Prevention of Ventilator-
Associated Pneumonia
Jennifer Crawford
Ashley Grey
Krista Keuchel
Stephanie Yates
OU – Tulsa Col...
PICO Question
• Population of Interest
Mechanically-ventilated adult ICU patients
• Intervention of Interest
Oral Care - t...
PICO Question
What is the most effective intervention to decrease
ventilator-associated pneumonia (VAP) in adult
ICU patie...
Ventilator-Associated
Pneumonia (VAP)
• Defined: hospital-acquired pneumonia occurring
within 48 h after initiation of mec...
Identification of the
Problem
• VAP Statistics
– leading cause of death due to nosocomial
infection in ICUs.
– Mechanicall...
Current Guidelines
• Oral care with antiseptic agents can decrease
the incidence of VAP.
– No optimal concentration or for...
Review of Literature
Review of Literature
• Summa Health System in Akron, OH
– Implementation of Q8H tooth brushing
regimen
– VAP rate dropped ...
Review of Literature
• Medical-surgical ICU in a university hospital
– Oral care protocol 3 times daily or once every
nurs...
Review of Literature
• 5 Chicago area acute care hospitals
– Oral care cleansing protocol
– Oral care every 2 hours
– Conc...
Review of Literature
• University hospital in Bangkok, Thailand
– Oral decontamination with 2% chlorhexidine
solution 4 ti...
Review of Literature
• 2 university hospitals and 3 general hospitals
– Chlorhexidine applied Q6H to buccal cavity
– Reduc...
Summary of Findings
Oral Care
• Oral care
• Potentially pathogenic bacteria
• Dental plaque
• Toothettes
• Standardized or...
Summary of Findings
Chlorhexidine
• Broad spectrum
• Oral decontamination with 2% chlorhexidine
solution
• Modulation of o...
Summary of Findings
“The disparity between what nurses think they do
and what is actually documented raises
questions abou...
What Are The PROS To
Solving This Problem?
• Decreased:
– Incidence of VAP
– Risk of VAP
– Mortality rate
– Length of ICU ...
What Are The CONS To
Solving This Problem?
• Increased:
– Cost of oral care
supplies
– Cost associated
with
implementation...
Recommended Protocol
Literature Recommendations
• Brushing: Every 3-4 Hours and PRN
– Tooth brushing for 1-2 minutes
– Gen...
Recommended
Interventions
• Establishment of new oral care protocol
• More comprehensive documentation
• More comprehensiv...
Recommended Protocol
• Tooth brushing: 4 times daily for a minimum of 1
minute
• Follow with use of chlorhexidine.
• To en...
Suggestions for Further
Study
• Determine ideal frequency of oral care
• Effect of chlorhexidine on patient outcomes
• Fre...
References
Cutler, C., & Davis, N. (2005). Improving oral care in patients
receiving mechanical ventilation. American Jour...
References
Mori, H., Hirasawa, H., Oda, S., Hidetoshi, S., Matsuda, K., &
Nakamura, M (2006). Oral care reduces incidence ...
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Prevention of Ventilator- Associated Pneumonia

Published on: Mar 4, 2016
Published in: Health & Medicine      
Source: www.slideshare.net


Transcripts - Prevention of Ventilator- Associated Pneumonia

  • 1. Prevention of Ventilator- Associated Pneumonia Jennifer Crawford Ashley Grey Krista Keuchel Stephanie Yates OU – Tulsa College of Nursing
  • 2. PICO Question • Population of Interest Mechanically-ventilated adult ICU patients • Intervention of Interest Oral Care - tooth brushing and use of Toothettes • Comparison of Interest Use of antiseptic agent - Chlorhexidine • Outcome of Interest Decrease incidence of VAP
  • 3. PICO Question What is the most effective intervention to decrease ventilator-associated pneumonia (VAP) in adult ICU patients: performing oral care (use of tooth brushes or Toothettes) versus use of an antiseptic agent (chlorhexidine)?
  • 4. Ventilator-Associated Pneumonia (VAP) • Defined: hospital-acquired pneumonia occurring within 48 h after initiation of mechanical ventilation with trachael intubation • Diagnosis: Presence of a new, persistent, or progressive infiltrate on a chest X-ray
  • 5. Identification of the Problem • VAP Statistics – leading cause of death due to nosocomial infection in ICUs. – Mechanically-ventilated patients: 9% to 28% – Mortality rate: 40% - 80%. – Hospital length of stay: 4-9 days. – Hospital cost: $29,000 - $40,000 per patient.
  • 6. Current Guidelines • Oral care with antiseptic agents can decrease the incidence of VAP. – No optimal concentration or formulation is specified. • Oral hygiene (removal of plaque from teeth and gums) is recommended every 12 hours. • Oral care (removal of secretions from oropharynx and moisturizing the mouth and lips) is recommended every 4 hours.
  • 7. Review of Literature
  • 8. Review of Literature • Summa Health System in Akron, OH – Implementation of Q8H tooth brushing regimen – VAP rate dropped to zero – Control group dropped after 6 months due to the success of the intervention group – Conclusion: Tooth brushing was found to be the most effective practice of removing dental plaque. Fields (2008): Randomized controlled trial
  • 9. Review of Literature • Medical-surgical ICU in a university hospital – Oral care protocol 3 times daily or once every nursing shift – Mechanical cleaning including tooth brushing – Conclusion: decreased the incidence and risk of VAP in ICU patients and delayed the onset of VAP Mori et al. (2006): Nonrandomized trial
  • 10. Review of Literature • 5 Chicago area acute care hospitals – Oral care cleansing protocol – Oral care every 2 hours – Conclusion: Increase frequency and comprehensiveness of oral care provided Cutler & Davis (2005): Observational study
  • 11. Review of Literature • University hospital in Bangkok, Thailand – Oral decontamination with 2% chlorhexidine solution 4 times daily – Intervention was effective at preventing pneumonia in patients receiving mechanical ventilation – Conclusion: Cost effective strategy for prevention of VAP Tantipong et al. (2008): Randomized controlled trial with meta-analysis
  • 12. Review of Literature • 2 university hospitals and 3 general hospitals – Chlorhexidine applied Q6H to buccal cavity – Reduced and delayed the development of VAP – Conclusion: highly attractive prevention of VAP Koeman et al. (2006): Randomized controlled trail
  • 13. Summary of Findings Oral Care • Oral care • Potentially pathogenic bacteria • Dental plaque • Toothettes • Standardized oral care protocol
  • 14. Summary of Findings Chlorhexidine • Broad spectrum • Oral decontamination with 2% chlorhexidine solution • Modulation of oropharyngeal colonization • Cost-effective strategy
  • 15. Summary of Findings “The disparity between what nurses think they do and what is actually documented raises questions about the reliability of documentation and the consistency of practice.” (Cutler & Davis, 2005)
  • 16. What Are The PROS To Solving This Problem? • Decreased: – Incidence of VAP – Risk of VAP – Mortality rate – Length of ICU stay – Cost for patient – Cost for hospital
  • 17. What Are The CONS To Solving This Problem? • Increased: – Cost of oral care supplies – Cost associated with implementation of new oral care protocol
  • 18. Recommended Protocol Literature Recommendations • Brushing: Every 3-4 Hours and PRN – Tooth brushing for 1-2 minutes – Gentle brushing of teeth, tongue, and hard palate • Chlorhexidine – Chemical decontamination with chlorhexidine at least twice daily
  • 19. Recommended Interventions • Establishment of new oral care protocol • More comprehensive documentation • More comprehensive oral care assessment
  • 20. Recommended Protocol • Tooth brushing: 4 times daily for a minimum of 1 minute • Follow with use of chlorhexidine. • To ensure oral care compliance: – Available resources – Supply kits and instructions • Key Players: Nurses
  • 21. Suggestions for Further Study • Determine ideal frequency of oral care • Effect of chlorhexidine on patient outcomes • Frequency of use of chlorhexidine • Determine optimal concentration and formulation of chlorhexidine • Nurse education to improve quality and frequency of oral care
  • 22. References Cutler, C., & Davis, N. (2005). Improving oral care in patients receiving mechanical ventilation. American Journal of Critical Care, 14(5), 389-395. Fields, L. B. (2008). Oral care intervention to reduce incidence of ventilator-associated pneumonia in the neurologic intensive care unit. American Association of Neuroscience Nurses, 2008, 40(5), 291-298. Koeman, M., Van der Ven, A., Hak, E., Joore, H., Kaasjager, K., De Smet, A., et al. (2006) Oral decontamination with chlorhexidine reduces the incidence of ventilator-associated pneumonia. Critical Care Medicine, 173, 1348-1355.
  • 23. References Mori, H., Hirasawa, H., Oda, S., Hidetoshi, S., Matsuda, K., & Nakamura, M (2006). Oral care reduces incidence of ventilator- associated pneumonia in ICU populations. Intensive Care Med, 32, 230-236. Tantipong, H.Morckchareonpong, C., Jaiyindee, S., & Thamlikitkul, V. (2008). Randomized controlledtrial and meta-analysis of oral decontamination with 2 % chlorhexidine solution for theprevention of ventilator-associated pneumonia. Infection Control and Hospital Epidemiology , 29(2), 131-136.

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