Using Evidence-Based Practice to Prevent Ventilator-Associated Pneumonia

BackgroundStrategies are needed to help prevent ventilator-associated pneumonia.ObjectiveTo develop a ventilator bundle and care practices for nurses in critical care units to reduce the rate of ventilator-associated pneumonia.MethodThe ventilator bundle developed by the Institute for Healthcare Improvement was expanded to include protocols for mouth care and hand washing, head-of-bed alarms, subglottic suctioning, and use of an electronic compliance feedback tool. Compliance audits were used to provide immediate electronic feedback.ResultsAdherence to practices included in the bundle increased. Compliance rates were greater than 98% for prophylaxis for peptic ulcer disease and deep-vein thrombosis, interruption of sedation, and elevation of the head of the bed. The compliance rate for the oral care protocol increased from 76% to 96.8%. Readiness for extubation reached at least 92.4%. Rates of ventilator-associated pneumonia decreased from 9.47 to 1.9 cases per 1000 ventilator days. The decrease in rates produced an estimated savings of approximately $1.5 million.ConclusionStrict adherence to bundled practices for preventing ventilator-associated pneumonia, enhanced accountability for initiating protocols, use of a feedback system, and interdisciplinary collaboration improved patients’ outcomes and produced marked savings in costs.

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

American Journal of Critical Care ◽

10.4037/ajcc2007.16.1.28 ◽

2007 ◽

Vol 16 (1) ◽

pp. 28-37 ◽

Cited By ~ 88

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.

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

Journal of Intensive Care Medicine ◽

10.1177/0885066608326972 ◽

2008 ◽

Vol 24 (1) ◽

pp. 54-62 ◽

Cited By ~ 52

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

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An Evidence-Based Oral Care Protocol to Decrease Ventilator-Associated Pneumonia

Dimensions of Critical Care Nursing ◽

10.1097/dcc.0b013e3182619b6f ◽

2012 ◽

Vol 31 (5) ◽

pp. 301-308 ◽

Cited By ~ 5

Author(s):

Lisa Cuccio ◽

Ellen Cerullo ◽

Heidi Paradis ◽

Cynthia Padula ◽

Cindy Rivet ◽

...

Keyword(s):

Oral Care ◽

Evidence Based ◽

Ventilator Associated Pneumonia ◽

Care Protocol

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Effect of an oral care protocol in preventing ventilator-associated pneumonia in ICU patients

Critical Care ◽

10.1186/cc6269 ◽

2008 ◽

Vol 12 (Suppl 2) ◽

pp. P48 ◽

Cited By ~ 3

Author(s):

L Yao ◽

C Chang ◽

C Wang ◽

C Chen

Keyword(s):

Oral Care ◽

Ventilator Associated Pneumonia ◽

Icu Patients ◽

Care Protocol

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A SIMPLE, LOW-COST ORAL CARE PROTOCOL REDUCES VENTILATOR-ASSOCIATED PNEUMONIA RATES.

Critical Care Medicine ◽

10.1097/00003246-200512002-00049 ◽

2005 ◽

Vol 33 ◽

pp. A13 ◽

Cited By ~ 1

Author(s):

Carrie Sona ◽

Jeanne Zack ◽

Lynn Schallom ◽

Linda Schwartkopf ◽

Way Huey ◽

...

Keyword(s):

Low Cost ◽

Oral Care ◽

Ventilator Associated Pneumonia ◽

Care Protocol

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Chlorhexidine Oral Care in Critically Ill Adults

Canadian Journal of Health Technologies ◽

10.51731/cjht.2021.172 ◽

2021 ◽

Vol 1 (10) ◽

Author(s):

Anusree Subramonian ◽

Jennifer Horton

Keyword(s):

Critical Care ◽

Randomized Clinical Trials ◽

Oral Care ◽

Clinical Effectiveness ◽

Ventilator Associated Pneumonia ◽

Specific Recommendation ◽

Mechanically Ventilated ◽

Care Protocol ◽

Significant Difference ◽

Critically Ill Adults

Three systematic reviews and 2 randomized clinical trials were identified regarding the clinical effectiveness of chlorhexidine oral care in adult patients who were in critical care and being mechanically ventilated. The evidence was of limited quality, with methodological limitations. Compared to ozonated water and to Nanosil, chlorhexidine oral care was associated with a significantly higher risk of ventilator-associated pneumonia. Compared to bicarbonate, chlorhexidine oral care was associated with a significantly lower risk of ventilator-associated pneumonia. There was no significant difference in the risk of ventilator-associated pneumonia between chlorhexidine and other agents, such as potassium permanganate, hydrogen peroxide, or miswak. There was no significant difference in the risk of mortality between oral care with chlorhexidine and that with other oral care drugs. An evidence-based guideline targeting individuals who require assistance on oral care recommended a multi-component oral care protocol. No specific recommendation regarding the use of oral care agents for the prevention of ventilator-associated pneumonia was made because of lack of evidence. There is a lack of evidence on the safety or cost-effectiveness of chlorhexidine oral care in adults who are in critical care and being mechanically ventilated.

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Preventing Ventilator-Associated Pneumonia Through Oral Care, Product Selection, and Application Method

AACN Advanced Critical Care ◽

10.4037/nci.0b013e31827df8ad ◽

2013 ◽

Vol 24 (1) ◽

pp. 38-58 ◽

Cited By ~ 3

Author(s):

Bianca Hillier ◽

Christine Wilson ◽

Di Chamberlain ◽

Lindy King

Keyword(s):

Mechanical Ventilation ◽

Oral Hygiene ◽

Best Practice ◽

Oral Care ◽

Nurse Education ◽

Future Research ◽

Ventilator Associated Pneumonia ◽

Care Product ◽

Care Protocol ◽

Application Techniques

Objective: Review the literature to identify the most effective method of oral hygiene to reduce the incidence of ventilator-associated pneumonia (VAP). Background: Ventilator-associated pneumonia is the most common nosocomial infection in patients being treated with mechanical ventilation. Method: This study is a systematic literature review. The databases searched included Web of Science, Cumulative Index to Nursing and Allied Health Literature, Ovid, and MEDLINE. Results: Implementation of oral care protocols and nurse education programs reduced VAP. Although chlorhexidine was the most popular oral care product, no consensus emerged on concentration or protocols for oral care. Conclusion: No consensus on best practice for oral hygiene in patients being treated with mechanical ventilation was found. Chlorhexidine was the most popular oral care product. Implementation of an oral care protocol, ongoing nurse education, and evaluation were important in reducing the incidence of VAP. Future research should analyze chlorhexidine concentration, application techniques, and frequency of oral care, to optimize VAP prevention.

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