Ventilator-Associated Pneumonia Essay

Ventilator-Associated Pneumonia Essay
Ventilator–Associated Pneumonia: A Quantitative Research Study Vanesia Davis Kelly Grand
Canyon University Intro to Nursing Research–NRS/433V April 15, 2012 Ventilator–Associated
Pneumonia Ventilator–associated pneumonia is a bacterial infection that occurs in the lower
respiratory system within the first 48 hours of endotrachal intubation (Lewis, Dirksen, Heitkemper,
Bucher, & Camera, 2011). Although any hospital patient is susceptible to pneumonia, ventilator
dependent patients are at the highest risk of acquiring pneumonia. The purpose of this paper is to
identify the risk factors, incidences, and preventions of ventilator–associated pneumonia (VAP)
using a quantitative research study performed in Malaysia. "The aim of this ... Show more content
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According to Lewis et al (2011), early VAP, the first 96 hours, sputum cultures often grow gram–
negative microbes. However, organisms of late VAP were associated with antibiotic resistant
microbes. Microbes resistant to antibiotics abundantly consume the hospital. For the collection of
data, developed and verified NI surveillance was used. The NI surveillance was useful for
measuring both the incidence and risk factors of VAP according to Katherason et al (2009).
Demographical data, past medical history, medications, nutritional status, laboratory results,
diagnosis, history of illness, etc were all included in the surveillance. The Acute Physiology and
Chronic Health Evaluation III score measured the severity of the illness. The APCHE is comprised
of the acute physiological score that entails the major physiological systems and the chronic health
evaluation that incorporates the influence of co–morbid conditions on the patient's current health
(O'Keefe–McCarthy, Santiago, & Lau, 2008). During the surveillance, data from nursing
documentation, physician progress notes, laboratory results, and direct observations. Data was
collected from the time of admission until the diagnosis of VAP was made. The patients who were
discharged from the ICU and sent to a regular medical surgical floor were followed for an additional
48 to ensure that VAP would be detected that manifested after the discharge. Risk factors involved
with VAP in the ICUs are
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Ventilator Associated Pneumonia Essay
This paper will discuss the prevention of ventilator associated pneumonia utilizing the ventilator
associated pneumonia care bundle and the impact it has on clinical practice. Topics that will also be
discussed include potential barriers that may arise during the implementation of the bundle
strategies, how they can be overcome and finally educational strategies for families.
According to Safer healthcare now (2012), "Ventilator–associated pneumonia (VAP) is defined as a
pneumonia occurring in patients requiring a device intermittently or continuously to assist
respiration through a tracheostomy or endotracheal tube" p11.The development of VAP has many
potential causes some of which included aspiration, intubation procedure, biofilm formation, ...
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Research has shown that leading factor in the development of VAP is aspiration of oropharyngeal,
nasopharyngeal secretions and stomach content that contains pathogenic bacteria (Klompas, 2010).
A review completed Sedwick, Smith, Reeder & Nardi studying the effects of HOB elevation,
demonstrated a direct correlation between back rest elevation of < 30' and the incidence of
aspiration. Furthermore, clinical trials established that there was a substantial decrease in the
development of aspiration and subsequent pneumonia when patients were placed in a semi–
recumbent position (2012). Elevation of the head of the bed is not without its potential
complications. The greatest concerning complication is related to impaired skin integrity,
specifically the development of decubitus ulcers. Nursing staff must be vigilant frequent skin
assessment and patient repositioning to ensure that skin integrity is not compromised. Educating
families of the importance of HOB elevation is also critical, as patients may potentially be very
uncomfortable and desire to have the HOB lowered. Utilization of head of the bed alarms, signs and
intervention documentation will provide as a continual reminder to ensure nurses are compliant in
adhering to this aspect of the care

Ventilate Oral Rinse
Ventilator–associated (VAP) is the number one cause of health care associated infection in the
intensive care unit. (ICU). It is a major cause of mortality in patients and increase in healthcare cost.
Risk of VAP is increased in hospitalized patients in ICU unit on a mechanical ventilator. The risk
may be due to inability of caring out good and adequate infection control measures to prevent the
spread of disease. A reduction of VAP incidence in ICU setting could be accomplished by
implementing Chlorhexidine gluconate oral rinse for decontamination.
PICOT QUESTION: What is the effectiveness of chlorhexidine gluconate oral rinse on reducing
VAP among mechanically ventilated patients compared to the use of saline swab in an ICU setting?
(P) ICU ... Show more content on Helpwriting.net ...
Research study concluded that the use of chlorhexidine gluconate reduces the rate of ventilator–
associated pneumonia (VAP) even in patients at highest risk. (Halm & Amolar 2009). Compared
with the normal saline solution had fewer cases of VAP (Boeser et al.2011).
Reference:
Chlorhexidine oral rinse is included in the standard protocol for cardiac surgery patients (Martin,
2010). References So What Does This All Mean? Ventilator Associated Pneumonia Boeser, K.,
Ingalls, L., Retzer, K., Tescher, A., Tismer, S., Weiner, C., & Wiersgallas, S. (2011). Prevention of
ventilator–associated pneumonia. Health care protocol. Institute for Clinical System Improvement.
Based oral care protocol to decrease ventilator–associate pneumonia. Dimensions of Critical Care
Nursing 31(5), 301–308. doi: 10.1097/DCC.0b013e3182619b6f
Halm, M., & Armola, R. (2009). Effect of oral care on bacterial colonization and ventilator–
associated pneumonia. American Journal of Critical Care, 18(3), 275–278.

Reducing The Risk Of Ventilator Acquired Pneumonia
Reducing the Risk of Ventilator Acquired Pneumonia through Head of Bed Elevation The American
Thoracic Society (1996) defines ventilator–acquired pneumonia or VAP as "the specified type of
nosocomial pneumonia that occurs after the first 48 hours of initiating mechanical ventilation." One
of the major causes of mortality among infections acquired at the hospital is VAP. Once a patient
develops VAP he/she will have to spend to longer amount of time in the ICU (Rello et al.,1996).
VAP initiating bacteria are often categorized into two groups: those that cause early–onset VAP
(usually with 4 days of mechanical ventilation) and those that cause late–onset VAP (usually after 4
days of mechanical ventilation) (Craven and Steger, 1996; George et ... Show more content on
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The various factors that increase a patient's susceptibility to VAP are discussed by Cook et al.(1998).
Background of study It has been found that the chances of developing nosocomial pneumonia is
reduced by situating seriously ill ventilated patients in a semi recumbent position. The goal of this
experiment is to compare and contrast between the effects of the present standard degree of bed
head elevation (i.e. 25 °) and 45° elevation on the occurrence of VAP. The incidence of VAP can be
prevented/reduced in the hospitals by taking nursing measures. Elevation of head of bed is one
among them. Nurses should maintain the angle of 45 degree of bed head elevation all times to
reduce the risk of aspiration. The flat position increases the risk of aspiration. The main purpose of
this study is to understand whether or not increasing the standard degree of bed head elevation will
help minimize the occurrence of VAP. Methods of study The method adopted was quantitative in
nature, using a randomized controlled trial. In order to achieve this, 71 adult patients were assessed
for eligibility and among this 59 met the given criteria. They were randomly categorized into
treatment groups consisting of 29 patients and a control group consisting of 27 patients. The
randomization was done by the same nurse who recruited the patients for

Prevention Of Ventilator Associated Pneumonia
Prevention of Ventilator–Associated Pneumonia Ventilator– associated pneumonia is a common
infection in patients admitted to the ICU. With the increasing rate in of ventilator associated
pneumonia it is estimated that it may "account for up to 60% of all death from healthcare–
associated infections( HAIs) in the U.S"( Ventilator Associated Pneumonia, 2015 ) . This statistic
has made ventilator–associated pneumonia one of the top concerns in the health care setting. It is
estimated that ventilator– associated pneumonia increases patient stay in the ICU and it generates "
an increase cost of $20, 000 to $40, 000" "(Ventilator Associated Pneumonia, 2015). In dealing with
ventilator– associated pneumonia prevention is crucial. Several guideless have been develop to
decrease the occurrence of ventilator–associated pneumonia but the most important measure is
continuous education. So, in ICU healthcare workers does the use of an easy to complete
questionnaire to assess personal knowledge and clinical practice help prevent ventilator associated
pneumonia compared to not having an user friendly assessment tool? In a research study, ICU
healthcare workers were asked to complete an anonymous questionnaire related to personal
knowledge of ventilator– associated pneumonia prevention. The most recognized prevention
guidelines of ventilation associated pneumonia were the use of a semi–recumbent position and the
need to have written guidelines in the unit, more than 90% of the health

Introduction . In High Acute Settings, Such As Intensive
Introduction
In high acute settings, such as intensive care units essential nursing care such as oral care is very
vital to prevent life–threatening complications such as nosocomial – acquired, Ventilator–Associated
Pneumonia (VAP), and also most patients in intensive care are on oral intubation, and medications
such as anticholinergics, antihypertensives, which may lead to xerostomia (dry mouth). One of the
challenging nosocomial infections is VAP, and a leading cause of mortality in hospital patients in
high acuity settings (Jones, 2007). The development of VAP is occurred due to mechanical
ventilation, longer ICU stays and longer intubation periods, increasing the mortality of ICU patients
to as high as 70 per cent (Jones, 2007). Good ... Show more content on Helpwriting.net ...
Which may further lead to prioritising oral care as a less priority for nurses than other aspects of
care (H. Jones et al., 2004). In turn, even the tapes that are used in the fixation of the tube quickly
become heavily contaminated with the bacterium in the existence of salivary secretions and the
hitches associated with cleaning the mouth (Abidia, 2007). So, they have greater susceptibility to
nosocomial–acquired infections such as ventilator–Associated Pneumonia (VAP) (Zurmehly, 2013).
Patients who are intubated are also forced to keep their mouths open which leads to xerostomia,
caused due to dryness of oral mucosa (Miranda, de Paula, de Castro Piau, Costa, & Bezerra, 2016).
Furthermore, patients who may have some medical conditions have oral manifestations such as
diabetes, Crohn's disease, Leukaemia (H. Jones et al., 2004). In order to prevent these life–
threatening complications, it is important to prioritise oral care as an essential nursing priority in
high acuity settings by doing appropriate and more frequent oral assessments followed by mouth
care with an evidence–based approach.
Oral Assessment
To initiate interventions, patients oral care requirements are to be identified. To process and
evaluate, assessment needs to be performed. Evidence suggested oral assessment should be
performed using a checklist within the 24 hours

According to the Centers of Disease Control and Prevention (CDC), "Ventilator–associated
pneumonia (VAP), is a lung infection or pneumonia that develops in a person who is on a
ventilator." A ventilator is a machine that delivers oxygen to the patient via mouth, nose, or endo
tracheal tube (CDC). Pneumonia can develop in a patient as soon as forty–eight to ninety–six hours
after receiving mechanical ventilation (AJN). VAP is a common hospital acquired infections,
especially on the intensive care units (ICUs). Our mouth has normal flora and also potentially
harmful microorganisms which are managed by our immune system. Patients whom are critically ill
or immunocompromised are unable to fight off these organisms. Their becomes home to pathogens,
the patient is at risk of infection if oral care is not provided and they are receiving mechanical
ventilation (AJN) Patients on ventilators are at higher risk of acquiring pneumonia, because the tube
provides a path for potentially harmful organisms to enter into the lungs. Some of these pathogens
may include Klebsiella pneumonia, Staphylococcus ... Show more content on Helpwriting.net ...
Also providing moisturizing measures, keep the patient's head of bed elevated thirty to forty–five
degrees to prevent the risk of aspiration unless the patient has another condition where this would be
contraindicated. Finally, it is very important to wash hands thoroughly before and after touching
ventilator tubing. It is also important to assess your patient's breathing on a regular basis, if your
patient is able to breath on their own, then they may be able to be taken off of mechanical
ventilation. All of these are very simple nursing interventions that should be implemented
consistently in order to provide the best possible care for these

The Effect of Manual Hyperinflation and Suctioning in...
A study was conducted to assess the effect of manual hyperinflation and suctioning in mechanically
ventilated patients to prevent the risk of ventilator associated pneumonia admitted in intensive care
unit of selected hospital, Belgaum, Karnataka – A randomised control trial.
Background and objective:
Mechanically ventilated patients are increasingly at the risk of acquiring Ventilator–associated
pneumonia (VAP) which is the leading infectious complication, affecting from 8% to 28% of
patients admitted in the intensive care units. Morbidity and mortality associated with the
development of VAP is high, with mortality rates ranging from 20 to 41%.Development of VAP
increases ventilator days, critical care and hospital lengths of stay. Essential airway management is
one of the important interventions to prevent ventilator associated pneumonia. Manual
Hyperinflation (MH) enhances clearance of airway secretions and thereby improved lung
compliance, reduced inspiratory resistance, improved V/Q matching, cleared airway and re–
expanding the collapsed alveoli. MH could resemble a forceful cough, with which, sputum could
propagate from distal to more proximal areas that is, from the smaller airways toward the larger
airways, where it can be easily removed through endotracheal suctioning. Hence MH followed by
suctioning is considered to be a suitable intervention to prevent VAP among intubated and
mechanically ventilated patients.
The objective of the study was to assess the effect

Ventilator-Associated Pneumonia
Abstract
Clinical problem: Oral care and ventilator–associated pneumonia (VAP) is extremely important in
all healthcare organizations and has gained increased attention. For this reason, oral care has been
introduced in many hospital settings. However, there is not enough evidence on critically ill patients
concerning the effect of oral care interventions on the development of VAP. In order to evaluate the
effect of oral care on VAP for hospitalized patients, additional studies are required.
Objective: To determine if oral care lowers the incidence rate of hospital acquired pneumonia
infection in hospitalized patients with ventilators.
The purpose of this paper is to assess the effects of oral care on ventilator–associated pneumonia for
inpatient ... Show more content on Helpwriting.net ...
The rate of development of VAP was significantly higher in the control group (68.8%) compared to
the CHX group (41.4%) [p = 0.03] : [odds ratio = 3.12 95% CI =

Ventilator Associated Pneumonia Prevention And Ventilator...
Ventilator–Associated Pneumonia Prevention
Leonard, T. N.
Thomas Edison State College
Abstract
Ventilator–associated pneumonia (VAP) remains a big drawback within the hospital setting, with
terribly high morbidity, mortality, and cost. Some people tend to perform an evidence–based review
of the literature that specializes in clinically relevant pharmacological and non–pharmacological
interventions to prevent VAP. Thanks to the importance of this condition the implementation of
preventive measures is predominant within the care of mechanically ventilated patients. There is
proof that these measures decrease the incidence of VAP and improve outcomes within the intensive
care unit. A multidisciplinary approach, continuing ... Show more content on Helpwriting.net ...
VAP has been seen to cause up to 71% of hospital pneumonia deaths. According to Koenig (2006),
Ventilator–associated pneumonia is defined as pneumonia occurring more than 48 hours after
patients have been intubated and received mechanical ventilation. Diagnosing VAP requires a high
clinical suspicion combined with bedside–examination, radiographic–examination, and
microbiologic analysis of respiratory secretions. Aggressive surveillance is vital in under–standing
local factors leading to VAP and the microbiologic milieu of a given unit. Judicious antibiotic usage
is essential, as resistant organisms continue to plague intensive care units and critically ill patients.
Simple nursing and respiratory therapy interventions for prevention should be adopted. (para.2) VAP
has two types, early on set (within the first 48 hours), and late on set VAP (after 90 hours). VAP will
usually appear within the first 48 hours after intubation. Diagnosis of VAP can sometimes be very
difficult. The usual and best way to diagnose VAP is to have a portable chest radiograph performed.
According to Koenig (2006),
While the portable chest radiograph still remains a mandatory component in the diagnosis of
ventilated patients with suspected pneumonia, as with clinical criteria for diagnosing VAP, it too has
problems with both sensitivity and specificity. Poor–quality films further compromise the accuracy
of chest X rays.

Chest X-Ray And Sputum Culture
It is vary minute to minute in the hospital, patients situation will be change in a blink of an eye.
Nowadays ventilated patients are easily infect pneumonia cause by serval bacteria, mortality rate for
ventilator–associated pneumonia (VAP) [1] lies between 20% and 60% [2][3], and can be even more
higher but it takes 3~5days for cultured and identify which type the bacteria is, by this time bacteria
keep growing and increase the difficulty of treatment so we are looking forward to change standard
operating procedure into instant detection without draw blood, chest X–ray and sputum culture. It is
usually unclear if the antibiotics are effective when culturing a specimen in the first 5 days, the most
critical period of patient survival. We try

Ventilator-Associated Pneumonia: An Examination
VAP: An examination I currently work as a professional health care provider on a team of clinicians
at an intensive care unit (ICU). One of the most commonly seen problems that we have to deal with
an attempt to prevent is Ventilator–Associated Pneumonia (VAP). VAP is one of the most
widespread hospital acquired infections and generally transpires two day post–mechanical
ventilation, generally as a consequence of microorganisms infiltrating the lower end of the
respiratory tract and the lung parenchyma often via an endotracheal tube or tracheostomy
(Amanullah, 2011). This truly is a problem that more professional health care providers need to be
acutely aware of so that they can engage in more efficient methods of adequately preventing this
condition. For many patients, receiving ventilation is not an option; it's a life–saving necessity.
However, clinicians need to work harder to lower the rates of corresponding pneumonia associated
with ventilation, so that it isn't such a "give–in" or overwhelming risk factor of receiving ventilation.
Generally VAP occurs at a rate of just over 20 percent in clients who are put on mechanical
ventilation (Augustyn, 2007). Mechanical ventilation bolsters the danger of acquiring pneumonia
from a rate of three–fold, tripling it to ten–fold (Augustyn, 2007). These numbers reflect a lack of
capability and deficit in high quality of care among members of the clinical staff. While certain
hospital borne infections are unavoidable, and while

Attitudes of Respiratory Therapists and Nurses about...
Attitudes of Respiratory Therapists and Nurses About Measures to Prevent Ventilator–Associated
Pneumonia: A Multicenter, Cross–Sectional Survey Study
Title of Article:
The title of the article "Attitudes of Respiratory Therapists and Nurses About Measures to Prevent
Ventilator–Associated Pneumonia: A Multicenter, Cross–Sectional Survey Study" clearly identifies
the purpose of the study. It clearly identifies the dependent variable as Ventilator–Associated
Pneumonia (VAP) rate, the independent variable of staff compliance to prevention measures, and the
population of Respiratory Therapists (RTs) and Registered Nurses (RNs).
Objective:
The authors clearly state the objective is to understand reported practices and adherences to
evidenced–based guidelines by RTs and RNs. The methods mentioned are; multicenter, cross–
sectioned survey, non–identifiable geographic information, and questions concerning practices to
prevent VAP based on evidence–supported guidelines. The authors report three major findings;
participants frequently practiced VAP prevention measures, the rate of adherence to ineffective
measures is relatively high, and a substantial portion did not know the VAP rate for their institutions.
The authors concluded consumers, Centers for Disease Control and Prevention, and other
organization's efforts to implement mandatory reporting of hospital infections, including VAP, the
need for a VAP definition suitable for individual organizations, a need for a

Running head: A QUALITATIVE ANALYSIS OF CLINICIANS' PERCEPTION OF A Qualitative
Analysis of Clinicians' Perception of Head–of–Bed Elevation Jolly Abraham Grand Canyon
University NRS–433V January 09, 2011 A Qualitative Analysis of Clinicians' Perception of Head–
of–Bed Elevation Ventilator – associated pneumonia (VAP) is the second most common hospital
acquired infection (HAI) and is associated with high morbidity and mortality rates for ventilated
patients in intensive care units (Bingham, Ashley, Jong, & Swift, 2010). The VAP increases
patients' mortality rates, length of stay and hospital costs (Hiner, Kasuya, Cottingham, &
Whitney, 2010). The VAP is the leading causes of death due to nosocomial infections and the ...
Grounded theory tries to account for people's actions from the perspective of those involved (Polit
& Beck, 2010, p. 269). The study was conducted at Harborview Medical Center, a level one
trauma center in Seattle, Washington. The study was reviewed and approved by the institutional and
university of Washington internal review boards (Hiner et al., 2010, p. 167). The word variable in
research refers as measurable characteristics, values, or properties of people or things that can take
on different values (Cherry, 2011). In this study the clinicians' perception of head of bed elevation is
the independent variable and clinicians' knowledge and their accuracy of performance is the
dependent variable. The sample for this study was 175 clinicians who were employed at medical
center and they were directly involved in patient care (Hiner et al.). The sample of clinicians
includes 89 registered nurses, 39 physicians, 21 respiratory therapists, 16 medical and hospital
assistants, and 10 physical and occupational therapists (Hiner et al., p. 166). In order to accomplish
the accuracy of the results the study excluded the clinicians who were not directly involved in
patient care. Although the study did not mention any thing about the informed consent was obtained
from the participants. The study was to describe clinicians' ability to estimate recommended HOB
elevation levels. The study Procedures In this study the researchers used

Ventilator Associated Pneumoni Pneumonia
Ventilator Associated Pneumonia Karissa Ellison George Washington University Ventilator
Associated Pneumonia Introduction Ventilator Associated Pneumonia (VAP) is defined as
pneumonia in a patient who is intubated and ventilated at the time of the onset of the event or 48
hours before, and VAP rate as the number of ventilator–associated pneumonias per 1,000 ventilator
days (Institute for Healthcare Improvement, 2014a). The Institute for Healthcare Improvement (IHI)
gives the following example of how to calculate the number of VAP's in a month: "if 25 patients
were ventilated during the month and, for purposes of example, each was on mechanical ventilation
for 3 days, the number of ventilator days would be 25 x 3 = 75 ... Show more content on
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One reason the costs increase is related to the fact that a patient who develops VAP increases their
length of stay in the ICU an additional 4 to 9 days. The Centers for Medicare and Medicaid Services
has listed VAP as a preventable disease; this could lead to hospitals not being reimbursed for care of
patients who develop VAP (Sedwick, Lance–Smith, Reeder, & Nardi, 2012). Promoting strategies to
improve this quality measure is imperative because critically ill patients are more vulnerable and
susceptible to infections. The focus of ICU's and the nurses who work there is providing care that
patients need and ensuring quality and safety. The purpose of this health care quality indicator is to
help nurses and physicians reduce the occurrences of VAP, resulting in reduced mortality and
morbidity among ICU patients who are mechanically ventilated, and to reduce costs for hospitals.
Quality Improvement Process The Centers for Disease Control's (CDC) National Healthcare Safety
Network (NHSN) is used nationwide to track healthcare–associated infections. NHSN provides data
needed to identify problem areas, measure the progress of prevention, and help to eliminate
healthcare–associated infections (Centers for Disease Control and Prevention, 2015a). The NHSN
provides a surveillance tool that hospitals can use to track VAP events. The CDC

Quality Indicator: Ventilator Associated Pneumonia
Quality of service is the process of measuring the characteristics of existing workplace culture, the
potential errors and improving those errors in the future. It assures the safety of the patients which
results the greater patient satisfaction. Quality care indicator is the method of analyzing the
outcomes of patients' conditions and nurses' performance while providing quality of service to the
patients. In this report, quality indicator: ventilator associated pneumonia (PAV) will be explored.
VAP is one of the nosocomial infection which is the most common infection in the intensive care
unit (ICU). Nosocomial infection is the infection that occurred in the hospital surroundings after
48hours of admission other than the disease for admitting ... Show more content on Helpwriting.net
...
In Egypt the incidence rate of VAP was 15.3% that increased the risk of mortality rate by 33% in
contrast to the patient without VAP which was just 24.3% (Timsit, Zahar and Chevret, 2011, p.469).
However, VAP independently cannot predict the death of the patient, there are other reasons
associated with the VAP such as severity of disease, and duration of ICU stay (Myny et al., 2014,
p.120). A study of Faisy et al.,(2011, p.1257) reveals that the risk factor associated with the VAP are:
history of lungs diseases, immune compromised state, nutritional deficiency. In order to reduce the
incidence rate of VAP in ICU settings, it is very necessary to follow the evidence based process
indicator as a quality indicator because it tries to find out the obstacle that had been faced in the past
and provides a proper guideline and feedback to improve the quality of service, in addition close
surveillance, monitoring the previous outbreak and feedback from results could help to reduce the
incidence rate (Wong, Mathieu and Williams, 2012, p.80). While working in ICU, the most patient
experiences the problem of weaning. A study of Prasad, Chaudhry and Khanna,(2009, p. 221)
reveals that patient experience the weaning failure at the time of extubate because of prolonged and
dependency on mechanical ventilation. Other reason behind the weaning failure are: old age,
increased minute ventilation, severe

Ventilator Associated Pneumonia Case Study
Ventilator–associated pneumonia (VAP) is known to be the second most common nosocomial
infection found in intensive care units. VAP has been associated with increased mortality, morbidity,
and health–related costs. A study by the University of Faisalabad (Pakistan) was published by the
Journal of University Medical & Dental College to determine if the severity of VAP can be
prevented through the implementation of comprehensive strategies and clinical practices. In this
study, eighty–six ventilated patients were placed in a randomized clinical trial located at the
intensive care unit of Shahid Sadoughi Hospital, yazd, Iran. Around ninety percent of pneumonias
that originate while the patient is in the ICU (Intensive Care Unit) occur due ... Show more content
on Helpwriting.net ...
22). These preventative measures were given to half (forty–three) of the patients in the study by the
University of Faisalabad and randomly chosen as the treatment group. The other half, the control
group, just received routine care (tracheal and oral suctioning, oral antiseptics, and elevation of the
patient bed) throughout the study. The differences from the two groups after two quarters of time in
2016 were clearly noticed. Results following the study show that implementing comprehensive
strategies for preventing ventilator–associated pneumonia ultimately decreased the incidence of
VAP. Specifically, a there was a difference between the two groups adjusted

Ventilator Associated Pneumonia in the Icu
Ventilator associated pneumonia (VAP) is a nosocomial infection occurring in hospitalized patients
who are mechanically ventilated. These infections are common in ICU settings, difficult to diagnose
early, and unfortunately have a high rate of mortality and morbidity. VAP accounts for almost half of
infections in ICU settings, up to 28% of mechanically ventilated patients will develop VAP and of
these patients the mortality rate is between 20% and 70% (Craven & Steger, 1998). A patient that
develops VAP while mechanically ventilated adds days to his recovery as well as thousands of
dollars to the care costs. Numerous studies have been conducted across the county in an effort to
understand VAP, however very few of those studies focus on ... Show more content on
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The research points to the idea that because many nurses are not responsible for the ventilator
circuit; they rely on the respiratory therapist to manage the ventilator, they may be less informed
than if they had more control and training in the interventions necessary to prevent VAP. The
research suggests more training and education for nurses who work with ventilated patients.
Research done at the University of Toledo College of Medicine has shown a decrease in the
incidence of VAP in its ten bed surgical ICU by implementing a "FASTHUG" protocol. Papadimos,
et al, (2008) explained the interventions that the college used as a tool to educate the critical care
team. "FASTHUG" stands for daily evaluation of feeding, analgesia, sedation, thromboembolic
prevention, head of bed elevation, ulcer prophylaxis, and glucose control in critically ill intubated
patients. The "FASTHUG" protocol was emphasized at morning and afternoon rounds and after a 2
year research period the incidence of VAP declined to 7.3 VAPs/1000 ventilator days down from a
historical rate of 19.3 VAPs/1000 ventilator days. Of note, in 2007 the surgical ICU that
implemented this program actually had no incidence of VAP from January to May. The research
suggests that the use of bundled care processes for ventilated patients may reduce the rate of VAP.
The nurse's knowledge of the use of the ventilator bundle is crucial to

Ventilator-Associated Pneumonia (Vap): the Key to...
Running head: VENTILATOR–ASSOCIATED PNEUMONIA Ventilator–Associated Pneumonia
(VAP): The Key to Prevention Aleisha N. Curry Professional Role Development II Nursing 402
Christian Brothers University February 20, 2012 Sue Trzynka, Ph.D., RN Introduction In the fast
paced Trauma Intensive Care Unit (TICU) there are many things to remember while working with
ventilated patients. Therefore, it is essential to implement practices that will decrease opportunities
for adverse incidents. Ventilated patients represent about forty percent of the average daily census in
the TICU. The Regional Medical Center at Memphis utilizes a ventilator bundle in order to decrease
the risk of adverse events associated with the ... Show more content on Helpwriting.net ...
Utilizing these interventions could decrease morbidity and cost. Literature Review Implementation
of the VAP bundle has greatly decreased VAP at various facilities. Even if the patient is unable to
tolerate certain interventions there are various other interventions that could be put in place that
would help halt the process of proliferation before it starts. The quality of care in relation to
ventilated patients has greatly increased due to the frequency in which oral care, turning and sitting
the patient up is recommended. The VAP bundle at the Regional Medical Center at Memphis consist
of elevating the head of the bed (HOB) to 30º to 45º, twice–a–day oral care with chlorhexidine
mouth rinse, stress ulcer prophylaxis, washing of hands before and after contact with each patient,
daily sedative interruption, and daily assessment of patients readiness to wean from mechanical
ventilation. A significant relationship between HOB elevation to 30º to 45º and a reduced incidence
of VAP has been reported (Tolentino–DelosReyes, Ruppert & Shiao, 2007). Elevating the head of
the bed 30° can decrease VAP by 34% (Augustyn, 2007). Elevation of the head of the bed is
hypothesized to decrease the frequency of gastroesophageal reflux, aspiration and hence pneumonia
(Klompas, 2010). If the patient

Ventilator Associated Pneumonia Compounds The Risks Of...
Ventilator–associated pneumonia compounds the risks that critically–ill patients face in
hospitalization. It affects a high proportion of patients on ventilators and has a fluctuating morbidity
rate. The goal of this paper is to demonstrate the potential usefulness of chlorhexidine in preventing
ventilator–associated pneumonia in adults. The paper features a review of literature found via
MedScape using the keywords "chlorhexidine," "ventilator–associated pneumonia," "long–term
ventilation" and "prevention." The results show that there is a positive correlation between using
chlorhexidine in the oral care of patients using a ventilator; however, the evidence thus far does not
present an opportunity to promote any clinical recommendations. ... Show more content on
Helpwriting.net ...
This literature review will look to see whether critical care patients (P) can benefit from
chlorhexidine treatment (I) as compared to tradition oral care (C) to prevent ventilator–associated
pneumonia (O) during the patients stay in the hospital (T). The literature demonstrates a potential
link between chlorhexidine treatment, oral health care and a potential reduction in the number of
cases and ventilator–associated pneumonia, ultimately recommending further studies.
Literature Search The literature found in this study was found by searching for relevant papers on
MedScape. The keywords "chlorhexidine," "ventilator–associated pneumonia," "long–term
ventilation" and "prevention."
Literature Review
In a trial by Arti et al, researchers used chlorhexidine to attempt to prevent ventilator–associated
pneumonia in children (2013). The group included 86 patients who were divided into two groups to
complete a double–blind, randomized placebo controlled trial. The first group included 41 children
who received 1% chlorhexidine gel every eight hours. The second group included 45 children who
received a placebo gel. The length of the study was three weeks, or until the patient was extubated.
The results demonstrated that 12 of out of the 41 children who received chlorhexidine and 14 out of
the 45 placebo patients developed ventilator–associated pneumonia. The results showed that there
was no clear reduction in the occurrence of pneumonia

Hospital Acquired Pneumonia Research Paper
Ventilator–associated pneumonia is defined as pneumonia arising 48 hours or more after
endotracheal intubation whereas pneumonia is defined as the presence of "new lung infiltrate plus
clinical evidence that the infiltrate is of an infectious origin, which include the new onset of fever,
purulent sputum, leukocytosis, and decline in oxygenation." Together with hospital–acquired
pneumonia (HAP) are the most common hospital–acquired infections. In a prevalence study in
USA, they accounted for 22% of all hospital–acquired infections [1]. VAP is the commonest
nosocomial infection in the Intensive Care Unit
(ICU) and in a recent survey from the USA, VAP affected 10% of patients requiring mechanical
ventilation ... Show more content on Helpwriting.net ...
Host factors, the virulence of bacteria, and most importantly the presence of an endotracheal tube
determine the development of VAP. The tube is detrimental not only because it provides the conduit
for bacteria, but also because it abolishes the cough reflex.
Bacteria get access to the lungs via microaspiration and through the biofilm that is formed in the
inner surface of the endotracheal tube or leakage of secretions around the cuff. Spread from an
adjacent site of infection or via the blood represent rare causes of VAP. Pathogenic bacteria usually
replace endogenous flora and colonize the nasopharynx, the oropharynx, the sinuses and the
stomach subsequently collecting inside and around the endotracheal tube. Positive pressure
ventilation also contributes to VAP development by thrusting bacteria into the airways. Antibiotic
exposure, severity of underlying disease and previous surgery have been implicated as host factors
[5,8].
Various strategies have been applied for the prevention of VAP, each with different levels of
evidence. Preventive measures against VAP development can be divided into five distinct groups:

Case Study: Hospital Acquired Infection
When a patient is admitted to the hospital an initial assessment is done. During that assessment we
are already thinking of what kind of care and treatment this patient will need in order to dis–charge
him as soon as possible. The longer a patient remains in the hospital, the more at risk he is for
Hospital Acquired Infections. "Hospital–acquired pneumonia is the second most common
nosocomial infection, but carries the highest mortality rate of 30–50 percent. Ventilator–associated
pneumonia is a type of HAP that is associated with endotracheal intubation and me–chanical
ventilation" (Pellico, 2012). "It is reported that HAP accounts for 25% of intensive care unit
infections, and 90% of those occur during mechanical ventilation" (ATS & IDSA, ... Show more
content on Helpwriting.net ...
"A mini–bubble protractor was placed on the patients chest at the second anterior intercostal space
to measure angle of turn and at the lowest portion of the back upper bed frame to measure the angle
at which the head of the bed was elevated" (Hannenman et al. 2015, p.26). A battery–powered angle
sensor was places at the base of the mattress to measure angle of turn in degrees. The patients with
manual rotation did not hold their correct positions, despite the fact that they had pillows and
wedges to keep them in place, and thus were unable to fully benefit from these turns. "Increased
prevalence of PPCs during the study, despite turning, reinforces the high risk for pulmonary
morbidity with intubation and me–chanical ventilation...PPC rates were high before, during, and
after study participation, making a strong argument for further research on ways to reduce PPCs in
ICU patients receiving mechani–cal ventilation"(Hannenman et al. 2015, p. 30). Researchers found
that regardless of how the pa–tients were being turned, manual or automatic, patients who were on
mechanical ventilation with endotracheal tubes in the ICU were more prone to PPCs because of
their intubation. "Compared with manual turning, automated turning appears to better reduce
progression/accelerate solution of, but not prevent, PPCs" (Hannenman et al. 2015, p.

Ventilator Associated Pneumonia
APInterventions and Practices Considered 1. General prophylaxis 2. Measures to achieve safe
mechanical ventilation 3. Measures to prevent aspiration 4. Selective use of antibiotics to control
outbreaks Note: Routine use of oral and systemic antibiotics was considered but not recommended.
5. Oral care with antiseptic agents 6. Daily interruptions or lightening of sedation and avoidance of
paralytic agents 7. Gastrointestinal bleeding prophylaxis with either H2 antagonists or sucralfate 8.
Transfusion of red blood cell and other allogeneic blood products in selected patients 9. Insulin
therapy if indicated
Major Outcomes Considered * Length of stay in intensive care unit (ICU) ... Show more content on
Helpwriting.net ...
Combinations of various criteria to establish a diagnosis in patients with VAP have been suggested
and validated (Table 1). The National Nosocomial Infection Surveillance (NNIS) system was
developed in the 1970s by the Centers for Disease Control as a tool to describe the epidemiology of
hospital–acquired infections and to produce aggregated rates of infection suitable for inter–hospital
comparison, but was never compared to pathological results. The NNIS system was compared to
bronchoalveolar lavage (BAL) fluid cultures in 292 trauma patients and had a sensitivity of 84% and
a specificity of 69% [15]. More recently, the Clinical Pulmonary Infection Score (CPIS) was
proposed by Pugin et al. [16], based on six variables (fever, leukocytosis, tracheal aspirates,
oxygenation, radiographic infiltrates, and semi–quantitative cultures of tracheal aspirates with Gram
stain) [16]. The original description showed a sensitivity of 93% and specificity of 100%, but this
study included only 28 patients and the CPIS was compared to quantitative culture of BAL fluid
using a 'bacterial index ' defined as the sum of the logarithm of all bacterial species recovered,
which is not considered an acceptable gold standard for the diagnosis of VAP. Compared to
pathological diagnosis, CPIS had a moderate performance with a sensitivity between 72 and 77%
and specificity between 42 and 85% [11,17]. Likewise, CPIS was not sufficiently accurate compared
to a BAL fluid–established

A Short Note On Preventing Ventilator Associated Pneumonia
Subglottic Suctioning: Preventing Ventilator Associated Pneumonia
Ventilator Associated Pneumonia (VAP) is a hospital acquired infection which happens to patients
who are intubated. It costs the hospital and the patient money. It is a deadly disease that can be
prevented through the right type of interventions. Current practice generally depends on the hospital;
most hospitals use a VAP bundle. According to the Institute for Healthcare Improvement (2012) the
VAP bundle consists of; head of the bed elevation of at least 30 degrees, daily sedation from
weaning, readiness to extubate, Deep Vein Thrombosis (DVT) prophylaxis, stress ulcer prophylaxis,
oral care with chlorohexidine (How to Guide, 2012). This currently is the protocol at Gerald
Champion Regional Medical Center. However, adding subglottic secretion suctioning to this bundle
has the ability to improve patient outcomes
According to Seckel (2007) The American Association of Critical Care Nurses (AACN), the
American Thoracic Society (ATC) and the Centers for Disease Control and Prevention (CDC)
recommend using continuous subglottic suctioning to further decrease VAP (Seckel 2007). This is
important because subglottic secretions pool around the cuff of the endotracheal tube; oropharyngeal
suctioning does not reach to the subglottic space. A specialized endotracheal tube is needed which
will allow suctioning of these secretions. This kind of suctioning will prevent the patient from
inhaling the secretions which can

Essay On The Best Evidence Based Nursing Practice In...
What is the best evidence based nursing practice in attempting to reduce (VAP) ventilated associated
pneumonia? I decided to do an evidence based paper on VAP after talking to respiratory therapy on
the sixth floor of Chippenham hospital during my clinical studies. I have a friend who has spent
many years as a RN in the critical care unit and has seen the effects of different methods in reducing
VAP first hand. This is a nursing intervention and the sole responsibility of the nurse. I can't think of
a better topic to research considering I am in my first semester of nursing school. I am very excited
to share what I have found. I have found a large amount of information on different methods to
reduce VAP but have decided on three to ... Show more content on Helpwriting.net ...
According to the Annals of Internal Medicine 08/17/2004 article, keeping the HOB elevated
between 30 and 45 degrees reduced the rate of VAP by 27% in a study from May 1, 2004 until July
31, 2004 in 275 patients. This article is only showing one source of a study at one hospital; however,
in my research I have found that this method is recommended by doctors and nurses seeming to be a
very effective measure in reducing the incidence of VAP combined with other methods. (American
College of Physicians, August 2006) The Annals of Internal Medicine was established in 1927 by
the American College of Physicians (ACP), Annals of Internal Medicine is the premier internal
medicine journal. Our 2009 impact factor of 16.2 makes the Annals of Internal Medicine one of the
most cited general medical journals in the world. Materials published in Annals are peer reviewed.
Oral care plays a vital role in reducing VAP. Effective oral care starts with the assessment of the
patient's mouth and acts as measure for needs for each patient. There have been studies performed
using different solutions including chlorhexidine gluconate (CHG) as an oral care agent to reduce
VAP. A test study was done using 101 patients 51 patients being the control group (using pink mouth
swabs and traditional methods of oral care) and 49 patients being the tested group (using
chlorhexidine gluconate at a minimum two times per day) VAP

"A study to determine the effectiveness of structured teaching programme regarding prevention of
ventilator associated pneumonia on staff nurses‟ knowledge, practices and reduction in incidence of
ventilator associated pneumonia in selected hospitals of Mysore".
BY
Miss.Emilymaria George Poulose
Dissertation Submitted to the
Rajiv Gandhi University of health Sciences, Karnataka, Bangalore .
In partial fulfilment of the requirement for the degree of
MASTER OF SCIENCE IN NURSING
In
Medical Surgical Nursing
Under the guidance of
Mrs Mamatha .G
Assistant Professor
Dept. of Medical Surgical Nursing
JSS College of Nursing
I st Main, Saraswathipuram
Mysore.
YEAR
2010–2012
i
RAJIV GANDHI UNIVERSITY OF HEALTH ... Show more content on Helpwriting.net ...
It is one of the leading causes of death from hospital acquired infections with an associated crude
mortality rate of approximately 30%. Prevention of VAP is crucial because it increases the risk of
death of critically ill patients and also increa ses patients‟ length of stay in the ICUs and
consequently health care costs.
Aims:This study was aimed to determine the effectiveness of STP regarding prevention of VAP on
staff nurses‟ knowledge, practices and reduction in incidence of VAP.
Design: Research design selected for the study is explorative survey (Phase I) as well as non–
equivalent control group pre–test post–test design (Phase II). The incidence of

VAP was assessed for one month duration using Modified Clinical Pulmonary
Infection Score and the data were collected using a structured knowledge

Assignment 2: Moral Duty Of Care In Healthcare
Moral Duty of Care 1
MORAL DUTY OF CARE
Moral Duty of Care 2 There are so many challenges when dealing with a sick loved one. But it can
even more difficult when they are unable to speak for themselves, uninsured and an illegal
immigrant. In this paper we will determine the best possible solution to this ethical dilemma by
applying the model for making moral decisions we will explain the moral duty of the hospital. As
the director of respiratory care ... Show more content on Helpwriting.net ...
Therefore the hospital has or is doing their moral duty of care by providing care by getting the
patient stable enough to move to another floor or discontinue treatment measures that are already in
place. The
Moral Duty of Care 4
Joint Commission (TJC) provides core measures of quality that health care organizations must
report and has set compliance standard for those measures and the patient's diagnosis does not meet
any of those core measures(Sadeghi et. al., 2013). Therefore we feel that the patient can be moved to
the stroke unit where there is measures set it place that can accommodate the patients current
condition since the family does not want to discontinue the ventilator. Informed consent is essential
for patient autonomy, as well as respecting the family cultural and religious values. But I assume
that this was done when the patient was admitted for a stroke and the patient's family signed off on
this consent when the physician informed them of the patient's underlying conditioned. Jesus respect
for those in need of healing acts as a guide for patient interactions (Mark 10:46–51). In this case the
patient is unable to communicate and has no advance directive or living will set in

Pneumocystis Case Studies
According to (Critical Care Therapy and Respiratory Care Section, 1987), aerosolized pentamidine
isethionate is typically administered in patients with Pneumocystis jiroveci (carinii) pneumonia, a
fungal infection that attacks the lungs of immunocompromised patients. Pneumocystis jiroveci can
be classified as an opportunistic pathogen, as it usually does not induce sickness in the healthy
human (Pneumocystis jiroveci Pneumonia, 2013). The most likely source of infection, in the case
proposed above, was the presence of hospital staff members in the same room as patients with
Tuberculosis undergoing aerosolized pentamidine isethionate therapy. Aerosolized pentamidine
isethionate has the potential to induce coughing in any patient undergoing this therapy. ... Show
more content on Helpwriting.net ...
Many factors related to how the giblets were handled enhance their likelihood of being the etiologic
agent for the fever and gastroenteritis seen in the 112 people. These factors include the following:
the giblets were uncooked and added to the stock mixture (cooking the giblets would have decreased
the amount of bacteria on the giblets), the gravy was not reboiled once the giblets were added
(reboiling the gravy would have killed some bacteria due to the high heat), and lastly, the gravy was
stored at room temperature throughout the day (storing it at room temperature provides an
environment where some bacteria can thrive, so storing the gravy in a refrigerator would have been
better to decrease the amount of potential bacteria growth). (Strelkauskas, Strelkauskas, & Moszyk–
Strelkauskas, 2010) The illness of the 112 patients are commonly seen when food is not stored at
proper temperatures or reheated (such as the gravy being stored at room temperature), or when meat
or poultry is undercooked or uncooked (such as the giblets) (Eisner, Zieve, & Ogilvie,

Ventilator– Associated Pneumonia Prevention with Head–of–Bed Elevation
Ventilator –associated pneumonia (VAP) is a hospital acquired infection affecting the respiratory
system which occurs on hospitalized patients in critical care unit on mechanical ventilator. VAP is
the second most common hospital acquired infection (HAI) with high mortality and morbidity rate
for ventilated patients in intensive care unit. (Bingham. Ashley, Jong & Swift, 2010). Patients on
mechanical ventilator spend more days in the hospital which in turn affects health care cost. VAP
prevention is ongoing for nurses working in Intensive care unit. It is the duty of the nurses to help in
VAP prevention by adhering to the interventions in the ventilator bundle in their daily ... Show more
The mannequins were dressed to resemble a critically ill hospitalized patient on a ventilator.
Endotracheal tube, egg–crate, headrest, cervical collar, hospital gown, blanket, and one pillow was
used to imitate a critically ill patient. (Hiner et al., 2010). This object was placed lying on the back
with head of bed increased to 30 degrees. Joint commission, Centers for Disease Control and
Prevention and the institute for Health care Improvement and five million campaign as well as the
hospital's standard guidelines recommended HOB elevation. This study took a two week duration,
within these two weeks, these mannequins were moved to 7 intensive care units of the hospital at
various times throughout the day both nights and evening. To determine the angle of elevation, the
clinicians were told to stand two feet away from the foot and side of the bed. The clinicians
documented their observations and answered questions in a survey regarding their knowledge of
HOB elevations and how to prevent VAP. (Hiner et al). 50% of nurses and 535 of clinicians were
able to demonstrate accurate perception of HOB elevation. Estimation of correct range was between
25 to 35 degrees. The nurses, respiratory therapist, followed by physical and occupational therapist,
and physicians were able to recognize why the HOB should be elevated.

Ventilator–associated pneumonia is the leading cause of death out of all hospital–acquired
infections. Pneumonia that is acquired 48 hours or longer after at patient has been mechanically
ventilated is considered hospital acquired. Endotracheal tubes provide pathogenic microorganisms'
with a direct access to the lungs where they can easily set up shop and cause deathly consequences
for patients' in the acute care setting. For example, the mortality rate of patients who have
ventilator–associated pneumonia is 46% whereas unaffected intubated patients mortality rate is
32%. When ventilator–associated pneumonia (VAP) occurs in a patient(s), it often increases the
amount of days a patient is on the ventilator and increases their overall hospital stay (Safe Care).
The big problem with this is that VAP is costing hospitals ... Show more content on Helpwriting.net
...
This includes elevating the head of the bed at least 30 degrees, preventing aspiration, turning and
positioning, and most importantly, performing oral care. A major source of VAP is the aspiration of
microorganisms from the mouth, proving oral hygiene for mechanically ventilated patients is of top
priority. Although, methods and timing of oral care varies widely between facilities, for instance,
some hospitals may brush teeth with a tooth brush while others may use a sponge swab. A common
oral care protocol is usually brushing teeth every 8 hours and using an antimicrobial rinse
(chlorhexidine) every 2 hours (Ignatavicius & Workman, 2013). It should be noted that quality
education on the link between poor oral hygiene and ventilator–associated pneumonia should be
provided to licensed nurses as well as nurses' aides that would be responsible for providing oral
care. Understanding the importance of being vigilant at providing oral care may further reduce VAP
occurrences due to increased compliance and efficiency of oral care

Retrospective Cohort Study
The article, "Prior Pneumococcal and Influenza Vaccinations and In–hospital Outcomes for
Community–Acquired Pneumonia in Elderly Veterans", uses a descriptive, correlational design by
which it describes the relationship between prior pneumococcal vaccinations (PV) and in–hospital
outcomes for community–acquired pneumonia (CAP) in elderly veterans. The research design that is
stated in the study is a Retrospective cohort study. A descriptive, correlational design properly
addresses the study's purpose because it allows the researchers to "examine the variables in the
situation that has already occurred and the researchers make no attempt to control or manipulate the
situation" (Grove, Gray, and Burns, 2015, p. 218).
The sampling method is a ... Show more content on Helpwriting.net ...
The participants' right to privacy was protected and during data collection, analysis, and reporting,
confidentiality of the research data was maintained. All the information recorded on the participants
was in agreement with the HIPAA Privacy Rules. The study received permission to use the
participant's information by "institutional review boards at the University of Arkansas for Medical
Sciences and the Central Arkansas Veterans Healthcare System" (Li et al., 2015, p. 288). The study
does not indicate if the participants were selected in a fair way. They were, however, treated in a fair
way and all participants were held to the same sample criteria. No discomfort or harm was inflicted
on the participants while the study was taking

Evaluation Of Using A Protocol Adoption Of A Bundle Care...
A timeframe of about 6–month test of pilot will be completed to test the feasibility and efficacy of a
protocol adoption of a bundle care for the prevention of ventilator associated pneumonia. The VAP
bundle protocol guidelines will be used to determine quality management and reflective data audit
for all patients admitted in the intensive care unit with mechanical intubation within this 6–month
trial period. Evaluation is a systematic way of checking a project's information on the activities, and
characteristics in order to make a judgement of the project. Evaluation can help to give
recommendations to the project and improve by adapting the recommendations and improve future
projects. Evaluation gives managers considerable evidence to support the decision process with the
well documented analysis. Described methods used to evaluate effectiveness of proposed solution.
In order to attain excellence in patient care, latest evidence to support care is necessary, and the
outcomes of the care in nursing should show aspects of the process change (Frisch & Kelley, 2002).
The purpose of an evaluation is to see if there is compliance with the intended change and measure
the impact of the process change. When doing evaluation it is important to engage the key
stakeholders in the process. In addition, working with the stakeholders to ensure that the training
objectives align with the business needs if of far great importance. Expectations of the training
should also be in agreement

Intubated Patients Develop Ventilator Associated Pneumonia
Critically ill patients who are intubated on mechanical ventilation for more than 24 hours of are at
an increased risk of 6 to 21 times of developing ventilator associated pneumonia (VAP). Patients
intubated for lesser than 24 hours are at 3 times the risk of acquiring VAP.15 VAP is the
parenchymal lung infection and alveolitis, the accumulation of inflammatory exudates and
infiltration of airway mucosa can lead to unfavourable respiratory mechanics occurring at least 48
hours after initiation of mechanical ventilation. VAP is one reason for high costs and prolonged
length of hospital stay in the intensive care units (ICU).9
The morbidity and mortality of VAP is increasingly high, mortality rates ranges from 20% to 41%.
The risk of development of VAP increases days of ventilation by 4 days, critical care by 4 days and
lengths of hospital stay by 9 days, respectively and these factors adds to additional costs per VAP
case.16
VAP prolongs the need for mechanical ventilation that may keep patients with a poor prognosis from
their underlying commodities in the ICU. Both these factors would increase the probability of death
rates in the ICU among patients who have developed VAP. 17
A prospective, matched cohort study was conducted to evaluate the attributable morbidity and
mortality of VAP in intensive care unit (ICU) patients. One hundred and seventy–seven patients
developed VAP and stayed in the ICU for 4.3 days longer and had a trend toward an increase in risk
of death

Ventilator Associated Pneumonia ( Vap )
Ventilator associated pneumonia (VAP) is among the most fatal hospital acquired infections, with
mortality ranging from 15% to 70%. Ventilator associated pneumonia is also known to increase
length of stay which directly affects unit budgets. In 2010 the institute for health care improvement
added daily oral care with chlorahexidine to the five evidence based interventions which include, "
(1) head–of–bed elevation between 30 degree and 45 degree; (2) a daily "sedation vacation" and a
readiness–to–wean assessment; (3) peptic ulcer disease prophylaxis; (4) deep vein thrombosis
prophylaxis; (5) daily oral care with chorahexidine." (Lim, et al., 2015)
Recently in 2015, the South Miami adult intensive care unit added oral chlorahexadine to the ...
National Taiwan University did a retrospective review of data to decrease VAP density by fifty
percent at a SICU medical center. The sample population consisted of adult surgical intensive care
unit invasively ventilated patients, "The primary aim of this study was to check the efficacy of the
VAP bundle by comparing the before and the after density at SICUs. A multidisciplinary teamwork
was set up including administrator (vice superintendent), quality improvement and infection control
professionals, SICU doctors, and nurses, respiratory therapists, pharmacists, and general affairs and
information technology specialists."(Lim, et al., 2015)
The National Taiwan University Hospital's Infection control department led the education of all
disciplines and a revised compliance tool from the institute of healthcare improvement bundle
checklist was implemented to track and assess daily compliance. VAP density differences from pre–
VAP bundle phase and post–VAP bundle phase was collected and analyzed on SPSS software and
the differences in data of inpatients and the outcomes were analyzed based on Mann–Whitney U
test.
Compliance rate for the SICU nurse's pre bundle phase and post bundle phase did improve, " The
compliance rates between before and after this re–education promotion

Does Elevation Head of the Bed Reduce Risk Ventilator...
Title:
Does elevating the head of the bed reduce the risk of ventilator–associated pneumonia (VAP)?
Introduction:
According to Polit and Beck (2012,p.3) "research is a systematic review inquiry that uses
disciplined methods to answer a question or solve problems. The ultimate goal of research is to
develop, improve and expand knowledge". Research in nursing can produce new knowledge into
nursing practice, develop and improve methods of caring and trial the efficacy of care (Gerrish, K
and Lacey A, 2007). However, research according to Hockey (1984) in the first edition of the book,
research is an attempt to increase the sum of what is known, usually referred to as a "body of
knowledge" by the discovery of new facts or relationships ... Show more content on Helpwriting.net
...
F. Punch 2009). (incorrect citation)
The research question is ' Does elevating the head of the bed reduce the risk of ventilator–associated
pneumonia?'
Search:
There are many ways to search for evidence base practice. After a topic has been chosen and the
question developed, the literature can be easy to search. Draft outline of the project before beginning
to search. Latest information regarding the topic that was chosen available at the website. You may
begin to search for literature via an internet search engine. How to access appropriate information
from proper website? An early chore in carrying out an electronic search is to classify keywords to
generate the search. From the lecture, the attending student was given access for the academic
library of University of Huddersfield. The student needs to log in to portal plus via Internet access.
Go for library services or summon and search for the article, type the key words into search column
provided by the electronic base. For example the research topic is "does elevating the head of the
bed reduce the risk of ventilator–associated pneumonia?" The key words are "ventilator–associated
pneumonia" and "head of bed elevation". You have to restrict the search by limiting a certain type of
page for example only research reports; to

Ventilator associated pneumonia
Prevention of Ventilator Associated Pneumonia Abstract Ventilator associated pneumonia (VAP) is a
hospital acquired infection occurs in the intensive care unit (ICU) for the patients who are on
mechanical ventilator. It further complicates the hospital course by extending the length of stay,
increase the cost of treatment, and increases the mortality rate. It is estimated that about 1% to 3%
patients on mechanical ventilator develops VAP per day. Compared to the previous years, the
Chlorhexidine mouth care and other ventilator bundle strategies decreased the VAP rate. Evidence
based research studies proved that almost 89.7% reduction in VAP occurs after the implementation
of ventilator bundle and other care related to it (Hutchins et al, ... Show more content on
Helpwriting.net ...
Review of Literature Arroliga, A. C., Pollard, C. L., Wilde, C. D., Pellizzari, S. J., Chebbo, A., Song,
J., Ordner, J., Cormier, S., & Meyer, T. (2012). Reduction in the Incidence of Ventilator Associated
Pneumonia: A Multidisciplinary Approach. Respiratory Care, 57(5). 688–696. DOI:
10.4187/respcare.01392 VAP is one of the common hospitals acquired infections, which got
significant importance in following evidence based practice to prevent it. The authors of this study
used a retrospective single center observational cohort study, done in the ICU at Scott and White
Hospital, Temple, Texas. The study took almost two years for its completion. The research team
implemented the ventilator bundle about 258 patients in mechanical ventilator. The limitations of the
study were its retrospective nature, single center study and the database does not have metrics for
severity, such as Acute Physiology and Chronic Health Evaluation (APACHE) score. The research
team identified there was a significant decrease in the number of VAP rate and the use of antibiotic
rate in the treatment of VAP was also decreased in patients who received evidence based oral care.
The team concluded by stating that the VAP rate is relatively low when the respiratory therapist is
giving mouth care at least twice a day with Chlorhexidine. Following the simple evidence based
practice like oral care can

Ventilator-Associated Pneumonia Case Study
Impact of the International Nosocomial Infection Control Approach on Rates of Ventilator–
Associated Pneumonia in Hospitals of 5 Within Argentina
Shelby L. Stone
SFCC
January 11, 2018
Abstract
This paper explores a published article that reports on results from research conducted using
International Nosocomial Infection Control Consortium Surveillance Online System. To analyze the
impact of the International Nosocomial Infection Control Consortium (INICC) multidimensional
approach (IMA) on ventilator–associated pneumonia (VAP) rates in eleven hospitals within five
cities of Argentina from January2014–April 2017. The article found in the American Journal of
Infection Control is supported by Victor D. Rosenthal, and the Foundation to Fight against
Nosocomial Infections. Keywords: Hospital infection, Healthcare acquired infection, Hospital–
acquired pneumonia, Nosocomial pneumonia, Limited–resource countries, Surveillance
Impact of the International Nosocomial Infection Control Approach on Rates of Ventilator–
Associated Pneumonia in Hospitals of 5 Within Argentina ... Show more content on Helpwriting.net
...
According to studies from both developed and limited–resource countries, the most important
clinical consequences due to VAP have increased death rates, significant disease, increased the
length of stay, and additional health care costs. Although hospitals in limited–resource countries do
implement infection control programs, agreement with infection control practices is inconsistent. A
multicenter, potential, before–after observation study was conducted using International Nosocomial
Infection Control Consortium Surveillance Online System. (V.D. Rosenthal et al/American Journal
of Infection Control

Ventilator Associated Pneumonia Literature Review
Almeida, Suely Morais; Cruz, Isabel CF da ( 2013) Brazil conducted a study on The elevation of the
head acting for prevention of ventilator–associated pneumonia – literature review which concluded
that Patients in intensive care often require the use of an artificial airway, it has its depressed level of
consciousness, respiratory failure, trauma or need for aspiration of secretions, making them
susceptible to pneumonia associated with mechanical ventilation. The objective of this study is to
investigate the effectiveness of elevating the head by 30 to 45 among other prevention measures.
The method used was a computerized literature search in the databases online, over the period 2007
to 2012. It was observed that the elevation of the head at 30 and 45, is one of the most simple and
effective prevention. We conclude that good nursing practices associated with elevated bed rest at 30
and 45, may prevent ventilator–associated pneumonia. It is recommended the creation of a protocol
for prevention, constant training of staff and preparation of posters displaying the ... Show more
The findings showed that VAP per 1000 vent days were significantly reduced after introduction of
the program [3.7 vs. 6.9] P < .01. The reduction in catheter related blood stream infection (CRBSI)
per 1000 line days was not significant [1.5 vs. 2.6], P = .09. Observed hand hygiene increased
during the study period. There was no significant difference in mortality. The study concluded that a
novel multi–modal hand hygiene system resulted in a reduction in VAP. Provider hand
contamination during patient care in the ICU is a modifiable risk factor for reducing ventilator
associated pneumonias

Preventing Ventilator Associated Pneumonia in Children Essay
Preventing Ventilator Associated Pneumonia in Children
Hospitalization for any family is a hard situation to deal with, when it is a child in the hospital the
situation because even tougher to handle. Because of the delicate situation of family members in the
hospital it is imperative that the patient does not obtain any hospital acccuired conditions. One of the
most common hospital acquired infections (HAI) is ventilator–assocaited pneumonia (VAP).
Although it is commonly seen in the hospital setting it can have devastating effects, especially on
children. Prevention of VAP is the goal for critical care nurses in all hospitals.
Although many people have heard of or had pneumonia many people are not aware of what
ventilator associated ... Show more content on Helpwriting.net ...
Younger children are more likely to acuire VAP than adults because of their decrease function of the
immune system.
Dental plaque is a main culprit of causing VAP in young patients. The mouth harbors many bacterias
including gram positive and gram negative bacterias. To prevent ventilator associated pneumonia
from dental plaque guidelines have been set up to decrease the risks. For all infants and children
every two hours the oral cavity should be moistened and the lips should be coated with petroleum
jelly. For children with teeth it is recommended that the teeth be brushed every twelve hours with
fluoride toothpaste, oral cavity suctioning should be done frequently but do not rinse the mouth.
Daily oral care with 0.6% chlorhexidine for children over 6 who have teeth is also indicated.
There are numerous other techniques used to prevent VAP. Like many respiratory problems the head
of the bed should always be elevated to between 30 and 45 degrees to prevent aspiration of fluids
and sputum. The tubing for the ventilator should only be changed on a as needed basis. The
continuous changing of tubes moves the bacteria and can introduce new bacteria into the respiratory
system. Patients should also receive "sedation vacations" and prophylaxis medications to prevent
peptic ulcers. Weaning of the mechanical ventilator should also be done as soon as possible

Ventilator-Associated Pneumonia Essay

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