Ventilator Associated Pneumonia|
Heather Heim, Erin Lovett and Crystal Inchiocca|
Molloy College |
Ventilator-associated pneumonia (VAP) is a nosocomial, or hospital acquired, infection that affects people who need mechanical assistance to breathe. VAP is the leading cause of nosocomial infection and nosocomial related death in adult critically ill patients when defined as new onset nosocomial infection that occurs more than 48 hours after the patient is intubated (Jacqueline A. Gallagher, 2012). VAP overall is a serious, preventable condition that places unneeded stress upon the patient, nurse and healthcare facility. It’s a condition that with proper training and standardized care, based on evidence based practice, should be able to be minimized and in most cases prevented. When a patient acquires VAP their original disease process is compounded and the body is further compromised with comorbidities. Recovery time becomes longer and more challenging. There is also greater emotional stress on patients and families, especially if someone is already critically ill. It also prolongs the patient’s length of stay in the hospital (Jacqueline A. Gallagher, 2012). Some studies suggest that patients with VAP have increased mortality (Scott P. Kellie, 2012). Therefore many new and innovative ways are being researched to help improve a standard bundle that healthcare accrediting agencies recommend. A bundle typically consists of interventions which are assembled collectively into a group of standardized measures for care. VAP is a condition that not only affects the patient and hospital impacted, but also the entire healthcare system. Insurance companies are no longer paying for infections acquired by what they deem to be a hospital’s negligence, like VAP, urinary tract infections, and surgical site infections. The cost of caring for patients with this condition is therefore forcibly absorbed by the healthcare facility. A great deal of extra money is essentially being wasted on treating a condition that could have possibly been prevented. VAP is detrimental to all parties involved, the nursing care, the hospital, the insurance company and especially the patient. It’s important to continue with research to develop new, more effective ways, to prevent and combat VAP. VAP is a nursing care problem because prevention of VAP is primarily in the hands of the nurse or those she delegates to the task. One of the biggest ways to decrease the incidents of VAP is to keep up with simple oral hygiene. Oral hygiene may not appear to be paramount, especially when average hospital policy is every four hours for oral care, but it is necessary for general overall health and specifically to reduce the instances of VAP. Nurses’ are masters of multitasking. They are busy attending to medication administration, ongoing assessments of patients, obtaining specimens, documenting, and carrying out other orders as well as working alongside their interdisciplinary team members to ensure a comprehensive level of care for their patients is being achieved. With this surmounting task list it is easy to see how simple oral hygiene can trickle down to the bottom of an ever growing to do list. The fact of the matter is that it does matter a great deal and should be a primary focus when working with patients that are on ventilators. Accrediting and supervisory agencies are working to implement standardized bundles in regards to dealing with patients on ventilators and preventing VAP. Things included in a typical VAP prevention bundle such as elevating the head of the bed to 45 degrees will help lessen te risk for aspiration acquired pneumonia. Timed turning and positioning of a patient also helps prevent secretions from being lodged in one spot and increases the proper drainage of the secretions. DVT prophylaxis, gastric ulcer prevention, and daily attempts at weaning off sedation are typically included to lessen...