1. PICOT Paper-Preventing VAP in ICU Settings.
PICOT Paper-Preventing VAP in ICU Settings. This is the requirements for the assignment
copied and pasted from my instructor's website. I have also included an attachment of my
PICOT question in which my paper must be based upon.APA Formatted paper will include -
Title PageFirst Level Headings –Title of the Paper - centered not boldedClinical Significance
- centered boldedReview of the Literature - centered boldedImplications to Nursing
Practice - centered boldedImplications to Patient Outcomes - centered boldedReferences -
centered not boldedORDER NOW.PAPER WILL BE SUBMITTED TO THE UTK PLAGIARISM
SOFTWARE APPLICATION IN CANVASAssignment Components–Identify an area of interest
and Clinical SignificanceFormulate a PICO question.Examination of current
literatureIdentify the implications to nursing practice and patient outcomesAssignment
Components Explained –1. Identify an area of interest and Clinical SignificanceChoose a
topic of interest which you want to learn more about and that that you feel there is a need to
provide evidence for within your clinical practice.PICOT Paper-Preventing VAP in ICU
Settings.2. Formulate a PICO question.Frame your problem and focus on what it is you want
to find out.Use the P-I-C-O-T method of asking the question:P – Population or disease of
interest, for example age, gender, ethnicity, with certain disorderI – Intervention or issue of
interest for example- therapy, exposure to disease, risk behaviorC – Comparison
intervention or issue of interest. What do you want to compare the intervention or issue
against, for example alternative therapy, placebo, or no intervention/therapy, no disease,
absence of risk factor?O –Outcome of interest, for example outcome expected from therapy,
risk of disease, accuracy of diagnosis, rate of occurrence or adverse outcomeT –Time. Some
questions might include a time frame to demonstrate an outcome, such as the time it takes
for the intervention to achieve the outcome, the time over which populations are observed
for the outcome to occur; given a certain condition. PICOT Paper-Preventing VAP in ICU
Settings.Examples:In patients living in a long-term care facility who are at risk for pressure
ulcers (P), how does a pressure ulcer prevention program (I) compared to the standard of
care (e.g., turning every 2 hours) (C) affect signs of emerging pressure ulcers (O) during
hospitalization (T)?In patients who have a family history of obesity (BMI>30) (P), how does
dietary carbohydrate intake (I) predict healthy weight maintenance (BMI<25) (O) over six
months (T)?3. Examination of current literatureFIVE (5) ORIGINAL NURSING RESEARCH
articles minimumCritique and synthesize the literature.Research articles must be peer
reviewed original nursing research articles. Meta-analysis, editorials, opinion pieces,
systematic reviews, and reviews of the literature are NOT acceptable.Look for articles
2. written by researchers who are reporting on their original research that includes study
purpose or aim, sample, method, findings or results, and discussion. You will see these exact
words in both the abstract and the body of the paper.PICOT Paper-Preventing VAP in ICU
Settings.Analyze the research report by applying your research knowledge. Compare and
contrast the results of the various studies in your literature review. Was the literature
consistent? Were there various or perhaps contradictory results?Critique and synthesize
the literature. Analyze the research report by applying your research knowledge. Compare
and contrast the results of the various studies in your literature review. Was the literature
consistent? Were there various or perhaps contradictory results?Extensive repetition or
summarization of the research article will result in point deduction.4. Identify the
implications to nursing practice and patient outcomes -Include with the poster a section
describing the implications to nursing practice and patient outcomes.There is also a
component of a poster that must be done on a single powerpoint slide, I have also attached
an example from the instructor's page.Preventing VAP In Adult Intubated Patients in ICU
SettingsPatients who are critically ill, unconscious or under sedation during treatment in
ICU settings require ventilator machines support to breathe properly. However, intubation
or mechanical ventilation exceeding 48 hours can result in VAP, a life-threatening
complication characterized by changes in sputum, signs of systemic infection and persistent
infiltration (Alimi et al., 2016). VAP accounts for half of the nosocomial-acquired pneumonia
incidences, with an estimated prevalence that ranges between 9-27% with the highest risk
occurring within the first five days of admission (Hoshijima et al., 2013). VAP jeopardizes
patient safety, causes inefficiencies in healthcare organizations and reduces the quality of
care.PICOT Paper-Preventing VAP in ICU Settings.According to the CDC, the most significant
mechanism that is responsible for VAP is aspirating oropharyngeal organisms into the distal
bronchi, a clear revelation that VAP is associated with contamination of the oral cavity with
pathologic bacteria during the intubation process. Therefore, existing literature emphasizes
on maintaining oral hygiene with 0.2% oral chlorhexidine before intubation to reduce the
risks of VAP. According to Zuckerman (2016), chlorhexidine is notably an antibacterial
agent with broad-spectrum properties extensively used as an oral rinse in healthy people to
treat and prevent gingivitis and control dental plaque.PICOT Paper-Preventing VAP in ICU
Settings.Clinical SignificanceAs the most significant HAI in ICU settings. Its incidence ranges
between 9-27% and the mortality rate among mechanically ventilated patients surpasses
50% (Hoshijima et al., 2013). VAP is linked to prolonged hospitalization, high mortality and
morbidity rates and increases the costs of treatment. Thus, VAP is still a medical issue of
significance that requires preventive interventions to limit its occurrence despite the
advancements made in its diagnosis and treatment.Review of LiteratureAccording to Alimi
et al. (2016), concurrent oronasal disinfection using chlorhexidine gives no significant
outcomes in comparison to independent disinfection of the oral cavity, despite the clinical
variations noted in the outcomes. Alimi et al. (2016) observed the following variables that
indicate VAP in their study: leukopenia/leukocytosis, hypothermia/hyperthermia,
pulmonary infiltration as observed in a chest radiograph and purulent tracheal discharge. In
the intervention group, these variables were less frequent. They further recommend that to
reduce the risks of VAP, VAP-associated morbidity and reduce the length of ICU stay, nurses
3. should practice the routine use of oral chlorhexidine to maintain oral hygiene.PICOT Paper-
Preventing VAP in ICU Settings.Villar et al. (2016) had similar findings but emphasize that
reducing VAP in adults is effective when oral chlorhexidine is administered four times daily
or at 2%. However, due to the heterogeneity of the study and had a limited number of RCTs
which examined the effectiveness and safety of 2% chlorhexidine or four times daily
administration, they suggest the need to interpret their finding cautiously. Before making
any definite recommendations, Villar et al. (2016) further recommend that further studies
should investigate intervention protocols that implement oral chlorhexidine at high
frequency and concentration to reduce VAP.PICOT Paper-Preventing VAP in ICU
Settings.The study by Zuckerman (2016) had a comprehensive outcome that supports using
CHX for VAP prevention among adult patients in ICU settings. By using oral chlorhexidine,
Zuckerman (2016) found a decrease patient VAP rates that was statistically significant. He
further suggests that oral CHX is an essential component of VAP bundles that must be
encouraged when managing patients in the ICU. However, Zuckerman (2016) emphasizes
that providers should comprehend how it correctly. It must be given orally with a sponge
swab round the oral cavity and tongue of patients under mechanical ventilated or
intubation. Besides, therapy should start instantaneously following intubation and progress
until extubation to prevent VAP. Zuckerman (2016) found that oral chlorhexidine should be
administered four times daily to have the most beneficial outcomes for preventing VAP, a
finding that is similar to that of Villar et al. (2016).PICOT Paper-Preventing VAP in ICU
Settings.Hoshijima et al. (2013) acknowledge VAP as the most common primary cause of
deaths and in adult patients admitted in the ICU. They conducted a meta-analysis of RCTs
that evaluated how effective and efficacious CHX is in preventing VAP. Their study
illustrated that oral CHX reduced VAP incidences in intubated patients at a concentration of
0.12-0.2% and this was consistent in both non-surgical and post-cardiac patients. However,
they found no overall reduction in VAP associated mortality from using oral
chlorhexidine.According to the study by Li et al., (2015), oral hygiene with CHX is linked
with a 28% reduced risk of VAP and has an enhanced effectiveness to prevent early-onset
than late-onset VAP. The findings further reveal that, in patients who have undergone
cardiac surgery, chlorhexidine 0.12% is the recommended concentration. However, in non-
cardiac patients in ICU settings, higher concentrations especially 2% is effective in reducing
VAP prevalence.Implications to Nursing PracticeBased on the findings of the literature
review, it is right to conclude that the clinical criteria of VAP such as: pulmonary infiltration,
purulent endotracheal discharge and WBC count outside the normal range decreased
significantly in the intervention groups. The incidences of VAP, VAP-associated mortality
and morbidity and reduced length of ICU stay also reduced significantly in the intervention
groups, an outcome that was clinically significant. This outcome indicates the clinical
significance and essence of nurses routinely disinfecting the oral cavity of adult patients in
the ICU under mechanical ventilation or intubation with 2% oral chlorhexidine or oral
chlorhexidine administered four times daily.The findings of the literature also reveal that it
is essential to be informed on the most recent literature that supports evidence-based
practice to improve patient care and interventions. This increases nurses’ ability to conduct
patient assessments and management as well as to educate other ICU staff on oral CHX to
4. prevent VAP. This is a perfect example of a strategy that nurses can implement in clinical
settings to prevent avoidable harm to patients.PICOT Paper-Preventing VAP in ICU
Settings.Besides, nurses should take part in daily rounds, assess patients, work with other
ICU staff for system-wide implementation of this change, and cultivate a spirit of
collaboration for VAP prevention. This promotes the ability of nurses to function as a link
between patients and all ICU staff to ensure that patients receive complete care with
positive outcomes in preventing VAP.Implications for Patient OutcomesVAP is a major
contributor to mortality and morbidity of patients in ICU settings as well as a principal
cause of HAIs deaths. Therefore, it is vital to consider it in discussions that involve patients’
outcomes. To minimize the risks, healthcare providers should focus on early extubation and
using 2% oral chlorhexidine with most notable patient outcomes as reduced incidences of
VAP, reduced length of ICU stay, decreases the intubation period, reduces healthcare costs,
and decreases VAP-associated mortalities and morbidities.PICOT Paper-Preventing VAP in
ICU Settings.
