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patients undergoing mechanical ventilation contract Ventilator Associated Pneumonia (VAP). This acute medical condition always results in increased death rates and associated medical costs among patients. This article reviews several literatures that try to enlighten masses on the diagnosis, medical treatments and VAP prevention methods. In addition, this article outlines recommendations medical practitioners can implement in their daily practices to curb VAP and offers an insight on controversies that usually arise during VAP diagnoses, treatment plans and prevention methodologies. This article defines VAP to be the causative agent of approximately 25 to 54% mortality rates among patients undergoing mechanical ventilation in ICUs. Factors responsible for VAP among patients include patients' population in ICUs, hospital stay durations and antimicrobial treatments. Even though antimicrobial medications are confirmed to reduce VAP casualties, further studies should be undertaken such as the ones outlined in the literatures below to help in early identification and treatment of VAP among patients undergoing mechanical ventilations. Additionally, clinicians are recommended to institute methods to help in reducing occurrences of VAP among patients and establish guidelines to that effect. Therefore, it is required that medical practitioners access new medical drugs for administering to patients diagnosed to be suffering from VAP and related illnesses.
Arroliga, A.C., Pollard, C.L., Wilde, C.D., Pellizzari, S.J., Chebbo, A., Song, J., et al. (2012).
Reduction in the Incidence of Ventilator Associated Pneumonia: A Multidisciplinary
Approach. Respiratory Care, 688-696.
Arroliga and Pollard outline several methods that are used in curbing escalating Ventilation Associated Pneumonia (VAP) casualties in their medical facility. They conducted a study on adults admitted to their ICU by using a ventilator bundle to analyze the rates of pneumonia attacks. The hospital conducted experiments on 2588 human subjects and realized that VAP was lowering; antibiotic use had also significantly reduced among the patients when oral care was done. The study concluded that VAP rates are directly influenced by oral care done by respiratory therapists on patients experiencing invasive mechanical ventilations.
Krein, S.L., Kowalski, C.P., Damschroder, L., Forman, J., Kaufman, S.R., & Saint, S. (2008).
Preventing Ventilator Associated Pneumonia in the United States: A Multicenter Mixed
Methods Study. Infection Control and Hospital Epidemiology, 933-940.
This panel's study offers an insight on hospital practices and processes used in preventing and diagnosing VAP. Surveys were mailed to lead infection control professionals at 719 hospitals to gauge methods they use in curbing escalating VAP occurrences. From this group, an in-depth analysis was conducted with 14 hospitals to get a detailed understanding of the methods used for VAP diagnoses and medication. The results showed that more than an eighth of the study group was using semi-recumbent positioning while the other segment incorporated the use of subglottic secretion drainage in controlling VAP incidences. From this study, it was concluded that semi-recumbent was widely used in preventing VAP while subglottic secretion was not fully integrated by most health facilities.
Crockett, M. (2011). Ventilator Associated Pneumonia: Education And Prevention . Muncie:
Crockett's research paper presents a hypothetical educational proposal that aims at addressing increasing VAP occurrences in health facilities ICU's. The article further theorizes that a training initiative will be conducted to enlighten respiratory therapists on methods used in curbing VAP. A study is to be conducted in two renowned Indiana hospitals with about 40 ICU and respiratory specialists expected to attend.
From the study, VAP rates will be scrutinized for half a year and, the findings used as evidence of the training to help minimize VAP casualties. This evidence will provide measures on reducing VAP even in scenarios whereby there is inadequate staffing in hospitals. Additionally, a Pre-test Post-test evaluation method will be used to educate the nurses on ways to reduce VAP risks and casualties in their ICU facilities.
Keeley, L. (2007). Reducing the Risk of Ventilator Acquired Pneumonia through Head of Bed
Elevation . Nursing in Critical Care Journal, 287-294.
Keeley confirms that having patients lying in semi-recumbent positions during mechanical ventilation reduces their chances of contracting pneumonia. His study involved a randomized controlled trial in which adult ventilated patients were assigned either as the treatment group or the control. For the final analysis, 30 individuals were used as subjects of whom 17 were the treatment group while the rest acted as the control. The research outcome showed that approximately 30% of the treatment group and 60% of the control had contracted VAP. Though the study never had a statistical significance, it was realized that there were signs of diminishing VAP among patients lying in semi-recumbent positions.
Garcia, R., Jendresky, L., Colbert, L., Bailey, A., Zaman, M., & Majumder, M. (2009). Reducing
Ventilator Associated Pneumonia through Advanced Oral Dental Care: A 48-Month
Study. American Journal of Critical Care, 523-534.
This medical study aimed at ascertaining the effect of comprehensive oral and dental protocols in minimizing of VAP. The study group comprised of individuals 18 years old and above monitored for four consecutive years. The group was divided into two; group with and without prior oral assessments. The research showed that before the assessment, the rate of VAP was high but after the study, the rate dropped to lows of 8 per 1000 individuals. In addition, it was realized that compliance with oral dental care increased after the administration of oral and dental protocols among medical practitioners.
The research concluded that using Evidence-Based Review, a comprehensive oral care protocol and staff compliance with oral protocols is essential in reducing occurrences of VAP and associated medical expenses. Moreover, the study made certain that VAP is contracted by patients receiving mechanical ventilations and thus, its prevention should be given top priority by most hospitals.
Munro, C.L., Grap, M.J., Jones, D.J., McClish, D.K., & Sessler, C.N. (2009). Chlorhexidine,
Toothbrushing, and Preventing Ventilator Associated Pneumonia in Critically Ill Adults.
American Journal of Critical Care, 428-438.
The impact of tooth brushing, oral chlorhexidine in the development of VAP in patients undergoing mechanical ventilation was the aim of this research. During this study, adults in ICUs were used as research subjects. They were examined for intubation in a controlled 2 x 2 clinical trial method for a day. Patients with edentulous and pneumonia were excluded from the study. In addition, the study subjects were given random treatments. Some were made to use chlorhexidine, tooth brushing daily, both tooth brushing and chlorhexidine and a control group instituted. Moreover, a Clinical Pulmonary Infection Score was used to determine the rates of VAP infection among the research subjects.
From the study, it was clear patients without pneumonia before the assessment had developed pneumonia after receiving mechanical ventilation. It was further found out that tooth brushing did not reduce VAP the way chlorhexidine did.
Dejuilio, P.A., Rivera, S., & Humi, J.P. (2012, June). A Successful VAP Prevention Program
Quality Improvement Inititative Results in a Successful VAP Prevention Bundle. RN
Magazine, pp. 25-29.
Rivera and team aimed at explaining the impact of Evidence Based Approach in VAP prevention. For their research, two 16-bed ICUs were used for the Quality Improvement initiative in reducing VAP occurrences. After the initiative, the research team sought permission from the hospital's IRB department to help them analyze collected data. The initiative confirmed that VAP could be reduced in patients under mechanical ventilation treatments. The study concluded that Evidence Based Approach was sustainable and efficient in managing the prevalence of VAP in most hospitals' ICUs.
Yeung, K.Y., & Chui, Y.Y. (2010). An Exploration of Factors Affecting Hong Kong ICU
Nurses in Providing Oral Care. Journal of Clinical Nursing, 3063-3072.
The sole purpose of this medical experiment was to find out factors that negatively influence Hong Kong's ICU oral care nurses. The study group instituted a qualitative data collection method, audio taped interviews; 10 nurses were used as study subjects given their widespread medical experience. The outcome was that factors such as insufficient workplace supports, and fear of unknowns were the contributing aspects of low morale for ICU nurses. The low morale thus directly influenced the nurses' poor oral care for ICU patients. Moreover, the study pointed out that sufficient staffing and institution of high clinical ethical standards should be carried out to help nurses offer better oral care for ICU patients.
Munro, C.L., Grap, M.J., McKinney, J., Sessler, C.N., Hummel III, R.S., & Junior, E.R.
(2006). Oral Health Status and Development of Ventilator Associated Pneumonia: A
Descriptive Study. American Journal of Critical Care, 453-460.
Munro's study affirmed that VAP is the leading cause of death among patients undergoing mechanical ventilation; a factor directly influenced by poor oral health. Furthermore, it was deduced that VAP causes lung illnesses and death 7 days after intubation due to microbial colonization of the orpharynx and trachea. The study encompassed 66 ICU patients checked on for a day and a seven day follow up initiated. In addition, a clinical pulmonary infection score was collected after the fourth and seventh day to gauge the effect of oral health on VAP among the subjects. Moreover, the research ascertained that increased salivary volume and low errin levels lead to increased VAP risk among patients.
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