set out to prove just that, that ventilator associated pneumonia can be prevented. The logic was simple. That logic was to clear the mouth and airway of any harboring microorganisms that can pool in the mouth and result into an infection. The test groups were relevantly the same size and the characteristics of age, sex, APACHE scores and reasons for admissions were comparable. The conclusion was predictable in verifying that strict oral cleaning did result in a lower incidence of ventilator associated pneumonia in patients. A.4. During the course of this research, ethics would be addressed. Before the study had begun, the Infection Control Department had meetings with nurses and doctors of the ICU, nurse educators, anesthesiologists, emergency room staff, Materials Management and the performance improvements...
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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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...during the confinement. Our Respiratory System is responsible for the breathing process of our body. Once infection arises it can delay and agrravate once patient’s condition and would subsequently deteriorate leaving sometimes major organs be affected,this what we call the multi-organ failure. Pnemonia as we all know is one of the most common nosocomial infections and one of the leading causes of death inside the hospital.It is defined as an inflammation of the lungs. Hospital-Acquired Pneumonia is one of the most common kind of it. It a pneumonia that has been acquired during or after one’s hospitalization for another illness with onset of at least 72 hours after admission. Once a patient has been admitted to Intensive Care Unit,it is very likely that the patient could be able to acquire this infection and so much more if patient ended up to be intubated and mechanically ventilated,a type of Pneumonia would be likely to be developed,this is known as the Ventilator Associated...
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...Abstract Pneumonia Introduction: I will not be looking too deep into this severe case of Community Acquired Pneumonia. My objectives in this case study will basically be to determine whether hospital admission for intravenous antibiotics are necessary. This will be done by using clinical scores and other in-hospital diagnostic criteria to determine prognosis and severity. The relevance to this case study with be treatment regime and a ventilator strategy you may not have heard of. Case study: 67 year old female of colored ethnicity from wellington, transferred from Paarl hospital intubated, ventilated will host of problems including Chronic Obstructive Pulmonary Disease grade ii , Community Acquired Pneumonia (CAP) , Gastro Intestinal Tract bleed which occurred just before transferring from Paarl, also history of smoking, one packet year, and ethanol (ETOH) abuser. Conclusion: Diagnostic criteria, is clinical presentation and chest x-ray. The simplest of all clinical scoring system is CURB-65 using 5 prognostic variables to determine the severity of Pneumonia, instead of 20. Much easier and practical can be applied at patient bedside. Inverse ratio ventilation to aid and improve filling of non-compliant...
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