Ventilator-associated pneumonia: critical appraisal and qualitative guidelines

Ventilator-Associated Pneumonia

The problem statement within the article by Berenholtz et al. (2011) concerns one of the most significant and common causes of patient morbidity and mortality, referring to ventilator-associated pneumonia (VAP). The study focuses on the impact of what they refer to as "multifaceted intervention" on reducing the incidences of this condition in the Intensive Care Unit. The gap identified exists between the translation of intervention guidelines to clinical practice in a routine sense. Successfully achieving such translation would significantly reduce a serious public health issue while also ensuring that the quality of care in hospitals across the country is improved.

In the light of the above, the purpose of the study was to determine whether a multifaceted intervention will have a positive impact on compliance in the use of evidence-based therapies and the reduction of VAP in intensive care units. To investigate this, the study formed part of a nationwide quality improvement program within hospitals.

Research questions are not explicit, but could be inferred to be as follows:

1 Will VAP rates be reduced with a multifaceted intervention method?

2 What can be done to ensure the translation of practice guidelines regarding VAP prevention to actual clinical practice?

3 Will the multifaceted interventions be successful in improving the quality of care among patients who are at risk of contracting VAP?

4 What are the impacts of VAP on public health?

In order to conduct the investigation and obtain answers for the research questions, the researchers first implemented two interventions for the improvement of the hospital's safety culture and communication among staff and patients. To ensure the consistency of data, VAP was identified using a standardized CDC definition. After reporting baseline data, postimplementation data were collected and reported for thirty days.

The purpose and research questions are indeed relevant to the problem identified, since VAP is a significant public health risk that must be addressed in hospitals. To improve quality of care and reduce mortality and morbidity, the results of the study suggest that a multifaceted intervention method is appropriate. The use of a survey to determine the safety culture at each hospital where the study was conducted is appropriate to the purpose of the study, as is the investigation regarding compliance with the evidence-based methods of preventing and curing VAP in the hospital setting.

Staff members were also educated on improving safety for patients via methods such as systems redesign, while also being questioned about any defects in the clinical or operational safety of the establishment. Management and frontline staff were partnered in teams to ensure the improvement of patient safety in a practical way. In addition, staff members were tasked with learning from one identified defect every month while implementing tools for the improvement of teamwork and communication among partners.

While the "Methods" and other sections of the document are extensively referenced, there is no explicit literature review in which studies were evaluated for their relevance to the current work. Nevertheless, the "Methods" section includes a large amount of relevant citations to inform the investigation. Such literature, for example, provides information about the nature of existing evidence-based therapies applied in cases where patients have contracted VAP in the hospital setting. The literature has also revealed information regarding the most effective methods for reducing VAP, such as what the authors refer to as the "ventilator care bundle." This refers to a set of 5 therapies to ensure the health of patients using ventilators in hospital settings.

Since the literature has been used for information and focus purposes, there is no explicit evaluation or indication of the weaknesses of available work. One reason for this is that the study focuses on identifying methods that can build upon existing strategies for the further reduction of VAP. Hence, the problem does not concern a gap in existing work but rather in a practical clinical setting. The literature has therefore been chosen with this purpose in mind.

None of the references has been published before 2005. Since the work was published in 2011, this appears both reasonable and current for both the qualitative and quantitative works cited. The information obtained was sufficient to build the discussion of the problem and methods to offer solutions.

The model the authors developed was a "change model," involving the use of elements such as systems of care, engagement of teams, centralizing support, robust data collection and ensuring the quality of data, and intervention adaptation. Although the authors could find only inconsistent existing evidence regarding the benefits of collaboration and knowledge translation, they remained focused on investigating and proving the effectiveness of their methods.