Ebp Vap
- 1. Ventilator Associated Pneumonia (VAP) Nadine Mullen Rachael Ross Svetlana Usataia SDSU Nursing Students
- 2. Objectives By the end of this presentation the student will be able to verbalize: Three symptoms of ventilator associated pneumonia Three risk factors of ventilator associated pneumonia Two EBP strategies for preventing ventilator associated pneumonia
- 3. What is VAP? Ventilator-associated pneumonia Nosocomial infection Very common Preventable
- 4. Pathophysiology Intubation and mechanical ventilation ET tube inhibits the body’s natural reflex to protect airway Such as cough reflex, secretion removal, and epiglottic reflexes (Pear, 2008) Bacteria infiltrates lungs Colonization of aerodigestive tract by gram-negative bacteria (O’Keefe-McCarthy, 2006)
- 5. Background Been an issue for almost four decades (Turton, 2008) 1994 Healthcare Infection Control Practices Advisory Committee (HICPAC) revised the CDC Guideline for Prevention of Nosocomial Pneumonia First time the goal was to prevent VAP (Tablan, 2003)
- 6. Risk Factors Length of mechanical intubation 48 hours or more Patient demographics Co-morbidities Patient oral health Compromised patient oral immunity Hospital environment and equipment Invasive pictures (O’Keefe-McCarthy, 2006)
- 7. Statistics Mortality rates are 20%-70% In 70% of the cases, Pseudomonas Aeruginosa and Staphylococcus Aureus are the causes of infection (Kleiman & Boody, 2009) VAP does not get as much attention as MRSA or VRE, however, it has been strongly linked to morbidity and mortality, and is the cause of longer hospital stays and increased medical cost (Turton, 2008).
- 8. Statistics 2 nd most common hospital associated infection after UTI Costs $40,000 to treat Increases hospital stay by 4-9 days (Tablan et al, 2003)
- 9. Signs and Symptoms Cough Fever Purulent sputum-new onset Development of new pulmonary infiltrate Leukocytosis (Tablan et al, 2003)
- 10. EBP strategies VAP bundle Collaborative care Multidisciplinary effort Oral cares (Napolitano, 2009)
- 11. EBP strategies Oral cares Tooth brushing Sponge cleaners Tongue cleaning Antimicrobial mouth rinse (Ridley & Pear, 2008)
- 12. Strategies cont… Silver-coated endotracheal tubes Tube prevents bacterial colonization and biofilm formation Also delays onset of VAP (Kollef, 2008)
- 13. CDC EBP strategies Monitor trends of at risk patients Thoroughly clean equipment and devices to be sterilized or disinfected Use standard precautions Hand hygiene Pneumococcal vaccine Elevated HOB to 30-45 degrees (Tablan et al, 2004)
- 14. IHI EBP strategies Ventilator bundle Elevate HOB Daily “sedation vacations” Daily assessment of Readiness to Extubate Peptic Ulcer disease Prophylaxis Deep Venous Thrombosis Prophylaxis (http://www.ihi.org)
- 15. Diagnosis Chest x-ray New pulmonary infiltrates Leukocytosis Positive bacterial sputum culture and gram stain (Tablan et al, 2004)
- 16. Treatment Antibiotic therapy Based on bacteria present Oral cares
- 17. Treatment Statistics MRSA is also a common cause of VAP Which medication is better for treatment of MRSA- Vancomycin or Linezolid (Study) Vancomycin Linezolid Linezolid as effective, if not more effective, then vancomycin.
- 18. Pediatric Statistics The financial cost of one instance of VAP is $2400 to $8300. Pediatric patients are not on ventilators for as long, however, they are still at risk. Not a lot of studies have been done on pediatric patients. (Turton, 2008 )
- 19. Pediatric VAP Modified strategies: Revise oral care standards for children with and without teeth Eliminate saline lavage during suctioning Reduce suctioning to only as needed Elevate head of bed 25° to 30° Change ventilator circuit only when dirty, rather than routinely Separate oral suction equipment from nasal suction equipment and change canisters daily (Stacey, 2008)
- 20. Preventative strategies Good hand washing technique http:// www.henrythehand.com/pages/content/sub_d.html Earlier extubation Elevating HOB to 30 degrees Reposition patient every two hours Adequate oral cares Use Chlorhexidine post intubation Reduce or delay development of VAP Avoid unnecessary antibiotic treatment Avoiding unnecessary stress ulcer prophylaxis (O’Keefe-McCarthy, 2006)
- 21. Importance of preventing VAP Shortens length of stay in hospital Decreases mortality Reduces health care costs (O’Keefe-McCarthy, 2006) Medicare and Medicaid no longer reimburse patients or hospitals (Bush, 2008)
- 22. Yes…More Statistics Basic hospital acquired infection statistics: Research suggests harmful HAI’s can add an additional $27,000 per patient. Patient’s with HAI’s remain in the hospital three to four times longer then those without. This ties up the nurses and takes up hospital beds that could be used for other patients. (High turnaround equals more revenue for hospitals) (Warye & Granato, 2009)
- 23. Why Care?! Legislature is beginning to take action. State laws already in place Pennsylvania- First state to require public reporting of infection rates. Four types of infections are the focus of the bills introduced: 1. Pneumonia 2. Surgical Site 3. Urinary Tract 4. Bloodstream (Weinstock, 2007)
- 24. EBP Summary VAP is a common problem Research has lead to new, improved practice. VAP is preventable Rising healthcare cost are already affecting nursing staff nation wide
- 25. Research approach Literature reviews CINAHL OVID Internet credible sources Personal expertise
- 26. Search Terms Ventilator associated pneumonia VAP Evidence-based nursing strategies VAP statistics Hospital acquired infection Nosocomial infection VAP video
- 27. References Bush, H. (2008, December). How to zap VAP. Hospitals & Health Networks, 82( 12 ), 18. Retrieved March 27, 2009, from CINAHL Plus with Full Text database. Chao, Y., Chen, Y., Wang, K., Lee, R., & Tsai, H. (2009). Removal of oral secretion prior to position change can reduce the incidence of ventilator-associated pneumonia for adult ICU patients: a clinical controlled trial study. Journal of Clinical Nursing , 18 (1), 22-28. Retrieved March 23, 2009, from CINAHL database. Deja, M., & Spies, C. (2009). Prevention measures of ventilator-associated pneumonia. Critical Care Medicine , 37 (1), 330-332. Retrieved March 23, 2009, from CINAHL database. Kleiman, C., & Boody, S. (2009, February). Ventilator-associated pneumonia: an emerging role in hospital intensive care units. RDH , 29 ( 2 ), 60-2. Retrieved March 31, 2009, from CINAHL Plus with Full Text database. Lisboa, T., Diaz, E., Sa-Borges, M., Socias, A., Sole-Violan, J., Rodríguez, A., et al. (2008). The Ventilator-Associated Pneumonia PIRO Score: A Tool for Predicting ICU Mortality and Health-Care Resources Use in Ventilator-Associated Pneumonia. CHEST , 134 (6), 1208-1216. Retrieved March 23, 2009, from CINAHL database. Luks, A. (2009, February). MRSA ventilator-associated pneumonia: vancomycin or linezolid?. Critical Care Alert , 16 ( 11 ), 81-3. Retrieved March 31, 2009, from CINAHL Plus with Full Text database. O’Keefe-McCarthy, S. (2006). Evidence-based nursing strategies to prevent ventilator-acquired pneumonia. Canadian Association of Critical Care Nurses , 17 (1), 8-11. Retrieved April 2, 2009, from CINAHL Plus with Full Text database. Pear, S. (2008, May). VAP prevention: Critical techniques and tools. Healthcare Purchasing News, 32 (5) , 40-1. Retrieved March 27, 2009, from CINAHL Plus with Full Text database. Pear, S. (2008, October). Prevent VAP with the right tools. Materials Management In Health Care, 17 (10), 34-6. Retrieved March 27, 2009, from CINAHL Plus with Full Text database.
- 28. References Powers, J. (2006, November). Managing VAP effectively to optimize outcomes and costs. Nursing Management , 37 ( 11 ), 48A-h. Retrieved March 31, 2009, from CINAHL Plus with Full Text database. Ridley, K. J. & Pear, S. M. (2008, September). Comprehensive oral care: A critical component of VAP prevention. Healthcare Purchasing News, 32( 9), 46. Retrieved March 27, 2009, from CINAHL Plus with Full Text database. Sawyer, W (2007). Henry's school visit. Retrieved April 2, 2009, from Henry the hand champion hand washer. Web site: http://www.henrythehand.com Stacey, S. (2008, June). Exceeding PICU goal with 0 VAP cases. Critical Care Nurse, 28 (3), 90- 2. Retrieved March 27, 2009, from CINAHL Plus with Full Text database. Tablan, O. C., Anderson, L. J., Besser, R.,Bridges, C., & Hajjeh, R. (2004, March). Guidelines for preventing health-care-associated pneumonia, 2003. Morbidity and Mortality Weekly Report, 53 (RR-3) , 1-36. Retrieved March 27, 2009, from CINAHL Plus with Full Text database. Turton, P. (2008, September). Ventilator-associated pneumonia in paediatric intensive care: a literature review. Nursing in Critical Care , 13 ( 5 ), 241-8. Retrieved March 31, 2009, from CINAHL Plus with Full Text database. Warye, K., & Granato, J. (2009). target: zero hospital-acquired infections. hfm (Healthcare Financial Management) , 63 ( 1 ), 86-91. Retrieved March 31, 2009, from CINAHL Plus with Full Text database. Weinstock, M. (2007, April). In box: storyboard. Legislatures turn up heat on hospital-acquired infections. H&HN: Hospitals & Health Networks , 81 ( 4 ), 24-24. Retrieved March 31, 2009, from CINAHL Plus with Full Text database.