Nosocomial Infections and Positioning

Potential topics
1. Patient positioning
2. Nosocomial infections
3. Infrequent monitoring
Picot Question
In mechanically ventilated patients on a pulmonary Med Surg floor, does positioning the patient in a semi fowlers position result in a decrease incidence of nosocomial pneumonia when compared to the supine or side lying positions?
Positioning can play a crucial role in developing nosocomial infections. Those under mechanical ventilation may experience a higher rate of nosocomial pneumonia (Gunay et al., 2018). Positioning in the semi-fowler’s position may prove to be beneficial because it decreases aspiration rate (Gunay et al., 2018). Aspiration rate happens more often in supine position and can lead to complications such as pneumonia (Gunay et al., 2018). Additionally, aside from placing patients in a better position like the semi-fowler position, increased hand sanitation can also decrease rate of nosocomial pneumonia (Gunay et al., 2018).
Interestingly some literature points to nurses not acquainting themselves with recently literature regarding alternative prevention methods for nosocomial pneumonia (Sevgisun & Gulten, 2017). Additionally, nurses did not practice according to research, hand hygiene with alcohol-based solutions (Sevgisun & Gulten, 2017). While it is important to position patients accordingly to what decreases chances for nosocomial infections, it is also important to realize what other factors are at play regarding patient safety. Although nurses express an interest for alternative prevention methods (Sevgisun & Gulten, 2017), the surprising lack of training and information among nurses leads to a desire to improve standards for nursing and hospitals regarding nosocomial infections (Sevgisun & Gulten, 2017).
What is the semi-fowler position? A nurse may position a patient in a semi-fowler's position in bed, by sitting upright on the side of the bed or in a chair with the feet supported and legs either bent or straight (). Patients in this position can breathe better and have a better flow of air. Although potential issues like catheter’s may make the position uncomfortable, if the patient is healing and can maintain this position, research shows it can help with aspiration rate. This topic is a great means of understanding nurse intervention (Rebeiro, Jack, Scully, & Wilson, 2014).
References
Gunay, L., Yesilbag, Z., Gedik, H., Nur, S., Gulcan, K., Nurhan, E., & Kadriye, G. (2018). Ventilator Associated Pneumonia Prevention Experience in Cardiovascular Surgical Intensive Care. The American Journal of Cardiology, 121(8), e158–e159.
Rebeiro, G., Jack, L., Scully, N., & Wilson, D. (2014). Fundamentals of Nursing: Clinical Skills Workbook. Elsevier Health Sciences.
Sevgisun, K., & Gulten, O. (2017). Nursing Interventions to Prevent Ventilator-Associated Pneumonia in ICUs. Konuralp Medical Journal, 9(1), 35-40.