scholarly journals Nursing in Intensive Care Unit: Exploring Factors Related to Ventilator-Associated Pneumonia

2020 ◽  
Author(s):  
Yanling Yin ◽  
Meirong Sun ◽  
Zhe Li ◽  
Jingjing Bu ◽  
Yuhong Chen ◽  
...  
Keyword(s):  
Quality Control ◽  
Intensive Care ◽  
Nursing Staff ◽  
Pearson Correlation ◽  
Oral Care ◽  
Hebei Province ◽  
Ventilator Associated Pneumonia ◽  
Suction Tube ◽  
Tertiary Hospitals ◽  
Nursing Training

Abstract Background:Most patients hospitalized intensive care units require mechanical ventilation.Ventilator-associated pneumonia is the most common and severe complication of mechanical ventilation.Nursing factors are closely related to the incidence of this type of pneumonia.Objectives:To explore nursing risk factors associated with ventilator-associated pneumonia(VAP ).Committing to provide the basis for future nursing training and quality control for technical offices.Methods:Through the quality control platform of Hebei province, questionnaires were sent to the intensive care nurses in 37 tertiary hospitals(5 hospitals were excluded due to incomplete information) in Hebei province,China, to collect the incidence of VAP and the nursing status of them from January to December 2019. All date was analyzed using an independent t-test, ANOVA, and Pearson correlation.Resluts:Two central themes were derived from the data analysis:Nurse human resources and standard of nursing practice.The incidence of VAP was higher when the proportion of nurses working less than five years and the number of nurses working night shifts increased(P = 0.000). The incidence of VAP was lower when the sputum suction tube radius was smaller and the selected oral care solution had disinfection effect(P = 0.000).Conclusions:The incidence of VAP is closely related to nursing factors.Choose different thickness of sputum suction tube and oral nursing liquid will lead to different outcomes.In addition, different nursing staff structure and scheduling mode will directly affect the incidence of VAP.Therefore, we should continue to standardize and unify nursing operation, and optimize nursing staff structure and scheduling mode.

Nurses’ Implementation of Guidelines for Ventilator-Associated Pneumonia From the Centers for Disease Control and Prevention

2007 ◽  
Vol 16 (1) ◽  
pp. 28-37 ◽  
Author(s):  
Carolyn L. Cason ◽  
Tracy Tyner ◽  
Sue Saunders ◽  
Lisa Broome
Keyword(s):  
Intensive Care ◽  
Disease Control ◽  
Intensive Care Units ◽  
Oral Care ◽  
The United States ◽  
Hand Washing ◽  
Ventilator Associated Pneumonia ◽  
Care Protocol ◽  
Control And Prevention ◽  
Centers For Disease Control

• Background Ventilator-associated pneumonia accounts for 47% of infections in patients in intensive care units. Adherence to the best nursing practices recommended in the 2003 guidelines for the prevention of ventilator-associated pneumonia from the Centers for Disease Control and Prevention should reduce the risk of ventilator-associated pneumonia. • Objective To evaluate the extent to which nurses working in intensive care units implement best practices when managing adult patients receiving mechanical ventilation. • Methods Nurses attending education seminars in the United States completed a 29-item questionnaire about the type and frequency of care provided. • Results Twelve hundred nurses completed the questionnaire. Most (82%) reported compliance with hand-washing guidelines, 75% reported wearing gloves, half reported elevating the head of the bed, a third reported performing subglottic suctioning, and half reported having an oral care protocol in their hospital. Nurses in hospitals with an oral care protocol reported better compliance with hand washing and maintaining head-of-bed elevation, were more likely to regularly provide oral care, and were more familiar with rates of ventilator-associated pneumonia and the organisms involved than were nurses working in hospitals without such protocols. • Conclusions The guidelines for the prevention of ventilator-associated pneumonia from the Centers for Disease Control and Prevention are not consistently or uniformly implemented. Practices of nurses employed in hospitals with oral care protocols are more often congruent with the guidelines than are practices of nurses employed in hospitals without such protocols. Significant reductions in rates of ventilator-associated pneumonia may be achieved by broader implementation of oral care protocols.

scholarly journals Oral Care Effect on Intubated Patient with 0.2 per cent Chlorhexidine Gluconate and Tooth Brushing in Intensive Care Unit

2017 ◽  
Vol 8 (1-2) ◽  
pp. 26-33
Author(s):  
Mohammad Khan ◽  
Zeehaida Mohamed ◽  
Saedah Ali ◽  
Norkhafizah Saddki ◽  
Sam’an Malik Masudi ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Oral Care ◽  
Chlorhexidine Gluconate ◽  
Tooth Brushing ◽  
Control Group ◽  
Ventilator Associated Pneumonia ◽  
Statistical Software ◽  
Patient Screening ◽  
Experimental Group

Aims and Objectives: Ventilator-associated pneumonia is associated with increased morbidity and mortality. The aim of this pilot study was to determine the effectiveness of oral care with both tooth brushing and 0.2 per cent chlor-hexidine gluconate compared to 0.2 per cent chlorhexidine gluconate alone for the intubated patient in an intensive care unit (ICU). Materials and Methods: Patient screening was done over a period of two months. After taking informed consent, those ICU patients were divided into two groups. Only nine subjects were enrolled. During the study, the experimental group (N = 4) got oral care that consisted of both tooth brushing and 0.2 per cent chlorhexidine gluconate thrice a day. The control group got oral care with 0.2 per cent chlorhexidine gluconate alone thrice a day. The data were analysed by IBM statistical software SPPS, version 24. Results: Preliminary results suggest that the risk of ventilator-associated pneumonia in intubated patients can be reduced by maintaining thrice-daily oral care involving both tooth brushing and 0.2 per cent chlorhexidine gluconate. Conclusion: Thrice-daily oral care consisted of both tooth brushing and 0.2 per cent chlorhexidine gluconate might be a promise as a ventilator-associated pneumonia-reduction strategy in ICU. Furthermore, more studies are required for its application widely.

Oropharyngeal Decontamination with Antiseptics to Prevent Ventilator-Associated Pneumonia: Rethinking the Benefits of Chlorhexidine

2017 ◽  
Vol 38 (03) ◽  
pp. 381-390 ◽  
Author(s):  
Michael Klompas
Keyword(s):  
Mechanical Ventilation ◽  
Intensive Care ◽  
Meta Analysis ◽  
Unit Length ◽  
Oral Care ◽  
Care Practice ◽  
Equal Weight ◽  
Ventilator Associated Pneumonia ◽  
Meta Analyses ◽  
Double Blinded

AbstractDaily oral care with chlorhexidine for mechanically ventilated patients is ubiquitous in contemporary intensive care practice. The practice is predicated upon meta-analyses suggesting that adding chlorhexidine to daily oral care regimens can reduce ventilator-associated pneumonia (VAP) rates by up to 40%. Close analysis, however, raises three concerns: (1) the meta-analyses are dominated by studies in cardiac surgery patients in whom average duration of mechanical ventilation is < 1 day and thus their risk of VAP is very different from other populations, (2) diagnosing VAP is subjective and nonspecific yet the meta-analyses gave equal weight to blinded and nonblinded studies, potentially biasing them in favor of chlorhexidine, and (3) there is circularity between diagnostic criteria for VAP and chlorhexidine; as an antiseptic, chlorhexidine may decrease the frequency of positive respiratory cultures but fewer cultures does not necessarily mean fewer pneumonias. It is therefore important to look at other outcomes for corollary evidence on whether or not oral chlorhexidine benefits patients. An updated meta-analysis restricted to double-blinded studies in noncardiac surgery patients showed no impact on VAP rates, duration of mechanical ventilation, or intensive care unit length of stay. Instead, there was a possible signal that oral chlorhexidine may increase mortality rates. Observational data have raised similar concerns. This article will review the theoretical basis for adding chlorhexidine to oral care regimens, delineate potential biases in randomized controlled trials comparing oral care regimens with and without chlorhexidine, explore the unexpected mortality signal associated with oral chlorhexidine, and provide practical recommendations.

The Impact of a Simple, Low-cost Oral Care Protocol on Ventilator-associated Pneumonia Rates in a Surgical Intensive Care Unit

2008 ◽  
Vol 24 (1) ◽  
pp. 54-62 ◽  
Author(s):  
Carrie S. Sona ◽  
Jeanne E. Zack ◽  
Marilyn E. Schallom ◽  
Maryellen McSweeney ◽  
Kathleen McMullen ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Low Cost ◽  
Oral Care ◽  
Surgical Intensive Care Unit ◽  
Ventilator Associated Pneumonia ◽  
Surgical Intensive Care ◽  
Care Protocol ◽  
The Impact

Oral Health and Care in the Intensive Care Unit: State of the Science

2004 ◽  
Vol 13 (1) ◽  
pp. 25-34 ◽  
Author(s):  
Cindy L. Munro ◽  
Mary Jo Grap
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Oral Health ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Dental Plaque ◽  
Oral Care ◽  
Microbial Flora ◽  
Tooth Surface ◽  
Ventilator Associated Pneumonia

Oral health is influenced by oral microbial flora, which are concentrated in dental plaque. Dental plaque provides a microhabitat for organisms and an opportunity for adherence of the organisms to either the tooth surface or other microorganisms. In critically ill patients, potential pathogens can be cultured from the oral cavity. These microorganisms in the mouth can translocate and colonize the lung, resulting in ventilator-associated pneumonia. The importance of oral care in the intensive care unit has been noted in the literature, but little research is available on mechanical or pharmacological approaches to reducing oral microbial flora via oral care in critically ill adults. Most research in oral care has been directed toward patients’ comfort; the microbiological and physiological effects of tooth brushing in the intensive care unit have not been reported. Although 2 studies indicated reductions in rates of ventilator-associated pneumonia in cardiac surgery patients who received chlorhexidine before intubation and postoperatively, the effects of chlorhexidine in reducing ventilator-associated pneumonia in other populations of critically ill patients or its effect when treatment with the agent initiated after intubation have not been reported. In addition, no evaluation of the effectiveness of pharmacological and mechanical interventions relative to each other or in combination has been published. Additional studies are needed to develop and test best practices for oral care in critically ill patients.

#52: Role of Good Oral Hygiene in Reducing and Preventing Ventilator-associated Pneumonia (VAP) in the Intensive Care Unit (ICU) in a Tertiary Care Hospital

2021 ◽  
Vol 10 (Supplement_1) ◽  
pp. S20-S20
Author(s):  
Mansoor Asma ◽  
Sohani Komal
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Oral Hygiene ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Oral Care ◽  
Chlorhexidine Gluconate ◽  
Ventilator Associated Pneumonia ◽  
Care Hospital ◽  
Vap Bundle

Abstract Background Ventilator-associated pneumonia (VAP) is when a patient who received mechanical ventilation for at least 48 hours develops pneumonia. According to the literature, the prevalence rate of VAP in patients experiencing mechanical ventilation is 9%–68%, its resulting mortality is 30%–70%, it also extends hospital and ICU stay by 6–7 days, raises healthcare costs by $40,000 per patient. VAP is a serious complication in the critically ill one factor causing VAP is an aspiration of oral colonization which may result from poor oral hygiene care. Oral hygiene care using either a mouth rinse or with help of forceps and gauze or combination together with the aspiration of secretion can reduce the risk of VAP in these critically ill patients. Method The main aim of this study was to evaluate the effect of strengthening oral hygiene practices and develop cost-effective and easy to use protocols of oral hygiene for ventilator-dependent patients. This study is an observational study conducted in all intensive care unit at tertiary care hospital, 41 bedded inpatient critical care area including high dependency unit (HDU)/coronary care unit (CCU), medical intensive care unit (MICU), surgical intensive care unit (SICU), neonate intensive care unit (NICU) and pediatric intensive care unit (PICU). Approximately 500 patients were admitted monthly to the intensive care unit. All ventilated patients admitted to the intensive care unit are included. Intervention is done in three phases: firstly, VAP device-associated infection (DAI’s) surveillance initiated according to the CDC guideline. HAI’s surveillance was done on daily basis. Secondly, educate staff regarding DAI’s surveillance, VAP bundle, Oral care and suction technique of ventilated patient). Ongoing training and hands-on practice on mannequin and also perform sign-off on the patient first under supervision of Nurse instructor and infection control officers. Finally, VAP bundle was initiated which include elevation of head, daily sedation vacation, and assessment of readiness to extubate, daily oral hygiene care, and assessment of stress ulcer and deep venous thrombosis prophylaxis. Result Before implementation, we just calculate all pneumonia rates together not using proper guidelines. But after we follow CDC guideline for DAI’s surveillance, we trained more than 50% of critical care staff out of 93 staffs, and 90% to 95% compliance of using chlorhexidine gluconate for oral care at least per shift and also as per patient needed observed in ventilated patients. Conclusion The implementation of these changes in practices along with using chlorhexidine gluconate products has made it possible to achieve goal and staff perform work according to the best practice guideline. Oral care hygiene using chlorhexidine gluconate (CHG) as an element of the ventilator bundle is supposed to decontaminate the mouth, avoid aspiration of contaminated secretion into the respiratory tract and prevent VAP.

Ventilator-associated Pneumonia Improvement Program

2007 ◽  
Vol 18 (2) ◽  
pp. 190-199
Author(s):  
Theresa Murray ◽  
Caryl Goodyear-Bruch
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Care Delivery ◽  
Oral Care ◽  
Patient Positioning ◽  
Clinical Problem ◽  
Cost Of Care ◽  
Hospital Length Of Stay ◽  
Ventilator Associated Pneumonia ◽  
Improvement Program

Ventilator-associated pneumonia (VAP) is a significant clinical problem associated with increased intensive care unit and hospital length of stay and substantial increases in delivery cost and associated morbidity and mortality. With system changes and management of the environment of care, the incidence of VAP was reduced in seven of our intensive care units across the system. Steps necessary to reduce VAP were identified and put into place in all the intensive care units. Patient positioning, oral care, nutrition, and management of comfort drugs are a few of the processes addressed to reduce VAP. Standardization of these essential care practices can reduce the incidence of this nosocomial infection and its associated increases in the cost of care delivery and mortality.

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