'Ventilator Associated Pneumonia in the Icu\r'

' breathing machine associated pneumonia (VAP) is a nosocomial transmittal occurring in hospitalized longanimouss who atomic number 18 mechanically ventilated. These infections ar common in ICU settings, gruelling to diagnose early, and unfortunately have a high position of mortality and morbidity. VAP accounts for roughly half of infections in ICU settings, up to 28% of mechanically ventilated patients ordain take aim VAP and of these patients the mortality target is amid 20% and 70% (Craven & Steger, 1998). A patient that develops VAP while mechanically ventilated adds years to his recovery as thoroughly as thousands of dollars to the business organization costs.\r\nNumerous studies have been conducted across the county in an effort to understand VAP, except very few of those studies nidus on the nursing interventions that can restrain this madly and costly nosocomial infection. Many of these studies focus on the â€Å"bundling” of certain interventi ons, so the question is does the carrying out of a VAP hatful compared with the character of non- bundle upd interventions decrease the incidence of VAP in ventilated patients. The explore that was found in nursing diarys along with a related to study from a medical journal follows.\r\nCason, Tyner, Saunders and Broome (2007) conducted a study of 1200 critical oversee nurses and the results demonstrate the variability in the recommended and describe care of the ventilated patient. Their study aims to distinguish the field of views of need improvement to comply with the CDC recommendations for stripe of VAP. The study consisted of a questionnaire distributed to nurses who attended the 2005 American Association of hypercritical Care Nurses case T separatelying Institute, with the findings demonstrating a need for much education and interrogation in the area of preventing breathing apparatus associated pneumonia.\r\nFerrer and Artigas (2001) also noted the need of com pliance in even the around basic of rubber measures. The study focuses on non-antibiotic preventative strategies for VAP; they conjure up the use of healthful hand soap, clorahexidine oral rinses, stress ulcer prophylaxis, cake of gastric over distension, providing comely nutritional support as well as frequent position changes. The explore also suggests that endotracheal furnishs with an extra lumen designed to continuously suction secretions pooled above the endotracheal tube cuff would lower the incidence of VAP by reventing these secretions from being aspirated into the lower airway. The authors also suggest more research be through with(p) to just limit the number of patients who develop VAP. Siempos, Vardakas and Falagas (2008) found that after meta-analysis of nine published randomized controlled trials that a unappealing tracheal suction system has no returns in reducing the incidence of VAP compared with an blunt tracheal suction system. The preliminary select ive information suggests that a disagreeable locomote would shrink the incidence of VAP, however the data and trials that were reviewed showed that at that place was no decrease in the rate of infection.\r\nDue to the fact that a closed system can be utilise more than once, and only needs to be changed every 24 hours, it does tend to be more cost effective. Also of note, in two separate trials, a closed system was found to increase v strokeage of both the respiratory tract and the breathing apparatus tubing. Obviously more research is needed to determine the best intervention when endotracheal suctioning is necessary. Ventilator associated pneumonia is both common and unfamiliar to nurses in the critical care setting, according to Labeau, vanguarddijck, Claes, Van Acken & Blot (2007).\r\nThey note that while nurses lie with with VAP frequently their familiarity of the infection and preventative measures may be a drive that VAP is still so prevalent in the intubated p atient. The research points to the idea that because many nurses are not responsible for the ventilator circuit; they rely on the respiratory therapist to manage the ventilator, they may be less(prenominal) informed than if they had more control and nurture in the interventions necessary to prevent VAP. The research suggests more training and education for nurses who operation with ventilated patients.\r\nResearch done at the University of Toledo College of Medicine has shown a decrease in the incidence of VAP in its ten pull back running(a) ICU by implementing a â€Å"FASTHUG” protocol. Papadimos, et al, (2008) explained the interventions that the college used as a barb to educate the critical care team. â€Å"FASTHUG” stands for chance(a) evaluation of feeding, analgesia, sedation, thromboembolic prevention, direct of bed elevation, ulcer prophylaxis, and glucose control in critically ill intubated patients. The â€Å"FASTHUG” protocol was emphasized at sunrise and afternoon rounds and after a 2 year esearch period the incidence of VAP declined to 7. 3 VAPs/1000 ventilator days deplete from a historical rate of 19. 3 VAPs/1000 ventilator days. Of note, in 2007 the functional ICU that implemented this program in truth had no incidence of VAP from January to May. The research suggests that the use of bundled care processes for ventilated patients may lower the rate of VAP. The nurse’s knowledge of the use of the ventilator bundle is significant to the success of the protocol according to research done at the University of Texas.\r\nEducation sessions were held with pre and posttests administered as well as observation to tax the nurse’s understanding of the bundles. The VAP bundle focused on the elevation of the head of the bed, continuous removal of subglottic secretions, change of the ventilator circuit no more often than every 48 hours, and washing of hold before and after contact with each patient. The rese arch done by Tolentino-DelosReyes, Ruppert and Shiao (2007) suggests that a lack of understanding and knowledge of VAP leads to a higher rates of infection.\r\nObservation of the nurses in the study revealed that after the education sessions nurses demo an increase in compliance with the conventional standards of care. Given the high mortality and morbidity of ventilator-associated pneumonia, compliance in the critical care unit is crucial to reducing the rate of VAP. The critical care nurse is vital to the prevention of VAP, and nurses need to initiate further research concentrating on education and prevention. References Cason, C. L. , Tyner, T. , Saunders, S. Broome, L. (2007) Nurses’ implementation of guidelines for ventilator-associated pneumonia from the Center for Disease Control and Prevention. American Journal of sarcastic Care, 16, 28-37. Craven, D. E. , Steger, K. A. (1998) Ventilator-associated bacterial pneumonias: Challenges in diagnosis, treatment, and preve ntion. New Horizons, 6(2). Ferrer, R. & Artigas, A. (2001) Clinical Review: Non-antibiotic strategies for preventing ventilator-associated pneumonia. circumstantial Care 2002, 6, 45-51.\r\nHunter, J. D. (2006) Ventilator associated pneumonia. Postgraduate aesculapian Journal, 82, 172-178. doi:10. 1136/pgmj. 2005. 036905. Labeau, S. , Vandijck, D. M. , Claes, B. , Van Aken, P. , Blot, S. I. & on behalf of the executive director board of the Flemish Society for particular Care Nurses (2007) Critical care nurses’ knowledge of evidence-based guidelines for preventing ventilator- associated pneumonia: An evaluation questionnaire. American Journal of Critical Care, 16, 371-377. Morrow, L. E. Shorr, A. F. (2008) The seven deadly sins of ventilator-associated pneumonia. Chest, 134, 225-226. doi:10. 1378/chest. 08-0860. Papadimos, T. J. , Hensley, S. J. , Duggan, J. M. , Khuder, S. A. , Borst, M. J. , Fath, J. J. , Oakes, L. R. , & Buchman, D. (2008, February) writ of execution of the â€Å"FASTHUG” concept decreases the incidence of ventilator-associated pneumonia in the surgical intensive care unit. Patient safeguard in Surgery 2(3). doi:10. 1186/1754-9493-2-3. Siempos, I. I. , Vardakas, K. Z. & Falagas, M. E. (2008) unopen tracheal suction system for prevention of ventilator-associated pneumonia. British Journal of Anasthesia 100(3), 299-306. doi:10. 1093/bja/aem403. Tolentino-DelosReyes, A. F. , Ruppert, S. D. , Shiao, S. P. K. (2007) Evidence-based employ: Use of the ventilator bundle to prevent ventilator-associated pneumonia. American Journal of Critical Care, 16, 20-27. Ventilator-associated pneumonia. (2008). Critical Care Nurse. Retrieved from http://ccn. aacnjournals. org\r\n'