This document summarizes a critique of a pneumonia prevention policy at The University of Texas Medical Branch. The policy aims to prevent nosocomial pneumonia through measures such as preventing person-to-person transmission, aspiration prevention, postoperative pneumonia prevention, and equipment sterilization. However, the evidence review found that the policy was missing key elements like a comprehensive oral care plan, requirements for continuous endotracheal cuff pressure maintenance, and fully implementing ventilator bundle practices. The critique makes recommendations to update the policy based on current evidence, such as including an in-depth oral care regimen, specifying ventilator bundle elements, and providing more education resources to reduce non-compliance.
Journal Club presentation in Nursing ResearchDhara Vyas
Journal presentation in Nursing Research,
Study of knowledge, attitude, anxiety & perceived mental healthcare need in Indian population during COVID-19 pandemic
Covid-19
Abstract
Introduction
Methodology
samples
Analysis
Impact of health education on tuberculosis drug adherenceSkillet Tony
Adherence is defined as the extent to which patients follow the instructions they are given for prescribed treatments. Until recently, adherence expertise was hard to find, assemble and empower. The study shall solely aim at investigating the influence of patients’ health education on Tuberculosis drug adherence. It will be guided by the following specific objectives; to identify the level of adherence among TB patients at MTRH, to assess the level of patient’s health education on TB drugs, to identify barriers of TB education, to investigate the challenges facing TB patients on treatment and to determine the level of training given to health workers on TB drug adherence. These objectives will enable the researcher to elaborate more on the topic and ensure that those who read through this research shall have a better perspective on the effects of health education on tuberculosis drug adherence. It will take place between the months of July and August. The study will target 17 doctors, 119 nurses and 143 patients of Tuberculosis. The study will employ a case study research design. The case study will enable the researcher be able to collected detailed information as to the influence of patients’ health education on TB drug adherence. The study will employ purposive sampling to sample the doctors and simple random sampling to select both the nurses and the patients who will participate in the study. The researcher will use one research instrument to collect data from the respondents selected to participate in the study which is a questionnaire that will be issued to the respondents on the day of the data collection.
The number of missed appointments in healthcare institutions in Nigeria caused problems, hence the need
for integrated healthcare system to intervene and provide seamless care for patients. Appointment
scheduling system lies at the intersection of providing efficiency and timely access to health services. This
research presents an online National Health Insurance Scheme (NHIS) Outpatient Medical Appointment
Booking System where NHIS patients can access and view any available personnel or doctor schedule in
order to book an appointment with the corresponding time as specified by the available doctor. The system
was developed using PhP, macromedia dreamweaver, apache and MYSQL. This is to ensure that the
application is robust, cheap and is able to run on different platforms. The system provides the platform to
facilitate the booking and management of patients’ appointment bookings. Patients can also view their
appointment reports. It also provides the healthcare workers an easy access to manage patients’
appointments and to generate relevant reports.
Implementation of Patient Safety Program as a Prevention and Controlling Heal...irjes
Hospital is a unique working area bringing health risk for the worker either of patient or visitor.
Society who received health service, health worker and visitor in hospital faced to the risk of occurrence
infection or nosokomial infection now called as Healthcare-Associated Infections (HAIs). The occurrence of
nosokomial infection in hospital is still on high level. The level of nosokomial infection in hospital for entire the
world showing improvement, it’s about 9% (variation 3 – 21 %) or more than 1.4 million inpatient spaces
(Depkes. 2009). The aimed of this study was to know the implementation of nosokomial infection prevention
program in supporting patient safety in Radjiman Wediodiningrat mental hospital.
Primer and secondary data was obtained from sanitation department and K3 of hospital, collected using
questionnaire interview sheet, polls, and observation using observation sheets. Data obtained using purposive
sampling technique. Data was analyzed by descriptive methode and presented into frequency distribution table.
The result of this research showed that Implementation of Patient safety in Outpatient and Inpatient mental
hospital of Wediodingrat Radjiman still less than optimal, infection Prevention and Control (PPI) at the
Outpatient and Inpatient room not been implemented. So It takes effort to improve the implementation of Patient
Safety in Outpatient and Inpatient especially in Anyelir, Napza, Camar, General clinic, Kemuning and VIP
room, required socialization, education and training on PPI programs in the room
Inadequate management of asthma can lead to physical handicap and death. The study aimedto assess knowledge and practice of
asthmatic participants for use meter dose inhaler device. A descriptive study involved 105 participants, conducted at public
hospitals in Khartoum state from July to October2014. Questionnaire and observational check list were used for data collection.
The study enrolled (51%) female and (49%) male. Most of participants their age group ranged, between 36 to 45 years, (35%)
were workers and (31%) received University education while 44 % had a chronic asthma. Level of participant’s knowledge was a
very good regard care and storage of the device; sequent (77% - 79%). There were(64%) had moderate level of knowledge for
preparation dose (69%) replacing inhaler device and cleaning mouthpiece (60%), while 56% had very poor knowledge to rinse
mouth after puff. A highly significant difference between the level of knowledge and education (P value<0.001) regard replacing
the inhaler device, and cleansing mouthpiece. All participants demonstrated correct technique of using inhaler device, position,
removed, pressed replacement the cap, shaking inhaler device and took deep breath. While half of them had moderate skill level
for opened mouth technique, continuous breathing and rinsed mouth after puffuse, and fewer of participants had poor technique
during repeating the puff. Most of participants reflected moderate to poor level of knowledge and have very good practice for
correct used inhaler meter device; this reveals the discrepancy between knowledge and practice.
Journal Club presentation in Nursing ResearchDhara Vyas
Journal presentation in Nursing Research,
Study of knowledge, attitude, anxiety & perceived mental healthcare need in Indian population during COVID-19 pandemic
Covid-19
Abstract
Introduction
Methodology
samples
Analysis
Impact of health education on tuberculosis drug adherenceSkillet Tony
Adherence is defined as the extent to which patients follow the instructions they are given for prescribed treatments. Until recently, adherence expertise was hard to find, assemble and empower. The study shall solely aim at investigating the influence of patients’ health education on Tuberculosis drug adherence. It will be guided by the following specific objectives; to identify the level of adherence among TB patients at MTRH, to assess the level of patient’s health education on TB drugs, to identify barriers of TB education, to investigate the challenges facing TB patients on treatment and to determine the level of training given to health workers on TB drug adherence. These objectives will enable the researcher to elaborate more on the topic and ensure that those who read through this research shall have a better perspective on the effects of health education on tuberculosis drug adherence. It will take place between the months of July and August. The study will target 17 doctors, 119 nurses and 143 patients of Tuberculosis. The study will employ a case study research design. The case study will enable the researcher be able to collected detailed information as to the influence of patients’ health education on TB drug adherence. The study will employ purposive sampling to sample the doctors and simple random sampling to select both the nurses and the patients who will participate in the study. The researcher will use one research instrument to collect data from the respondents selected to participate in the study which is a questionnaire that will be issued to the respondents on the day of the data collection.
The number of missed appointments in healthcare institutions in Nigeria caused problems, hence the need
for integrated healthcare system to intervene and provide seamless care for patients. Appointment
scheduling system lies at the intersection of providing efficiency and timely access to health services. This
research presents an online National Health Insurance Scheme (NHIS) Outpatient Medical Appointment
Booking System where NHIS patients can access and view any available personnel or doctor schedule in
order to book an appointment with the corresponding time as specified by the available doctor. The system
was developed using PhP, macromedia dreamweaver, apache and MYSQL. This is to ensure that the
application is robust, cheap and is able to run on different platforms. The system provides the platform to
facilitate the booking and management of patients’ appointment bookings. Patients can also view their
appointment reports. It also provides the healthcare workers an easy access to manage patients’
appointments and to generate relevant reports.
Implementation of Patient Safety Program as a Prevention and Controlling Heal...irjes
Hospital is a unique working area bringing health risk for the worker either of patient or visitor.
Society who received health service, health worker and visitor in hospital faced to the risk of occurrence
infection or nosokomial infection now called as Healthcare-Associated Infections (HAIs). The occurrence of
nosokomial infection in hospital is still on high level. The level of nosokomial infection in hospital for entire the
world showing improvement, it’s about 9% (variation 3 – 21 %) or more than 1.4 million inpatient spaces
(Depkes. 2009). The aimed of this study was to know the implementation of nosokomial infection prevention
program in supporting patient safety in Radjiman Wediodiningrat mental hospital.
Primer and secondary data was obtained from sanitation department and K3 of hospital, collected using
questionnaire interview sheet, polls, and observation using observation sheets. Data obtained using purposive
sampling technique. Data was analyzed by descriptive methode and presented into frequency distribution table.
The result of this research showed that Implementation of Patient safety in Outpatient and Inpatient mental
hospital of Wediodingrat Radjiman still less than optimal, infection Prevention and Control (PPI) at the
Outpatient and Inpatient room not been implemented. So It takes effort to improve the implementation of Patient
Safety in Outpatient and Inpatient especially in Anyelir, Napza, Camar, General clinic, Kemuning and VIP
room, required socialization, education and training on PPI programs in the room
Inadequate management of asthma can lead to physical handicap and death. The study aimedto assess knowledge and practice of
asthmatic participants for use meter dose inhaler device. A descriptive study involved 105 participants, conducted at public
hospitals in Khartoum state from July to October2014. Questionnaire and observational check list were used for data collection.
The study enrolled (51%) female and (49%) male. Most of participants their age group ranged, between 36 to 45 years, (35%)
were workers and (31%) received University education while 44 % had a chronic asthma. Level of participant’s knowledge was a
very good regard care and storage of the device; sequent (77% - 79%). There were(64%) had moderate level of knowledge for
preparation dose (69%) replacing inhaler device and cleaning mouthpiece (60%), while 56% had very poor knowledge to rinse
mouth after puff. A highly significant difference between the level of knowledge and education (P value<0.001) regard replacing
the inhaler device, and cleansing mouthpiece. All participants demonstrated correct technique of using inhaler device, position,
removed, pressed replacement the cap, shaking inhaler device and took deep breath. While half of them had moderate skill level
for opened mouth technique, continuous breathing and rinsed mouth after puffuse, and fewer of participants had poor technique
during repeating the puff. Most of participants reflected moderate to poor level of knowledge and have very good practice for
correct used inhaler meter device; this reveals the discrepancy between knowledge and practice.
Topic: Critical review of an ERP post-implementation Article (Grade Mark: Distinction of 79%)
Module: Research Principles and Practices
Sheffield Hallam University
If you are looking for Article critique on public health care, then you can check the complete presentation here or download from http://studentsassignmenthelp.co.uk/answers/article-critique-assignment-help/
Running head RESEARCH PAPER1RESEARCH PAPER15.docxtodd521
Running head: RESEARCH PAPER 1
RESEARCH PAPER 15
Assessment of the knowledge, practice, and the associated factors of Healthcare Acquired Infection Prevention
Name
Institutional Affiliation
Date
Table of Contents
Table of Contents 2
Assessment of the knowledge, practice, and the associated factors of Healthcare Acquired Infection Prevention in Blessings Healthcare Facility 4
The Problem 5
Significance of the problem 6
Purpose of this study 7
Research Questions 8
Masters Essentials aligned with the topic 8
Design 10
Literature Review 10
Methodology and the design of the study 13
Sampling Methods 14
Necessary tools 14
Any logarithm or flow map developed 15
Healthcare Facility 15
Implementation 15
Stage 1: Assessment of the current practices (One Week) 16
Stage 2: Identification of the factors leading to high cases of healthcare-acquired infection (5 days) 17
Stage 3: Pre-Training (Two Weeks) 17
Stage 4: Training (5 weeks) 17
Stage 5: an ongoing process of assessing the situation 18
Materials, activities and the cost 20
Results 21
Socio-demographics features of the research population 21
Knowledge concerning the infection prevention 23
Aspects related to the knowledge of the healthcare professionals regarding the issue of preventing healthcare-acquired infections 27
Limitation of the study 28
References 30
Assessment of the knowledge, practice, and the associated factors of Healthcare Acquired Infection Prevention
Healthcare acquired infection/nosocomial infection/hospital acquired infections are becoming a major international challenge in many healthcare facilities especially in the low or middle income nations. It is anticipated that around 10 percent of patients in the healthcare facilities from developing nations are developing healthcare acquired infections and this subsequently leads to negative impacts on healthcare outcomes. It also leads to increase hospital stay, economic burden, morbidity cases, and increase in the mortality incidences. Some of the common healthcare acquired infections include Hepatitis B and C virus, HIV infections, and even Tuberculosis which are often transmitted by healthcare workers who are not observing the practice related to the infection prevention measures.
According to the United States Center for Disease Control and Prevention, there are about 1.7 million patients who have been hospitalized as a result of acquiring infection within the facilities while undergoing treatment for other healthcare concerns. Many studies reveal that simple infection control procedures like cleaning of the hands using alcohol-based hand rub is helping in the prevention of the spread of the disease. The increase in the infection rate caused by the healthcare acquired infection is due to the poor practices of infection prevention and control, lack of knowledge or failure to implement knowledge related to the process of preventing and controlling nosocomial illnesses, and other associated f.
18
Annotated Bibliography
3164 words
Rough Draft on Infection Control
by
Submitted to
Semester
Date
Contact
Address
Phone
Email
Infection Control
2
Introduction of the Paper
Background
According to various reports by the Centers for Disease Control and Prevention, a significant number of lives are lost each passing year due to the spread of infections in hospitals that could otherwise have been prevented. 3 Therefore, effort geared towards understanding infection control plays a significant role in reducing the otherwise unnecessary loss of lives. Infection control entails the power to directly prevent or determine the spread of infections with the aim of avoiding it. 4 Indeed, the pathological state resulting from the invasion of the body by pathogenic microorganisms has far-reaching consequences. While so much has been done to prevent its spread, there is still a lot more to be done. This research paper intends to focus on Healthcare-associated Infections and how it can be prevented if not eliminated altogether.
Statement of the Problem
Healthcare-Associated Infections are a common occurrence in the modern healthcare setting resulting in huge financial losses and loss of lives. According to the Office of Disease Prevention and Healthcare Promotion (ODPHP), these are infections that patients contract while receiving treatment in a medical facility. Percival, Suleman, Vuotto & Donelli, (2015) pointed out that its prevalence is as a result of the employment of invasive devices and procedures meant to treat patients and to help them recover. 6 While most of them are accidental in nature, they still remain to be seen as accidents that could have been prevented. The US government, through the establishment of Healthy People 2020 and the U.S. Department of Health and Human Services (HHS) have taken a lead role in spreading the news on infection control. To that effect, recent research reveals that there could be a 70% reduction in infections by implementing existing prevention practices. This translates to a financial benefit estimated to be $31.5 billion in medical cost savings (ODPHP, 2019). Understanding these prevention measures should, therefore, be a priority to all healthcare practitioners. That is why this research study intends to shade more light on nosocomial infections. These are infections that occur within 48 hours upon admission into a hospital. They can also occur in three days of discharge or 30 days of operation. They affect one in every 10 patients admitted in a hospital. 5, 7
The rationale for addressing the issue
Addressing this issue is important to the health sector from a political, social as well as environmental perspective. As a matter of fact, its impact will be on a short term, interim basis and long term basis. Politically, health has always been a major subject of concern as it is used by voters to determine how best an administration has taken care of their needs. Establishing an infection contro.
8
Catheter-Associated Urinary Tract Infections (CAUTI)
Walden University
Leadership Competencies in Nursing and Healthcare
NURS-4220-5
Catheter-Associated Urinary Tract Infections (CAUTI)
The healthcare system must provide safe and quality care to all patients. For years, hospitals nationwide have struggled with healthcare-associated infections (HAIs). Since HAIs are considered preventable events in a hospital setting the Centers for Medicare and Medicaid Services (CMS) established reimbursement changes and hospitals are focusing more on patient safety practices and improving processes to have better patient outcomes (Thornlow & Merwin, 2009). According to The Centers for Disease Control and Prevention (CDC, 2017), approximately seventy-five percent of hospital-acquired urinary tract infections are associated with a urinary catheter with a prolonged use being the most critical risk factor for developing a CAUTI. Also, CAUTIs can cause an overabundance of complications included but not limited to gram-negative bacteremia, sepsis, and mortality (Skanlon, 2017). In a long-term acute care hospital (LTACH), prolonged and unnecessary use of indwelling urinary catheters is interrelated with a higher risk of catheter-associated urinary tract infections (CAUTI) and extended lengths of stay (LOS) (Felix, 2016). The purpose of this paper is to reduce the usage of indwelling catheter days and decrease CAUTI rates from 2.48 to below the target rate of 1.71 by utilizing prevention practices in a 72-bed long-term acute care hospital emphasizing on the assurance of a continuous improvement process. This proposal consists of implementing alternatives before deciding to insert an indwelling catheter, utilizing maintenance bundles, and daily assessment of the necessity of the catheter. All these interventions are aiming at preventing and decreasing catheter-associated urinary tract infections (CAUTIs).
The role of nurses in the prevention of CAUTIs is critical; we are the frontline of patient care and safety. Although, sometimes we encounter situations where a CAUTI occurs, the quality of care we provide to our patients reflects by the interventions we take to prevent our patients from getting an infection. Every action we make while providing care for a patient is an essential step in the quality of their care. Most patients admitted into long-term acute care have wounds or infections that require long-term antibiotics. These patients come in from acute care hospitals, and in the majority of the cases patients already have an indwelling urinary catheter, however, there are situations where the patient doesn’t come with an indwelling catheter, and nurses get orders to place one on admission. Finding alternatives to either discontinue or insert a foley is an essential part of the daily nursing assessment and on the hospitalization of these patients. Important factors to consider while assessing the patient are mobility, cognitive status, gender, and wounds.
L.
8
Catheter-Associated Urinary Tract Infections (CAUTI)
Walden University
Leadership Competencies in Nursing and Healthcare
NURS-4220-5
Catheter-Associated Urinary Tract Infections (CAUTI)
The healthcare system must provide safe and quality care to all patients. For years, hospitals nationwide have struggled with healthcare-associated infections (HAIs). Since HAIs are considered preventable events in a hospital setting the Centers for Medicare and Medicaid Services (CMS) established reimbursement changes and hospitals are focusing more on patient safety practices and improving processes to have better patient outcomes (Thornlow & Merwin, 2009). According to The Centers for Disease Control and Prevention (CDC, 2017), approximately seventy-five percent of hospital-acquired urinary tract infections are associated with a urinary catheter with a prolonged use being the most critical risk factor for developing a CAUTI. Also, CAUTIs can cause an overabundance of complications included but not limited to gram-negative bacteremia, sepsis, and mortality (Skanlon, 2017). In a long-term acute care hospital (LTACH), prolonged and unnecessary use of indwelling urinary catheters is interrelated with a higher risk of catheter-associated urinary tract infections (CAUTI) and extended lengths of stay (LOS) (Felix, 2016). The purpose of this paper is to reduce the usage of indwelling catheter days and decrease CAUTI rates from 2.48 to below the target rate of 1.71 by utilizing prevention practices in a 72-bed long-term acute care hospital emphasizing on the assurance of a continuous improvement process. This proposal consists of implementing alternatives before deciding to insert an indwelling catheter, utilizing maintenance bundles, and daily assessment of the necessity of the catheter. All these interventions are aiming at preventing and decreasing catheter-associated urinary tract infections (CAUTIs).
The role of nurses in the prevention of CAUTIs is critical; we are the frontline of patient care and safety. Although, sometimes we encounter situations where a CAUTI occurs, the quality of care we provide to our patients reflects by the interventions we take to prevent our patients from getting an infection. Every action we make while providing care for a patient is an essential step in the quality of their care. Most patients admitted into long-term acute care have wounds or infections that require long-term antibiotics. These patients come in from acute care hospitals, and in the majority of the cases patients already have an indwelling urinary catheter, however, there are situations where the patient doesn’t come with an indwelling catheter, and nurses get orders to place one on admission. Finding alternatives to either discontinue or insert a foley is an essential part of the daily nursing assessment and on the hospitalization of these patients. Important factors to consider while assessing the patient are mobility, cognitive status, gender, and wounds.
L ...
Evidence-Based Practice Project Student ExampleTab.docxSANSKAR20
Evidence-Based Practice Project Student Example
Table of Contents
Generating Evidence for Evidence-based Practice
Part 1: Introduction
1. The problem statement ………………………………….……………………....……….3
1. The evidence-based question ………………………………………..……….……….…4
Part 2:Assemble relevant evidence & related literature
1. Locating credible evidence………………………………………………….…...………3
1. Appraise the evidence……………………………………………………….……...……4
Part 3:Implementation of the intervention
1. Planning of change………………………………………………………………..…....8-9
1. Clinical protocol and pilot project………………………………………………9-14 & 23
1. Integration and Maintenance …………………………………………………….…..14-15
1. Barriers and strategies………………………………………………….……………15-18
Part 4: Conclusion ………………………………………………..…………………………….18
Part 5: References……………………………………………………………………………20-22
Part 6: Appendices …………………………………………………………..…………….……23
I. Management of Mechanically Ventilated Patients: Pilot Project ……………………23-24
II. Questions for Patient Ventilator Rounds ………………………………………………..25
III. Methodological matrix ………………………………………………………………26-28
IV. Prevention In-Service Flyer ………………………………………………………….…29
Problem Statement
The development of pneumonia caused by mechanical ventilation is a significant problem in the intensive care units of hospital facilities. Ventilator-associated pneumonia (VAP) is the “most commonly reported healthcare-acquired infection” in patients requiring mechanical ventilation support (Garcia et al., 2009, p. 524). One of the most common reasons for an ICU admission is related to respiratory distress or failure. VAP is described as a form of nosocomial infection which occurs after the first 48 hours of receiving mechanical ventilation (Augustyn, 2007). The length of stay (LOS) for patients developing VAP is higher than those never requiring mechanical ventilation by an increase of approximately six days (Garcia et al. 2009). In intensive care units (ICUs) across the United States (US), ventilator-acquired pneumonia also results in prolonged periods of actual mechanical ventilation, the excess use of antimicrobial products, increased utilization of healthcare resources and costs, and significant increase in morbidity and mortality (Coffin et al., 2008). Garcia et al. (2009) found on average, estimated costs of an additional $11, 897 to $150,841 per individual case were spent. VAP has a significant economic impact on our society, costing hospitals money which potentially could have been saved.
Numerous risks factors contribute to the development of ventilator-acquired pneumonia as mechanical ventilation presents a unique set of challenges for the patient requiring intubation and ventilator support. Rigorous clinical studies show oral secretions pose an increased risk for developing VAP (Augustyn, 2007). Treatments, strategies and evidence-based interventions have been developed to decrease the risks and reduce the prevalence of VAP. There is evidence indicating the use of oral chlorhexidine and the removal of ora ...
Evidence-Based Practice Project Student ExampleTab.docx
NURS 411_rachel_bowe Assignment 6
1. Running head: PNEUMONIA PREVENTION POLICY CRITIQUE 1
Pneumonia Prevention Policy Critique
Rachel Bowe
NURS 411: Evidence-Based Practice for Nurses
May 3, 2016
Professor Alison Pittman
2. PNEUMONIA PREVENTION POLICY CRITIQUE 2
Abstract
The policy on nosocomial pneumonia prevention by The University of Texas Medical Branch
covers the topics of person to person transmission of bacteria, prevention of aspiration,
prevention of postoperative pneumonia, and the proper disinfection and sterilization of
equipment. The evidence revealed key elements of the policy were not up to par with current
evidence based practice. There was no comprehensive oral care plan, no requirement for
continuous cuff pressure at a set range, and there were ventilator bundle practices missing. The
policy will reduce the incidence of nosocomial pneumonia once it is updated to reflect current
evidence based practices.
3. PNEUMONIA PREVENTION POLICY CRITIQUE 3
Pneumonia Prevention Policy Critique
Nosocomial pneumonia has the “highest mortality among all nosocomial infections
ranging from 20% to 50%,” (Nair & Niederman, 2013). Nosocomial pneumonia is a costly,
deadly, and preventable complication that can affect many susceptible patients in health care
facilities. Decreasing the incidence of nosocomial pneumonia would decrease patient mortality,
as well as decrease the extra costs to hospitals that could be put to use in other health care areas.
Nosocomial pneumonia can be linked to various unsafe practices in health care from simple poor
hand hygiene to improper management of at risk patients such as postoperative and high
aspiration risk patients. The prevalence of nosocomial pneumonia in health care facilities is a
testament to the need for hospitals to update policies and procedures to current evidence based
practices on a regular basis.
The University of Texas Medical Branch has created a policy to prevent nosocomial
pneumonia in their health care facilities. The policy is designed to address all areas of care from
general healthcare professionals to specialties. The policy is meant to be comprehensive in
nature by directing attention to the main causes of nosocomial pneumonia in health care
facilities. Evidence has been compiled and synthesized, and realistic recommendations have
been made to improve the policy based on current evidence based practices. The evidence can
be accessed in an evidence grid found in Appendix B.
Policy Overview
“Prevention of Nosocomial Pneumonia”, provided in Appendix A, is a hospital policy
designed to decrease the cases of pneumonia and other respiratory infections during hospital
stays (University of Texas Medical Branch, 2004/2009). The policy focuses on preventing the
4. PNEUMONIA PREVENTION POLICY CRITIQUE 4
spread of bacteria, aspiration prevention, postoperative pneumonia prevention, and proper
sterilization of equipment.
Nurses in any clinical department will adhere to this guideline throughout normal shift
work by following standard precautions of care and proper hygiene. This includes effective amd
timely cleaning of the equipment used or patient centered interventions to improve lung function
and decrease the risk of infection. Nurses are expected to be knowledgeable on proper procedure
and timelines for sterilizing and cleaning the equipment used by the patient to prevent the spread
of infection. The target population for the policy includes any hospital inpatients with a focus
on patients at risk for aspiration or postoperative patients. Nurses treating these patients may use
more direct interventions focused on preventing pneumonia.
The Center for Disease Control’s guideline on prevention of noscomial pneumonia
published in 2003 is the only cited source for the policy. One reference for an important policy
such as this is not sufficient. The reference is from a credible source but is more than a decade
old. The policy was drafted in 2004 and last reviewed and revised on 04/06/09.
Synthesis of Evidence
There were 5 research studies found to be relevant to the topic of nosocomial pneumonia
prevention, this included 3 qualitative studies, 1 quantitative study, and 1 national guideline. All
of the studies discussed ways to improve nosocomial pneumonia prevention within the
healthcare field. Information on all articles in the form of an evidence grid can be found in
Appendix B.
The policy includes information on oral care using an antiseptic agent, such as
chlorhexidine, which complies with the research that Jaiyindee, Morkchareonpong, Tantipong,
and Thamlikitkul (2008) published discussing the use of 2% chlorhexidine rather than normal
5. PNEUMONIA PREVENTION POLICY CRITIQUE 5
saline in oral care. In the randomized control trial there were 207 patient participants, 102 of the
patient participants received chlorhexidine while the other 105 patient participants received
normal saline during mechanical ventilation. The rate of VAP went form 11.4% with normal
saline oral cleansing to 4.9% with 2% chlorhexidine oral cleansing (p=0.08) (Jaiyindee,
Morkchareonpong, Tantipong, and Thamlikitkul, 2008).
There are no specific guidelines regarding the oral or dental care regimen which refutes
the research in the experiment conducted by Garcia et al. (2009). There were 759 adult patient
participants that were mechanically ventilated for more than 48 hours. The rate of VAP went
from 12 per 1000 ventilator days to only 8 per 100 ventilator days (p=0.06), proving that the
dental and oral care protocol was successful in reducing the incidence on VAP (Garcia et al.,
2009).
There is no mention of maintaining continuous cuff pressure or a set cuff pressure
guideline in mechanically ventilated patients within the policy. Lorente et al. (2014) revealed in
a study that continuous cuff pressure helped to decrease VAP incidence of mechanically
ventilated patients. There were 248 patients observed, 150 of those patients received continuous
pressure while 138 received intermittent cuff pressure. Results revealed that the incidence of
VAP went from 22.0% with intermittent cuff pressure to 11.2% with continuous cuff pressure
(p=0.02) (Lorente et al., 2014).
Gurses et al. (2008) performed semi-structured interviews to determine the main reasons
for non-compliance for four hospital acquired infections, one of which is VAP. There were 20
interviews with various medical professionals including attending physicians, infection control
practitioners, respiratory therapists, and pharmacists. The results revealed that there were five
main areas of confusion that increased task non-compliance. These five areas include the task,
6. PNEUMONIA PREVENTION POLICY CRITIQUE 6
their responsibility, the expectation, the methods, and exception ambiguity. The policy itself
existing could help to prevent non-compliance by providing an education reference; it includes
exceptions, specific responsibilities, methods, and tasks (Gurses et al., 2008). The hospital
included no other information regarding required education on the subject. There were no points
of contact for further education on the subject as well.
The policy includes portions of the ventilator bundle suggested in the Institute for
Clinical Systems Improvement (2011) national guideline on VAP prevention. There are
specifics for head of bed angle, oral antiseptic care, and less frequent circuit changes. There are
not any specifics for endotracheal cuff pressure, use kinetic bed therapy, or venous
thromboembolism prevention (Institute for Clinical Systems Improvement, 2011).
Recommendations for Practice
There are no specific guidelines regarding the oral or dental care regimen which refutes
the research in the level III quasi-experiment conducted by Garcia et al. (2009). There should be
a detailed regimen of dental and oral care in the policy which can reduce the risk of VAP in
mechanically ventilated patients. This is based on the statistically significant (p=0.06) results of
the experiment performed (Garcia et al., 2009). This could include cleaning products,
procedures, exceptions, and time frames.
There is no mention of maintaining continuous cuff pressure or a set cuff pressure
guideline in mechanically ventilated patients in the policy which should be included in a
ventilator bundle. Lorente et al. (2014) revealed statistically significant results (p=0.02) in a
Level IV perspective observational study that continuous cuff pressure helped to decrease VAP
incidence in the mechanically ventilated patients (Lorente et al., 2014). There should be a set
7. PNEUMONIA PREVENTION POLICY CRITIQUE 7
range for the cuff pressure to be maintained and a time frame for what is considered continuous
for mechanically ventilated patients in the policy.
The policy includes portions of the ventilator bundle suggested in the Institute for
Clinical Systems Improvement (2011) Level I national guideline on VAP prevention. There are
specifics for head of bed angle, oral antiseptic care, and less frequent circuit changes. There are
not any specifics for endotracheal cuff pressure, use kinetic bed therapy, or venous
thromboembolism prevention (Institute for Clinical Systems Improvement, 2011). The inclusion
of these practices into the ventilator bundle could reduce the risk of VAP by preventing
pulmonary embolisms from venous thromboembolisms, preventing atelectasis and fluid build-up
in the lungs from immobility, and reduce the risk of aspiration of secretions. The policy should
include specifications on kinetic bed therapy including frequency and procedure, venous
thromboembolism prevention including medications and devices used, and the range for the cuff
pressure that should be maintained (20-25 cm H2O).
According to the level VII evidence from the semi-structured interview and grounded
theory based qualitative study by Gurses et al. (2008) including information on areas of
ambiguity and providing additional resources reduces non-compliance to key policies (Gurses et
al., 2008). To accomplish this, the hospital should provide information on proper procedure,
responsibilities, and exceptions for new requirements such as the oral and dental care of
mechanically ventilated patients. Educational resources that are simple such as overviews or
pictorial aides should be placed in areas of the hospital that will be performing these procedures
frequently. The policy should contain a point of contact for further questions and education on
the topic as well.
8. PNEUMONIA PREVENTION POLICY CRITIQUE 8
Polit and Beck (2014) provided the information for all the level of evidence for the
research provided (Polit & Beck, 2014).
Conclusion
The policy on preventing nosocomial pneumonia produced by The University of Texas
Medical Branch is designed to reduce the incidence of nosocomial pneumonia in the health care
setting. The policy covers many areas of health care from standard precautions to specialty
practices such as disinfection and sterilization of equipment or care of ventilated patients. The
policy is supported by the evidence provided in the instance of oral care with an antiseptic. The
policy should update the information to include an in-depth oral and dental care regimen, a
complete ventilator bundle including kinetic bed therapy, venous thromboembolism prevention,
and continuous cuff pressure at 20-25 cm H2O. To accompany these changes the hospital should
provide educational resources to reduce non-compliance. The hospital should conduct further
research into nosocomial pneumonia prevention to provide numerous current resources on
evidence based practices in this field. The research and policy should be updated at least every
3-5 years since this subject is not only of great importance but is constantly changing with
updated evidence based practices and procedures as well as current technology and
pharmacology.
9. PNEUMONIA PREVENTION POLICY CRITIQUE 9
References
Garcia, R., Jendresky, L., Colbert, L., Bailey, A., Zaman, M., & Majumder, M. (2009).
Reducing ventilator-associated pneumonia through advanced oral-dental care: a 48-
month study. American Journal of critical care, 18(6), 523-532.
Gurses, A. P., Seidl, K. L., Vaidya, V., Bochicchio, G., Harris, A. D., Hebden, J., & Xiao, Y.
(2008). Systems ambiguity and guideline compliance: a qualitative study of how
intensive care units follow evidence-based guidelines to reduce healthcare-associated
infections. Quality and Safety in Health Care, 17(5), 351-359.
Institute for Clinical Systems Improvement (ICSI). Prevention of ventilator-associated
pneumonia. Health care protocol. Bloomington (MN): Institute for Clinical Systems
Improvement (ICSI); 2011 Nov. 29
Lorente, L., Lecuona, M., Jiménez, A., Lorenzo, L., Roca, I., Cabrera, J., Llanos, C., & Mora, M.
L. (2014). Continuous endotracheal tube cuff pressure control system protects against
ventilator-associated pneumonia. Critical Care (London, England), 18(2), R77.
doi:10.1186/cc13837
Nair, G. B., & Niederman, M. S. (2013). Nosocomial pneumonia: lessons learned. Critical care
clinics, 29(3), 521-546.
Polit, D. F. & Beck, C.T. (2014). Essentials of nursing research: Appraising evidence in
nursing practice (8th ed.). Philadelphia, PA: Lippincott Williams & Wilkins.
Tantipong, H., Morkchareonpong, C., Jaiyindee, S., & Thamlikitkul, V. (2008). Randomized
controlled trial and meta-analysis of oral decontamination with 2% chlorhexidine solution
for the prevention of ventilator-associated pneumonia. Infection Control & Hospital
Epidemiology, 29(02), 131-136.
10. PNEUMONIA PREVENTION POLICY CRITIQUE 10
University of Texas Medical Branch. (2009). Prevention of nosocomial pneumonia, 1.40.
Retrieved from http://www.utmb.edu/policies_and_procedures/Non-
IHOP/Healthcare_Epidemiology/01.40%20-%20Pneumonia%20Prevention.pdf
(Original work published 2004)
16. Running head: PNEUMONIA PREVENTION POLICY CRITIQUE 16
Appendix B: Evidence Grid
Citation (APA) Purpose Sample Design Measurement Results/Conclusions Level of
Evidence
Garcia, R., Jendresky, L.,
Colbert, L., Bailey, A.,
Zaman, M., & Majumder,
M. (2009). Reducing
ventilator-associated
pneumonia through
advanced oral-dental care:
a 48-month
study.American Journal
of critical care, 18(6),
523-532.
Determine if an
in-depth oral and
dental care
protocol reduces
ventilator-
associated
pneumonia
N=759
Adult patients
receiving
mechanical
ventilation for more
than 48 hours in
ICU at a university-
affiliated medical
center
Quasi-
experimental
Collected intubation date,
extubation date, MICU
admission, transfer, or
death
Measured temperature,
leukocyte levels
(leukocytosis), perform
sputumculture, and chest
radiography to diagnose
VAP
Primary outcomes
measured is the rate of
VAP
Secondary outcomes
measured include length
of stay in ICU, duration
of ventilation, and ICU
mortality
Three tiers of review –
surveillance infection
control professional,
assistant directorof
infection control and 4
pulmonary specialists
rate of ventilator-associated
pneumonia was 12 per 1000
ventilator days prior to the study
rate of ventilator-associated
pneumonia was 8 per 1000
ventilator days during the study
p=0.06
the in-depth dental and oral care
protocol can decrease ventilator-
associated pneumonia incidence
and cost
Level III
Gurses, A. P., Seidl, K.
L., Vaidya, V.,
Bochicchio, G., Harris, A.
D., Hebden, J., & Xiao,
Y. (2008). Systems
Identify the main
reasons for non-
compliance of
guidelines for four
hospital acquired
N=20
3 attending
physicians,2
infection control
practitioners, 2
Semi-structured
interviews
Grounded
Theory
Analyzed data collected
using open coding,axial
coding, and selective
coding
Task, responsibility, expectation,
methods, and exception ambiguity
increase non-compliance
Clarify expectations with
education, use visual cues,
Level VII
17. PNEUMONIA PREVENTION POLICY CRITIQUE 17
ambiguity and guideline
compliance: a qualitative
study of how intensive
care units follow
evidence-based guidelines
to reduce healthcare-
associated
infections. Quality and
Safety in Health
Care, 17(5), 351-359.
infections respiratory
therapists,and 2
pharmacists in two
surgical intensive
care units in two
urban hospitals
Final categorization
structure agreed on by all
authors of study
overview tools, standardized
orders, and role clarification
decrease ambiguity
Institute for Clinical
Systems Improvement
(ICSI). Prevention of
ventilator-associated
pneumonia.Health care
protocol.Bloomington
(MN): Institute for
Clinical Systems
Improvement (ICSI);
2011 Nov. 29
Ventilator-
associated
pneumonia
prevention
guideline
Hospitals should consistently use
ventilator bundles to decrease
ventilator associated pneumonia
incidence.
Head of bed at 30-45 degrees
Cuff pressure maintained at 20-25
cm H2O
Less frequent circuit changes
Provide oral care with an
antiseptic such as chlorhexidine
Provide kinetic bed therapy
Provide venous thromboembolism
prophylaxis to prevent pulmonary
embolism
Level I
Lorente, L., Lecuona, M.,
Jiménez, A., Lorenzo, L.,
Roca, I., Cabrera, J.,
Llanos, C., & Mora, M. L.
(2014). Continuous
endotrachealtube cuff
pressure control system
protects against
ventilator-associated
pneumonia. Critical Care
(London,England),18(2),
To determine if
the use of
continuous
endotrachealcuff
pressure has an
effect on the
incidence of
ventilator-
associated
pneumonia
N=248
150 Continuous cuff
pressure patients
138 intermittent cuff
pressure patients
Patients undergoing
mechanical
ventilation for more
Nonexperimental
(prospective
observational)
Multivariate logistic
regression analysis
(MLRA) and Cox
proportional hazard
regression analysis used
to predict VAP.
Tracheal aspirate samples
during intubation, twice
per week, and on
extubation.
Throat swabs taken on
Lower incidence of ventilator-
associated pneumonia with
continuous cuff pressure (11.2%)
rather than intermittent cuff
pressure (22.0%)
P=0.02
Therefore continuous cuff
pressure reduces the rate of VAP
in patients ventilated for more
than 48 hours.
Level IV
18. PNEUMONIA PREVENTION POLICY CRITIQUE 18
R77.doi:10.1186/cc13837 than 48 hours in
ICU.
admission to ICU, twice
per week, and at
discharge from the unit.
Outcomes measured
include rate of VAP
Tantipong, H.,
Morkchareonpong,C.,
Jaiyindee, S., &
Thamlikitkul, V. (2008).
Randomized controlled
trial and meta-analysis of
oral decontamination with
2% chlorhexidine solution
for the prevention of
ventilator-associated
pneumonia. Infection
Control & Hospital
Epidemiology,29(02),
131-136.
To assess if use of
2% oral
chlorhexidine
decreases
ventilator-
associated
pneumonia
incidence
N=207
102 chlorhexidine
patients
105 normal saline
patients
Adult patients
receiving
mechanical
ventilation in ICU or
general medical
wards in a tertiary
university hospital
in Bangkok,
Thailand
Experimental
(Randomized
control trial) and
meta-analysis
Measured the
development of VAP and
colonization of gram-
negative bacilli.
Meta-analysis was
performed by combining
the results of the present
study with one other
RCT that used 2%
chlorhexidine
formulation for oral
decontamination
2% chlorhexidine is effective for
oral care to reduce ventilator-
associated pneumonia
rate of 4.9% ventilator-associated
pneumonia in chlorhexidine group
rate of 11.4% ventilator-associated
pneumonia in normal saline group
p=0.08
Level II