ventilator associated pneumonia

Ventilator Associated Pneumonia and Oral Care Processes:

Ventilator Associated Pneumonia and Oral Care Processes Kim Faimon, Brian Luedke, Katie Bangert & Esther Ngotho Creighton University School of Nursing Accelerated Nursing Curriculum

Clinical Problem:

Clinical Problem Ventilated patients are susceptible to ventilated associated pneumonia (VAP) Good oral care is significantly associated with the prevention of VAP

Clinical Significance:

Clinical Significance Providing good oral care with ventilated patients Impacts: Stay Cost Quality of Care Patient Satisfaction

Purpose of Project:

Purpose of Project Synthesizing information about appropriate oral care for ventilated patients

P.I.C.O:

P.I.C.O Would different strategies, methods and frequency of providing oral care to mechanically ventilated patients in the Intensive Care Unit (ICU) lead to a reduction of ventilator-assisted pneumonia (VAP)?

Purpose of Studies:

Purpose of Studies Develop an oral hygiene protocol for mechanically ventilated patients (1) Look at difference practices for oral care of VAP patients for critical care nurses (2) To compare three different oral care methods in intubated patients and determine if there was an improvement in oral mucosa (3) Determine the strategies, methods and frequencies of oral care for mechanically ventilated patients(4)

Research Evidence:

Research Evidence Level V (1) Level VI (2) Level III (3) Level VI (4)

Sample:

Sample Ventilated patients in the ICU in various hospitals (1) 347 American Association of Critical Care Nursing (AACN) (2) 81 ICU patients with an oral-endotracheal tube (3) Non-random sample of 264 nurses in ICUs(4)

Findings:

Findings Implement formal oral care guidelines for mechanically ventilated patients in both medical and surgical ICUs (1) Inconsistent protocol(2) Variable- no conclusive findings (3) Nurses have positive attitudes, but supplies not efficient(4)

:

Level of Evidence Sample Findings Location Study One V Ventilated Patients in the ICU Standard oral protocol decreases VAP 5 hospitals in South Texas Study Two IV Critical care nurses Inconsistent protocol in place Survey conducted in the USA Study Three III Ventilated Patients in the ICU No conclusive findings 3 hospitals in Malaysia Study Four V Nurses in ICU Positive attitudes (nurses), but insufficient supplies Medical Centers in Taipei, Taiwan Summary

Quality of Study:

Quality of Study Good to moderate Threats include: Auditability (4) Non-random sampling (2, 3 & 4) Attrition and mortality (2) History (2)

Recommendation for Practice:

Recommendation for Practice Evidence based oral cares should be implemented to decrease patients risk of VAP(1-4)

Recommendations:

Recommendations Develop protocol and prevention (1) Addressing oral care practices and gaps in procedures (2) Keep developing the best practices (3) Updating oral care protocol (4)

Recommendations for Future Nursing Practice:

Recommendations for Future Nursing Practice Establish protocol utilizing evidence based practice Standards in each facility Implementation EBP with other risk factor for VAP

Synthesis of Critiques:

Synthesis of Critiques Many different guidelines in place Not all studies chose to utilize them Some superficially used them In some cases lack of equipment

Implication for Practice:

Implication for Practice Increased quality of care (1-4) Decrease cost (1) Decrease length of stay (1) Motivate nurses (2)

Interdisciplinary :

Interdisciplinary Nurses Respiratory Therapists Health Care Provider Hospital Administrators

References :

References (1) Browne, J. A., Evans, D., Christmas, L.A., & Rodriguez, M. (2011). Pursuing excellence: Development of an oral hygiene protocol for mechanically ventilated patients. Critical Care Nursing Quarterly, 34 (1), 25-30. (2) Feider, L. L., Mitchell, P., & Bridges, E. (2010). Oral care practices for orally intubated critically ill adults. American Journal of Critical Care, 19 (2), 175-183. doi:10.4037/ajcc2010816

References (cont.):

References (cont.) (3) Hsu, S., Liao, C., Li, C., & Chiou, A. (2011). The effects of different oral care protocolson mucosal change in orally intubated patients from an intensive care unit. Journal of Clinical Nursing , 20(7/8), 1044-1053. doi:10.1111/j.1365702.2010.03515.x (4) Soh, K., Lam, Soh, K., Geok, Japar, S., Raman, R., A., & Davidson, P., M. (2011). A cross-sectional study on nurses' oral care practice for mechanically ventilated patients in malaysia. Journal of Clinical Nursing, 20(5), 733-742. doi:10.1111/j.1365-2702.2010.03579.x