NUR589: EVIDENCE-BASED NURSING PRACTICE
NANCY STYNCHULA, BSN, RN
OCTOBER 6, 2010
Ventilator Associated Pneumonia (VAP) is the second most common infection that patients develop while in the hospital and the leading cause of death due to hospital acquired infections (Augustyn, 2007). Hospital acquired infections are also known as nosocomial infections. VAP usually happens when patients are on mechanical ventilation (the ventilator) for over 48 hours. VAP is costly because it increases the hospital length of stay, often times in the Intensive Care Units (ICU). Patients are often on the ventilator and are receiving antibiotics to treat the pneumonia. This paper will show that by doing something as simple as swishing a drug known as Chlorhexidine around in your mouth (or for those who are ventilated, having their mouth swabbed with it) can decrease the number of VAPs and patients, hospitals and insurance companies money. PICOT QUESTION
In patients requiring mechanical ventilation for over 48 hours, is the usage of oral Chlorhexidine solution twice daily effective in reducing Ventilator Associated Pneumonia (VAP)? Population Any patients that are on the ventilator for over 48 hours, regardless of age, sex, or past and current medical history. Intervention Patients on the ventilator for over 48 hours will be given Chlorhexidine to “swish and spit” to help kill bacteria present in the mouth. For patients that are extubated, the Chlorhexidine will be treated like a mouthwash. For those who are on the ventilator, the Registered Nurses (RNs) will swab out their mouth with the Chlorhexidine liquid. Comparison There is no comparison because all patients will be given Chlorhexidine twice a day. Outcome The outcome will prove that there will be a lower number of VAPs due to the use of Chlorhexidine treatments on all patients. Time One year will be needed to complete this study.
Ventilator, Chlorhexidine, Ventilator Associated Pneumonia, Pneumonia, Intensive Care Unit, Prevention, Patients INTRODUCTION
Pneumonia is the second most common hospital acquired infection (also known as nosocomial infections) in the United States. It is also the leading cause of death in comparison to other nosocomial infections. Ventilator Associated Pneumonia (VAP) can occur when a patient has been mechanically ventilated for over 48 hours. It is a costly infection. The cost of VAP is estimated to be an additional $40,000 per hospital admission per patient and an estimated $1.2 billion per year. Education is the number one way to reduce the transmission of VAP to patients. Interventions should start before a patient is intubated. Nurses need to educate patients and other staff about the importance of good mouth care, proper suctioning (both orally and via the endotracheal tube (ETT), the importance of inserting a nasogastric or orogastric tube, having the patient’s head of bed (HOB) at 30 degrees (or higher) and finally the importance of using chlorhexidine twice daily which will be discussed in this paper. Pneumonia is the 2nd most common hospital acquired (nosocomial) infection that can lead to death of many hospitalized patients. Ventilator associated pneumonia (VAP) is a form of nosocomial pneumonia that can occur to patients that are intubated for over 48 hours. Since there is a high ratio of patients who get VAP, it is to the hospital's advantage to learn ways to decrease the incidence of contracting it. By decreasing the number of VAP patients, the hospital can save money because the patients will spend less time in the Intensive Care Units (ICU) and the additional cost of care (such as antibiotics, salaries, and equipment needed to treat patients). The cost of VAP is estimated to be $40,000 per hospital admission per patient. By using chlorhexidine, which is relatively inexpensive, hospitals will save billions of dollars a year. Interventions to prevent VAP...
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