NRS-441V Capstone Project: Preventing Ventilator Associated Pneumonia using VAP Bundle

CONSTRUCTING THE WRITTEN EVIDENCE-BASED PROPOSAL
PREVENTING VENTILATOR ASSOCIATED PNEUMONIA USING VAP BUNDLE.
(Student Name)(Grand Canyon University
(NRS 441V: Professional Capstone)
Instructor: (Name)
(Date)
Preventing Ventilator Associated Pneumonia Using VAP Bundle
Abstract
The healthcare sector is the most sensitive of all industries. It is one whose importance is a matter of life and death, quite literally. As a result, the care given by the nurses is important in the entire process of healthcare delivery. This is especially so when it comes to the cases of infections caused by the healthcare elements. Among such infections is the ventilator-associated pneumonia. This paper provides a detailed review and an implementation plan of handling this problem in a healthcare setting.
Key Words: Ventilator Associated Pneumonia, VAP Bundle, implementation plan
* Introduction
A series of studies done in the intensive care units to test the risks of exposure of patients to healthcare associated infections revealed the exposure of patients to VAP as a significantly case that needs address (Al-Thaqafy, 2014). Also, poor hygienic conditions in the intensive care unit resulted in a high increase of VAP infections from 149 to 885. This was a clear indication that hygiene had a greater role in increasing or decreasing VAP infections. According to Saber (2013), proportions of VAP cases were high when VAP bundles were not used. Their research was conducted to test the morbidity and mortality rates of VAP.
Research that was done using Vitek MS- Biomerieux- France revealed that packages of contamination regulation are capable of reducing VAP incidences. Alsadat et al. (2012) in his study conducted by applying VAP bundles in training hospitals, it was established that a decrease in the cases of infections was a probable aspect that would be achieved. A greater improvement was shown after control charts, and other relevant statistical method were used to analyze the results that were achieved. It was also revealed that technological development in matters related ventilator development and VAP control significantly reduced the infection cases.
Tests that were done in intensive care unit based on oral hygiene, tranquility, protocols and intra- cuff pressure, revealed that the cases of ventilator-associated pneumonia were reduced considerably (Carseta, 2012). Others studies done showed the relevance of ensuring that the masses obtain the knowledge of reducing the risks of healthcare related infections. An article by Blot, Poelaert, and Kollef (2014) was among the best articles that had relevant information about how VAP cases should be reduced.
Ruffel and Adamcova (2008), in their study, argued against the jeopardy caused by nurses. They said that nurses were found of placing patients in conditions that predispose them to germs hence they end up contracting healthcare-related infections. They suggested that there was the need for the nurses to receive training on the methods that can be used to protect patients. They were to receive training on following the recommended procedures when handling patients with breathing difficulties and observing general hygiene. It was stated that healthcare providers washed their hands less than half the number of times that they need to.
Abbott et al. (2016), in his paper, surveillance data were gathered to appraise approval of VAP bundle when concerned for 106 patients who were ventilated. Rates of ventilator-associated pneumonia in the intensive care units were higher even though the modification was not substantial as per what was revealed by the statistical results. The ICU interval of stay weakened at both amenities, instigating cost savings.
Ventilator-associated pneumonia is still a recurrent and high-cost impediment of grave concern with a mortality of more than 25 percent and a pooled relative risk of up to 27 percent. Amazingly, ventilator-associated pneumonia enhances an assessed expenditure of more than $ 40,000.
According to Efrati et al. (2010), evidence-based exercise guidelines consent comprises the usage of every day sedation vacations and sanitization of the pharynx. The research concisely analyses epidemics related to pathogens along with a deep assessment of evidence-based exercise guidelines. New technological inventions for curbing ventilator-associated pneumonia are also assessed. Various recommendations that are aimed at managing the spread of ventilator-associated pneumonia amongst various target groups were offered. This was mainly through evaluating the trends in ventilator-associated pneumonia. The results were used to project the possible failures that would be expected to dominate the progression in these matters.
Safdar et al. (2005) carried out research to test for the frequency of ventilator-associated pneumonia. They made a conclusion that chances of obtaining a zero rate of infections were high. This was enabled by the applications of ventilator-associated pneumonia bundles. The QI development was felt to be efficient, and permission was attained from the competence's institutional review board to examine the quality insurance data prospectively and retrospectively to study the VAP prevention inventiveness for an extra year. There were adequate statistical resources to discover total difference as minor as 12.5% as a statistically substantial decrease. The avoidance of ventilator-associated pneumonia, a hospital integrated infection in the mid of acute care patients, is a primary clinical challenge.
* Problem Statement
From the studies done, some of the leading causes of ventilator-associated pneumonia can be controlled. Currently, people lack knowledge on how to curb the infection. Healthcare providers are also failing in performing their roles. Most of them are not observing proper hygiene, lack of which research reveals that it causes up to 25 percent of ventilator-associated pneumonia. There are also issues with the current technology where the old and outdated technology is used in the modern intensive care units. Inadequate procedures are also used by healthcare providers when attending to patients. If all these are solved then, it will be one of the best ways of obtaining a zero frequency of ventilator-associated pneumonia.
Ventilator-Associated Pneumonia (VAP) in medical terms is considered as a lung infection that usually affects patients who are on a ventilator. Most of the patients with breathing difficulties suffer from VAP which results from germs that enter into their systems via the tubes that supply them with oxygen. Healthcare-associated infections commonly result in high morbidity and mortality rates which in turn leads to wastage of funds, since a lot of money is spent on hospital bills (Azab et al., 2015).
Healthcare practitioners apply all the resources at their disposal to facilitate patients with a safe environment that helps recovery regardless of their condition. But it is natural and unfortunate that patient fails to achieve positive results with the care provided to them. There have been many cases reported where patients acquire severe conditions in the process of their care and recovery. Ventilator-Associated Pneumonia (VAP) is a major form of infection of the lungs usually seen in patients with a critical illness that necessitate their breathing to be mechanically supported (Azab et al., 2015). This indicates that the largest group of patients that at risk for developing VAP involves patients in the ICU and mostly in an acute care hospital set up. VAP is considered as the primary causes of illness and reason for death among acutely ill patients (Rello, 2013). This exacerbates the fact that patients in the ICU are at high risk of dying from their primary conditions. Studies have proved that VAP drastically increases the length of stay for patients in the ICU and thereby tremendously increases the cost of their care (Caserta, et al., 2012).
The major challenge associated with VAP is that patients in the ICU are most likely sedated and are unable to communicate. This, therefore, makes it hard to identify the symptoms of VAP. The condition usually occurs within two days of intubation, and this can compromise the integrity of trachea and the oral pharynx thereby allowing the gastric and oral secretions to enter the lower parts of the lungs. Ventilator-Associated Pneumonia is caused by the invasion of the microorganisms to the lung parenchyma and the lower respiratory tract (Rello, 2013).
Diagnosis of VAP mainly relies on the clinical suspicion, radiology examination and microbiological testing of the secretions. The most common indicators of VAP include high, or low body temperatures decreased blood oxygen concentration and purulent sputum. It is estimated that more than 27% of critically ill patients in the ICU are affected by VAP, and it becomes the second leading cause of nosocomial infections (Caserta et al, 2012). It has been estimated that more than 300,000 cases of VAPs occur annually in the United States. This translates to a rate of five patients per every 1,000 hospitals (Beattiea, et al., 2012). Most of the studies conducted on the topic of VAP are aimed at determining the actual causes of this condition, the predisposing factors and the treatment and prevention. The prevention of VAP is a major life-saving strategy which employed in the ICU. Prevention of VAP not only lessens the possible deaths in the ICU but also saves time and money by reducing the length of stays in the hospitals (Al-Thaqafy et al., 2014).
Studies have revealed that VAP has significant impacts on the work environment, quality of care provided by the staff and the patient outcomes. VAP results in increased adverse healthcare outcomes and healthcare costs. VAP causes more than half of all prolonged hospital stays. This is similar to conditions characterized by antibiotic resistance among gram-negative pathogens. Extended hospital stay increases the burden of care among caregivers (Brierley, et al., 2012). Considering that VAP patients require specialized care to manage their condition effectively, there is a high likelihood that provision of care to other patients may be compromised as attention is diverted to this group. Most of the microorganisms that cause VAP vary from one health care facility to the other. It is therefore upon care providers to perform the necessary tests to determine the actual microorganism that caused VAP (O’Keefe-McCarthy, Santiago & Lau, 2008).Also, most of these organisms’ are resistant to commonly used antibacterial agents. This necessitates the need to use costly, but highly effective prevention strategies (Alsadat, et al., 2012). Care providers are also required to use highly specialized care delivery tactics to ensure the risk of VAP is minimized. Potentially fatal activities such as administration of inappropriate medications should be kept to a minimum at all costs. For instance, inappropriate antimicrobial agents affect the use of health care resources together with the outcome of care (Blot Poelaert& Kollef, 2014).
VPA is an important determinant of the length of hospital stay and health care costs. Thus, data obtained from different studies about the clinical and economic importance of this condition point out that VAP is highly significant to the nursing profession. Nurse leaders are required to initiate and implement patient care that holds the promise of tackling the challenges associated with the management of VAP. There is an urgent need to identify and apply effective strategies to treat VAP to minimize the risk and other unfavorable outcomes including the spread of infections to other patients (Saber, 2013).
The use of high-quality treatment strategies can reduce the amount of financial and hospital resources allocated to the management of VAP. This can bring clinical and economic benefits to the hospital, the patient and the family members. One major recommendation for prevention of VAP is the avoidance of micro aspiration though eliminating the possibility of epiglottis secretion accumulation over the cuff. Drainage of subglottic secretions helps to decrease the likelihood of developing VAP among patients. Decontamination of the oropharynx can minimize VAP cases (Caserta, et al. 2012).Identified Components in relation to Ventilator-Associated Pneumonia (VAP)
(P) Population of Focus - Critically ill Patients in ICU
(I) Intervention – Prevention Bundle for VAP
(C) Comparison – Pharmacological Agents
(O) Outcome -- Reduced length of stay in the Hospital and improved Patient Outcome
(T) Time – Less than 10 days of admission to ICU
C. PICO Question/Statement
In Critically ill Patients in Intensive Care Unit with Ventilator-Associated Pneumonia (P), does the use of Ventilator Bundle (I) accomplish improved results compared to pharmacological agents (C) in reference to the reduced length of stay in ICU and improved patient outcome (O)? This essay recommends the use of multidimensional VAP Prevention Bundle in order to prevent ventilator associated pneumonia and thereby decrease the length of stay in ICU in the hospital. The Ventilator Bundle is an effective method to reduce VAP rates in ICUs. The prevention bundle involves a combination and simultaneous applications of various preventive strategies for all patients. Studies have revealed that the use of bundles in the prevention of VAP has been highly successful as compared to other management and prevention strategies. The ventilator bundle should be modified and expanded to include specific processes of care that have been definitively demonstrated to be effective in VAP reduction.
* Solution Description
Considering the current situation in healthcare, changing the procedures is the best method of controlling ventilator-associated pneumonia. It sounds inhuman to learn that most of the cases of ventilator-associated pneumonia reported are caused by the healthcare providers. They are found guilty of using wrong procedures when it comes to handling patients. It is said that healthcare providers rarely clean their hands, which is against the professional ethos and regulations that govern them. They wash their hands less than half the number of times they are required to which causes infection for 25 percent of the reported cases. The change of procedures will be closely supported by a change of the policy of handling patients (Melnyk & Fineout, 2011). This will help force the healthcare providers to start treating patients with care thus moderate cases of ventilator-associated pneumonia.
Safety also will be another measure of controlling ventilator-associated pneumonia. Safety will be observed from the different perspectives which may be safety when administering injections and when transferring patients to other places. If safety is found, then the rate at which patients with breathing difficulties contract ventilator-associated pneumonia will be minimal.
According to Rello (2013), a package of VAP prevention, as well as the impact it has on the affected group results, needs authentication with a prolonged effect. A cooperative multi-center regiment research accompanied by five units of intensive-care from Spain was performed. A maintenance bundle method on five procedures was employed after a season of three months, and submission, VAP levels, a unit-length vacation of intensive-care unit and interval of automated ventilation were observed for sixteen months. From the study, cases of VAP increased from 149 to 885. This is a clear indication of how hygiene had a high effect on the VAP infection.
* Implementation Plan
VAP infections cannot be controlled by an individual but as a collective measure of all the stakeholders in the industry. The first step of implementing the proposed solutions is by creating awareness. The training will start directly from the healthcare providers who will be taught on how to observe hygiene. Posters, handouts and other materials will be used. The general population will also receive the training from the medical training staff who will tell them the importance of observing hygiene. Apart from hygiene, the healthcare providers will receive training on how to handle patients during transfer and during the injection administration to ensure safety for both the healthcare providers and the patients.
For the implementation of this plan to be a success, there is need for the cooperation of all the stakeholders (Wolper, 2004). These include the management, physicians, nursing and subordinate staff. Their cooperation will be important not only in the approval of the entire process, but also a seamless embracement and exercise of the same. Once the stakeholders are in full support of the program, it will be easier to go through any other hurdles that might arise. It is very obvious that some of the members that form this team will be uneasy about the new plan. After all, resistance to change is usually inevitable.
It would be important to therefore, listen to them and their concerns, before continuation of the rollout. In this manner, there will be encompassing of all the issues. The significance of the program should be a point that would need emphasis to these members, so that they can understand that the benefits far outweigh the negatives. Once they understand the rationale of the same, it becomes easier to reason out during implementation. The following resources will be required to make the implementation of the solution;
* Funds- this will be the first resource that will be necessary without which, the implementation of the solution will be difficult. Resources will require during data correction for evaluation and printing implementation materials like handouts and posters.
* Education materials like posters and handout for the spread of information.
* Assessment tools like questionnaires to monitor change during evaluation.
* Technological gadgets - they will be used in analyzing data. They include data software.
* Training staff- this involves people with the technical knowledge that will be helping in initiating the project and carrying out the evaluation.
* Evaluation Plan
It is important to have an evaluation plan after implementing VAP bundle to Prevent Ventilator-Associated Pneumonia (VAP). Evaluation will start immediately after the program is initiated, and its primary role will be to answer questions on the implementation and outcomes of the program. Evaluation will be done through both qualitative and quantitative means. (Yaakop &Mokhlis, 2012). Use of statistical methods will then analyse the outcomes. Different methods of evaluation will be employed at various stages ranging from the period of initiation to completion. The methods will be as shown below;
Formative assessment
Formative evaluation will be done before the real launch of the project. It will be done to check if the project if feasible or not. The feasibility of the project will be tested about the resources that will be used in its implementation. If it is likely to stretch the resources, then its implementation may be terminated (Houser & Oman, 2011).Feasibility will be viewed from the perspective of how meaningful the implementation will be to the society. If its application is likely to have a little impact on the society and won’t solve the issue of ventilator- associated pneumonia due to hygiene, then it will be advisable to terminate the proposed solution.
Impact evaluation
This will be done after the initiation of the project. The main objective of impact evaluation will be to check the extent to which the project objectives have been met. The purpose of implementing the project was to ensure that high hygiene is observed by the health care providers since we believe its change will reduce the frequency of ventilator- associated pneumonia cases that will be reported. It will also check whether a change of the way the healthcare providers handle patients can help in reducing the cases of ventilator- associated pneumonia. From the result obtained from impact evaluation, one will be able to see how the implementation has affected the outcome. Use of surveys may do impact assessment to some extent.
Outcome of Evaluation
Outcome evaluation will be done aimed at coming up with feedback on the impact that has been created by implementing the proposed solution. It will test whether what was obtained in impact evaluation will last for a long or short period. This method of assessment will prove whether what was implemented was the real solution to the problem or not. Here, a qualitative method will not be used during evaluation since it may take a long time in trying to observe changes from the past conditions to the present after the implementation of the proposed solution (Elizabeth & Tuite, 2008). With this reason, quantitative methods will be used instead of observation. The quantitative method that may be applicable includes experimentation and use of a mixed method.
Variables assessed during evaluation
The variables to be evaluated during program evaluation all depends on the proposed solution. Since it was proposed that change of hygienic conditions and methods of handling patients will solve the high cases of ventilator- associated pneumonia cases, the variables will be related to these. They include;
* The attitude of patients towards the current hygienic condition- This will give out qualitative data that will show if or not the patients are satisfied with the change of hygienic conditions and were they are handled by the healthcare providers.
* The attitude of nurses towards the current sanitation- This will give the perceptions of nurses on the changes made in their departments.
* Attitudes of the general public about the modification of hygienic conditions- this will provide data on the whether the public is satisfied on how their patients are handled or not.
* Some cases of ventilator- associated infections reported after the implementation of the project- this will give the quantitative data on the number of cases of VAP reported before and after the implementation of the project.
The variables used will yield different types of date. The first three variables will yield qualitative data while the last variable will yield quantitative data. It means that when applying statistical methods in analysing the data obtained both quantitative and qualitative methods will be used (Malasi, 2012).
Tools used during evaluation
Different tools will be utilized at various stages of the project. There are those that will be used at the start of the project implementation where the participants of the project will be educated. They will include the following;
* Hand outs
* Pamphlets
* Posters
* Articles
* Power Point slides
* Hygienic experts will be hired to address seminars composed of both healthcare providers and the general public.
There are other tools that will be used in the evaluation of the outcome. These tools include;
* Surveys
* Questionnaire
* Technology- This will be represented by a computer that will be used to record the results and statistical software that will be employed in the analysis of the results.
* Dissemination Plan
Different methods will be used in disseminating the outcome. It will involve sharing of information with the stakeholders who will be mainly the nursing community and the general public. Dissemination will be of great importance since it will act as one way of appreciating the stakeholders for their participation and a way of showing them that their efforts in participation were fruitful (Christina et.al. 2010).
The following are some of the main and important methods that will be used to spread the information about change of hygiene and patient handling methods as a way of reducing cases of Ventilator- associated infections;
* Use of Oral Presentations- this will be done in seminars and other community gatherings. People will be given information on the causes of ventilator- associated pneumonia and its solutions. They will be informed that observing hygiene was one of the important aspects to be observed when handling patients as a way of controlling the infection. The presentations will be delivered by medical and hygiene experts (Laudon, 2010).
* Written Reports- The reports will be written from the findings obtained from the project evaluation. The report will entail the methods that were used in collecting data and steps that were followed to come up with the conclusion. The written materials then will be given out to allow its access by both the nursing community and the general public.
* Journal- this will be another important method of spreading out the information. Academic experts and writers will write journals on the research done, and through it, they will be able to convince the healthcare providers and the general public that hygiene observance can act as a way of controlling ventilator- associated pneumonia.
* Web sites- the information obtained from the research will be put available min different websites to allow easy access by the healthcare providers and the general public as a whole. Web sites that will spread the information include those of organizations that deal with medical consultancy.
* Newsletters- Newsletters with the information about the findings of the research will be printed and placed in reception areas of hospital, outlets of malls and many other places to ensure that the information reaches the public.
* Media Houses- this will be a highly recommended method of dissemination. At least each household has access to radio, TV or newspaper. If this information is passed via any of the mediums, it will create a great impact to the society.
* Literature Review
According to Azab et al. (2015), Ventilator-associated pneumonia is a severe health care- associated infection, causing high morbidity and mortality. It makes the stay in the hospital long and increases hospital bills. Methods chosen to prevent VAP in several nations are hardly reported. The clinical, microbiological laboratory evaluated the samples by the use of Alert 3D- Biomerieux-France and Bact and delivered micro-organism documentation followed by antibiotic compassion according to the segregate using Vitek MS –Biomerieux- France. Multidrug unaffected organisms need special ABX sensitivity order. It signifies the illness cause, and death in this populace with a high risk. The research results provided the classification of VAP in a NICU in Egypt. It revealed that a package of contamination regulation performs could efficiently bring down the incidence of VAP in the course of neonatal exposure to air. The “VAP anticipation bundle” can be prolonged other low-income countries besides NICU in Egypt.
In the study by Alsadat et al. (2012), a bundle of VAP was applied in four training hospitals, when educational conferences were over, and p...