...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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.......................................................................…...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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...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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...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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...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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...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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...University Tracy Wallace Hospital-acquired pneumonia has a very high morbidity and mortality rate here in the United States and is the second most common nosocomial infection. HAP consists of approximately fifteen percent of all hospital-acquired infections and occurs in five to fifteen percent of every 1,000 admissions. Critical care nurses are presented with unique challenges when caring for patients who are at risk for developing VAP. Strategies must be developed using evidence-based practice and incorporated into daily care in order to prevent VAP in patients receiving mechanical ventilation. ICU Doctors, Nurse Educators and the DON on the ICU unit are currently responsible for our current oral care practice. Our hospital is currently using (OAG), which stands for Eiders’ Oral Assessment Guide, it measures a patient’s oral health status and the frequency of oral hygiene. This tool measures oral health by using 8 different categories: swallow, lips, tongue, saliva, mucous membranes, gingiva, teeth, and voice. They are graded 1 (best), 2, or 3 (worst). Normal findings would be a score of 8, whereas 24 would be the total worst score in all 8 categories. I will now explain how using evidence based practice and OAG can improve the oral health of patients on ventilators. The conclusion will be supported by the research that I have obtained in this research project, which is decreasing the risk of pneumonia on patients who are on ventilators. The provided back ground information was...
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...Laboratory diagnosis of respiratory infections In our laboratory, we offer tests for the diagnosis of upper respiratory tract infections-pharyngitis, sinusitis, ocular and ear infections, and lower tract infections including pneumonia and bronchitis. Today we will focus on the diagnosis of common bacterial causes of pharyngitis and lower respiratory tract infections. Dr Miller will cover mycobacterial, fungal, and viral causes of lower respiratory tract infections with a special emphasis on the use of molecular methods to detect these organisms. Upper respiratory tract infections Pharyngitis- Group A streptococci is the most important bacterial cause of pharyngitis. Although pharyngitis is typically a self-limited disease, the diagnosis of group A streptococci may be attempted. The reasons may be to prevent the overuse of antimicrobials to treat pharyngitis (GAS negative patients are not treated) and to prevent ping-ponging of GAS in family with susceptible children. 1. GAS diagnostic strategy- Rapid Antigen Detection Test (RADT)- can be used in adults; test has high specificity (99%+) but sensitivity ranging from 80-90% (dependent upon test used and quality of specimen collection). Antigen positive patients would be treated but antigen negative patients would not. a. What about back-up culture- pro-can detect other agents of pharyngitis including Group C and G strep which is a common cause of bacterial pharyngitis as well as Arcanobacterium. ...
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...Attributable Hospital Cost and Length of Stay Associated with Health Care-Associated Infections Caused by Antibiotic-Resistant Gram-Negative Bacteria Patrick D. Mauldin, Cassandra D. Salgado, Ida Solhøj Hansen, Darshana T. Durup and John A. Bosso Antimicrob. Agents Chemother. 2010, 54(1):109. DOI: 10.1128/AAC.01041-09. Published Ahead of Print 19 October 2009. Downloaded from http://aac.asm.org/ on January 1, 2012 by guest Updated information and services can be found at: http://aac.asm.org/content/54/1/109 These include: REFERENCES This article cites 43 articles, 12 of which can be accessed free at: http://aac.asm.org/content/54/1/109#ref-list-1 Receive: RSS Feeds, eTOCs, free email alerts (when new articles cite this article), more» CONTENT ALERTS Information about commercial reprint orders: http://aac.asm.org/site/misc/reprints.xhtml To subscribe to to another ASM Journal go to: http://journals.asm.org/site/subscriptions/ ANTIMICROBIAL AGENTS AND CHEMOTHERAPY, Jan. 2010, p. 109–115 0066-4804/10/$12.00 doi:10.1128/AAC.01041-09 Copyright © 2010, American Society for Microbiology. All Rights Reserved. Vol. 54, No. 1 Attributable Hospital Cost and Length of Stay Associated with Health Care-Associated Infections Caused by Antibiotic-Resistant Gram-Negative Bacteria Patrick D. Mauldin,1,2 Cassandra D. Salgado,3 Ida Solhøj Hansen,1 Darshana T. Durup,1 and John A. Bosso1,3* Department of Clinical Pharmacy and Outcome Sciences, South Carolina College of Pharmacy...
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...AFT Task 4: Periodic Performance Review Accreditation Audit Case Introduction The accreditation process is designed to assist healthcare establishment to identify and enhance the patient’s safety and the quality of service delivery. This paper presents a review of the readiness Nightingale Community Hospital for accreditation audit. The paper comprises of a periodic performance review of the establishment. The review has focus of several priority areas. These areas include; assessment and care; quality improvement; patient safety, and staffing effectiveness. Trend within the hospital indicates the Nightingale has made significant progress towards fulfilling the standards of the Joint Review Commission. However, the trends in staffing effectiveness are limiting the organization’s compliance. Periodic Performance Review (PPR) The PPR is based on data collected in the Joint Commission Survey. The survey utilized the priority focus methodology to evaluate the compliance of Nightingale Community Hospital. The priority focus process is a methodology that makes use of data to establish priority areas for reviewing compliance. This process has utilized of both external and internal data to evaluate the compliance of Nightingale Community Hospital. This methodology identified several priority areas. These include; assessment and care services; quality improvement activities, and patient safety. This paper evaluates Nightingale’s compliance in these three priority areas. Compliance...
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...Northwest Point Boulevard, Elk Grove Village, Illinois, 60007. Copyright © 2004 by the American Academy of Pediatrics. All rights reserved. Print ISSN: 0031-4005. Online ISSN: 1098-4275. Downloaded from pediatrics.aappublications.org at University of Southern Queensland Library on August 5, 2014 Hand Hygiene Practices in a Neonatal Intensive Care Unit: A Multimodal Intervention and Impact on Nosocomial Infection Barbara C.C. Lam, MBBS, FRCP(Edin, Lond.), FRCPCH(UK), FHKCPaed; Josephine Lee, RN, MSN; and Y.L. Lau, MD (Hons), FRCP(Edin, Glasg. Lond.) FRCPCH(UK) ABSTRACT. Objective. Health care–associated infections persist as a major problem in most neonatal intensive care units. Hand hygiene has been singled out as the most important measure in preventing hospital-acquired infection. However, hand hygiene compliance among health care workers (HCWs) remains low. The objective of this study was to assess the frequency and nature of patient contacts in neonatal intensive care units and observe the compliance and technique of hand hygiene among HCWs before and after the implementation of a multimodal intervention program. Methods. The nature and frequency of patient contacts, the hand...
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...Case Study for Final Exam Myasthenia gravis is a chronic autoimmune neuromuscular disease characterized by varying degrees of weakness of the skeletal (voluntary) muscles of the body. The name myasthenia gravis, which is Latin and Greek in origin, literally means "grave muscle weakness." With current therapies, however, most cases of myasthenia gravis are not as "grave" as the name implies. In fact, for the majority of individuals with myasthenia gravis, life expectancy is not lessened by the disorder. The hallmark of myasthenia gravis is muscle weakness that increases during periods of activity and improves after periods of rest. Certain muscles such as those that control eye and eyelid movement, facial expression, chewing, talking, and swallowing are often, but not always, involved in the disorder. The muscles that control breathing and neck and limb movements may also be affected. Myasthenia gravis is caused by a defect in the transmission of nerve impulses to muscles. It occurs when normal communication between the nerve and muscle is interrupted at the neuromuscular junction - the place where nerve cells connect with the muscles they control. Normally when impulses travel down the nerve, the nerve endings release a neurotransmitter substance called acetylcholine. Acetylcholine travels through the neuromuscular junction and binds to acetylcholine receptors which are activated and generate a muscle contraction. ...
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...Running head: ACCREDITATION AUDIT- TASK 4 COMPLAINCE STATUS Joint Commission clearly explained that a Periodic Performance Review is as an assessment tool designed to help in assisting the healthcare organization contributes greatly in the improvement and monitoring performance all through the year. The periodic performance focuses more on the measures that has to do with patients safety and care and at same time given the facility for unremitting standards fulfillment. NCH is 100% compliance with most standards of Joint Commission in the following area; Emergency Management, Human resources, Infection Prevention and Control, Performance Improvement, Right and Responsibilities of the Individuals, Transplant Safety. During the inspection at the facility, the hospital was found to be non- compliant in this listed areas; Environment of Care, Leadership, Life Safety, universal protocol, Medication Management, Medical Staff, National Patient Safety Goals, Nursing, Record of Care, Treatment and Services, and provision of care During the PPR, the hospital was found with an increase cluster in the hallways, it is a fire hazard and a safety issue. The nurses are not familiar with verbal order procedures, using the range of orders that received and the abbreviations that are prohibited in the documents. From the trend, there are areas at which the hospital needs to implement proper education and audit. An action plan needs to be implemented by the administration to address the fallout...
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...A hospital-acquired infection (HAI) or nosocomial infection is an infection whose development is favored by a hospital environment, such as one acquired by a patient during a hospital visit or one developing among hospital staff. In the United States, the Centers for Disease Control and Prevention estimated roughly 1.7 million hospital-associated infections, from all types of microorganisms, including bacteria, combined, cause or contribute to 99,000 deaths each year. In Europe, where hospital surveys have been conducted, the category of Gram-negative infections are estimated to account for two-thirds of the 25,000 deaths each year. Nosocomial infections can cause severe pneumonia and infections of the urinary tract, bloodstream and other parts of the body. Many types are difficult to attack with antibiotics, and antibiotic resistance is spreading to Gram-negative bacteria that can infect people outside the hospital. HAI is sometimes expanded as healthcare-associated infection to emphasize that infections can be correlated with health care in various settings (not just hospitals). Nosocomial infections are commonly transmitted when hospital officials become complacent and personnel do not practice correct hygiene regularly. Also, increased use of outpatient treatment in recent decades means that a greater percentage of people who are hospitalized today are likely to be seriously ill with more weakened immune systems than in the past. Moreover, some medical procedures bypass...
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...Case Study for Respiratory Disorders #2 Scenario A.W., a 52-year-old woman disabled from severe emphysema, was walking at a mall when she suddenly grabbed her right side and gasped, “Oh, something just popped.” A.W. whispered to her walking companion, “I can’t get any air.” Her companion yelled for someone to call 911 and helped her to the nearest bench. By the time the rescue unit arrived, A.W. was stuporous and in severe respiratory distress. She was intubated, an IV of lactated Ringer’s (LR) to KVO (keep vein open) was started, and she was transported to the nearest emergency department (ED). On arrival at the ED, the physician auscultates muffled heart tones, no breath sounds on the right, and faint sounds on the left. A.W. is stuporous, tachycardic, and cyanotic. The paramedics inform the physician that it was difï¬cult to ventilate A.W. A STAT portable chest x-ray (CXR) and arterial blood gases (ABGs) are obtained. A.W. has an 80% pneumothorax on the right, and her ABGs on 100% oxygen are pH 7.18, PaCO2 92 mm Hg, PaO2 32 mm Hg, HCO3 27 mmol/L, base excess (BE) -5 mmol/L, SaO2 53%. 1) Given the diagnosis of pneumothorax, explain why the paramedic had difï¬culty ventilating A.W. The paramedics couldn’t ventilate C.W. because the pleural space is full of air, which then forces pressure on the lungs which doesn’t allow the lungs to inflate when air is inhaled in. 2) Interpret A.W.’s ABGs. [c] PH 7.18 acidotic PaCO2 92 mm Hg PaO2 32 HCO3 27 Respiratory Acidosis ...
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