VAP Prevention and Management Strategies

Prevention and Management of Ventilator-Associated Pneumonia in the Hospitals

Ventilator-associated pneumonia is an infection in the airways that develops more than 48 hours after a patient is intubated. While the prevention and management of pneumonia of any kind is considered as a commendable objective, it is characterized with several concerns given the significant effect of pneumonia linked to ventilator use. Ventilator-associated pneumonia has attracted considerable concern in the recent past because it has become the leading cause of death among infections acquired in the hospital. Actually, the rates of deaths from ventilator-associated pneumonia have exceeded those associated with central line infections, respiratory tract infections, and serious sepsis in the non-intubated patient ("Preventing Healthcare and Community Associated Infections," n.d.). It is increasingly likely that the most concerning aspect of ventilator-associated pneumonia is the high associated mortality (Kalanuria, Zai & Mirski, 2014). Consequently, several peer reviewed studies have been carried out to help in the prevention and management of this condition in hospitals.

Background of Study

Junega et. al. (2011) has conducted a study examining the prevention and management of this type of pneumonia based on the current practices by intensivists in the Indian subcontinent (p.122). This group of researchers has conducted the study based on the fact that VAP is the most widespread nosocomial infection that occurs among seriously ill patients admitted in intensive care units and characterized by high mortality rate. The study was also carried out because ventilator-associated pneumonia is associated with increased hospital stay and patient costs to those who acquire it. Therefore, the prevention of this condition has attracted considerable significance across every quality control program in order to enhance outcome and lessen costs. The significance of prevention and management of ventilator-assisted pneumonia to nursing is to help improve patient outcome and lessen costs that are related to hospital-acquired infections.

The purpose of the study is to evaluate the current practices about prophylaxis and management of ventilator-associated pneumonia within the Indian subcontinent, especially among the intensivists. In this study, intensivists is a term used to refer to general physicians, anesthesiologists, or pulmonologists who engage in taking care of severely ill patients in the intensive care units across various hospitals. In essence, the researchers seek to evaluate the implementation of various prevention strategies for the condition and learn how these various practitioners manage it in the Indian subcontinent.

Methods of Study

The researchers utilized questionnaires to examine prevention and management strategies for ventilator-associated pneumonia. They identified and developed a 10-point questionnaire with various questions related to the use and components of VAP bundles, diagnosis of the condition, and treatment of ventilator-associated pneumonia. They distributed 300 questionnaires to delegates who attended an International Conference of Critical Care Medicine that was held by Asia Pacific Critical Care society in 2009 in New Delhi. The participants were expected to return the questionnaires at the end of the conference.

Since the questionnaires were distributed at a conference, the researchers utilized random sampling and did not use a particular criterion for choosing research participants. 43.7% of the distributed questionnaires were returned and three of them excluded from the final analysis since they belonged to delegates from Hong Kong, Saudi Arabia, and London. A huge portion of the respondents were from New Delhi while the rest were from India, Sri Lanka, and Nepal. The participants or intensivists reported used various VAP bundles such as head elevation, early weaning, stress ulcer prophylaxis, heat and moisture exchangers, and chlorhexidine mouthcare.

Results of Study

The study generated several findings including the fact that recommended practices for management of ventilator-associated pneumonia are characterized by some ambiguities. Secondly, the researchers found that using a set of evidence-based practices to prevent this condition i.e. using VAP bundles may help in lessening the occurrence of the illness in mechanically ventilated patients (Junega et. al., 2011, p.125). Moreover, the use of VAP bundles contributes to decreased mortality rates, ventilator days, and stay in intensive care units. Third, the most common method for sampling in diagnosis of ventilator-associated pneumonia was endotracheal suction.

The findings provide valuable insights to nursing practice and nursing knowledge/science in the prevention and management of the condition. The study demonstrates the significance of evidence-based recommendations and guidelines in the prevention and treatment of VAP. The contribution to nursing practice and knowledge is the need for further validation regarding the role of popular measures like closed suction systems and stress ulcer prophylaxis in preventing and managing VAP. Furthermore, the nursing profession should promote the use of selective decontamination of the digestive tract to prevent and manage VAP through educational programs, creation of local protocols, and more availability of specialized endotracheal tubes.

Ethical Considerations