Ventilator Associated Pneumonia
Ventilator Associated Pneumonia (VAP) is one of the main challenges when providing medication for intensive care unit (ICU) patients. In brief, this serious disease strikes the patient suddenly and it leads to his/her death. As a result, it is essential to develop a proper evidence based method of preventing this disease. In brief, this paper will demonstrate the use of a PICOT method in developing evidence-based research for the use of oral sanitation in the prevention of Ventilator Associated Pneumonia.
Basically, the PICOT method refers to the use of well-structured and systematic questions in evidence-based research. Accordingly, when using a PICOT system to conduct an evidence-based research, the physician espouses to consider all relevant factors and make a well-thought conclusion. In a nutshell, PICOT is an acronym whose meanings are as follows:
- Population/ Patient: Indicates of the disease, age or gender of the patient
- Intervention: Describes the specific therapies required for the medication
- Comparison: Shows an alternative treatment method
- Time: Indicates the period within which the therapy is expected to be effective
Ventilator Associated Pneumonia PICOT
In brief, the PICOT will describe the study to be undertaken. In addition, it will make a comparison with an alternative method for the treatment undertaken within a specified timeframe. Basically, PICOT question is as follows: In hospitalized adults (P), how does oral care (I) compared with no oral care (C) affect the number of Ventilator Associated Pneumonia in the ICU (O) during a one week period (T).
Evidence Based Research of the PICOT
In brief, the evidence-based method of determining the effectiveness of the use of oral care in Ventilator Associated Pneumonia will use secondary data from a research conducted at the Lankenau Hospital, Main Line Health System ICU in Wynnewood, Pennsylvania. Generally, the hospital used a combination of methods to evaluate their effectiveness in the treatment of VAP. Basically, they created a VAP treated bundle that was composed of the head of the bed elevation, DVT and PUD prophylaxis, interruption of sedation and readiness for extubation, and oral care (Sedwick, et al., 2012).
Notably, microbes in the mouth significantly increase the risk of acquiring VAP. Basically, pathogens that may result in VAP in orally intubated patients hide in the dental plaque and oral mucosa. Evidently, within 48 hours after admission, the patient changes their oral flora, which mainly comprise of gram-negative and other virulent organisms (Abele-Horn, et al., 1997). In addition, dental plaque provides a conducive environment for respiratory pathogens such as Staphylococcus aureus and Pseudomonas aeruginosin (Grap, et al., 2005). Essentially, a research conducted on 11 trials that had 3242 patients who were receiving mechanical ventilation showed that oral application of antibiotics, antiseptics or standard oral care showed a significant reduction in incidences of VAP.
Noteworthy, oral antiseptics such as chlorhexidine significantly reduced VAP (relative risk, 0.56; 95% CI, 0.39-0.81). On the contrast, the use of oral applications of antibiotics did not show significant improvement (relative risk, 0.69; 95% CI, 0.41-1.18) (Chan, et al., 2007). In yet another study by Munro et al. (2006), which examined the relationship between VAP, oral health status, changes in oral health in the first week after intubation, and changes in microbial colonization of the oropharynx and trachea showed that microbes in the mouth increased over time. Specifically, the research concluded that higher dental plaque indicated a higher risk of VAP.
Notably, 105 nurses were involved in the experiment which was carried out from October 2008 to December 2009. In a nutshell, the research aimed at reducing the number of VAP cases. Additionally, the nurses were educated on the VAP bundle and its importance in ensuring effective treatment. Further, compliance audit by personnel from the quality department was conducted to ensure there was an effective application of the outlined regulations. Further still, the SMART approach method which comprises of specific, measurable, relevant and time-bound approach was used (Sedwick, et al., 2012). Basically, this method involved nurses setting specific objectives that defined the desired outcomes. Accordingly, the interdisciplinary team established goals that aimed at achieving 100% compliance to the VAP bundle. In essence, this involved the use of checklists, flagged order sheets, and regular feedback.
Essentially, this method was implemented as a joint effort with the respiratory therapy department. Generally, the old method which comprised of 4 hours with toothettes was revised to 2 hours. Basically, the decision was based on studies which suggest that increased oral care reduces microbes in the mouth (Munro & Grab, 2004). In brief, the patients’ had their mouths brushed twice between 8am and 8pm with chlorhexidine. Later, they were wiped with a cleansed sponge after every 2 hours.
Notably, the VAP bundle, which was composed of oral care, was found to be effective in minimizing Ventilator Associated Pneumonia. Basically, the compliance level was more than 98% for the overall VAP bundle. Specifically, for the oral care, it was at between and 91.4% and 96.8% due to the difficulty in its implementation. Noteworthy, the use of an interdisciplinary method led to a reduction in VAP cases per 1000 cases from 34.4 to 23.4 (Sedwick, et al., 2012).
In summary, the use of oral care alongside other methods in the VAP bundle is effective in reducing incidences of Ventilator Associated Pneumonia. Additionally, training of nurses is important to ensure compliance with the set procedures for effective implementation of this method. Importantly, this method not only saves money, it also reduces mortality rates and should be implemented in all hospitals.
Abele-Horn, M., Dauber, A., Bauernfeind A., Seyfarth-Metzger. I., Gleich, P., & Ruckdeschel, G. (1997). Decrease in nosocomial pneumonia in ventilated patients by selective oropharyngeal decontamination (SOD). Intensive Care Medicine, 23(2), 187-195.
Chan, E., Ruest, A., Meade ,M. Cook, D.. (2007). Oral decontamination for prevention of pneumonia in mechanically ventilated adults: systematic review and meta-analysis. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1857782/pdf/bmj-334-7599-res-00889-el.pdf
Grap. M., Munro, C., Hummel. R., Elswick. R., McKinney, J. &,Sessler, C. (2005). Effect of backrest elevation on the development of ventilator-associated pneumonia. American Journal of Critical Care, 14(4), 325-332.
Munro, C., & Grap, M. (2004). Oral health and care in the intensive care unit: state of the science. American Journal of Critical Care, 13(1), 25-33.
Munro, C., Grap, M.., Elswick, R., McKinney, J., Sessler, C., & Hummel., R. (2006). Oral health status and development of ventilator-associated pneumonia: a descriptive study. American Journal of Critical Care, 15(5), 453-461.
Sedwick, M., Lance-Smith, M., Reeder, S., & Nardi, J. (2012). Using evidence-based practice to prevent Ventilator Associated Pneumonia. CritcalCentreNurse, 32(4), 41-50.