PRACTICAL NURSING ASSISTANTS AND PNEUMONIA PREVENTION ASSOCIATED WITH MECHANICAL VENTILATION IN ICU

PRACTICAL NURSING ASSISTANTS AND PNEUMONIA PREVENTION ASSOCIATED WITH MECHANICAL VENTILATION IN ICU

References

Oliveira Gonçalves, É., Santos de Lima, M., de Lima Melo, J., Rodrigues Pontes, M. S., Barros Sousa, A. O., & Pinheiro Albernaz, M. (2015). PRACTICAL NURSING ASSISTANTS AND PNEUMONIA PREVENTION ASSOCIATED WITH MECHANICAL VENTILATION IN ICU. Journal Of Nursing UFPE / Revista De Enfermagem UFPE, 9(12), 1069-1077. doi:10.5205/reuol.8127-71183-1-SM.0912201503

Abstract:

Objective: to assess the knowledge of nurses in pneumonia prevention practices associated with mechanical ventilation in patients hospitalized in intensive care unit. Method: exploratory, descriptive study of qualitative approach, developed with 19 nurses in an ICU, guided with a semi-structured interview, after approval of the research project by the Ethics Committee in Research, CAAE 26654314.3.0000.5175. Results: the level of knowledge that nurses have about the care practices involving pneumonia associated with mechanical ventilation was satisfactory showing no difficulty to answer. It was identified the importance of the nurses´ role to care practices in the care of critically ill patients and the importance of recognizing the clinical findings to establish a diagnosis. Conclusion: the results provide subsidies for a reflection on the role of nurses in intensive care healthcare practices in the prevention of pneumonia in patients who are undergoing mechanical ventilation. Descriptors: Intensive Care; Nursing; Pneumonia; Health Care.

References

Krein, S., Olmsted, R., Hofer, T., Kowalski, C., Forman, J., Banaszak-Holl, J., & Saint, S. (n.d). Translating infection prevention evidence into practice using quantitative and qualitative research. American Journal Of Infection Control, 34(8), 507-512.

Abstract:

Infection control professionals and hospital epidemiologists, using the valid methods of applied epidemiology-surveillance, benchmarking, intervention, evaluation-have largely been responsible for dramatically reducing the incidence of health care-associated infections over the past several decades. However, we believe that the field of infection control can-and should-also be a leader in understanding how research findings can be efficiently and effectively translated into clinical practice. Unfortunately, there is no current reliable information about which preventive practices are being used in US hospitals to prevent common device-related infections. If we are to understand how best to translate research into practice, the reasons hospitals are using some preventive practices-or are not-must be explored more fully This article provides a framework for one proposed research endeavor to promote the successful translation of proven infection prevention practices and a subsequent decrease in health care-associated infections. In addition, we hope that this article will stimulate increased interest and research in identifying strategies that will successfully move evidence from the peer-reviewed literature to the patient’s bedside.

References

Vijai, M. N., Ravi, P. R., Setlur, R., & Vardhan, H. (2016). Efficacy of intermittent sub-glottic suctioning in prevention of ventilator-associated pneumonia- A preliminary study of 100 patients. Indian Journal Of Anaesthesia, 60(5), 319-324. doi:10.4103/0019-5049.181592

Abstract:

Background and Aims: Oropharyngeal colonisation followed by aspiration of contaminated secretions is the major cause for ventilator-associated pneumonia (VAP). Pooled secretions present in the sub-glottic area above inflated endotracheal tube cuff may be aspirated into the lower airways. It was hypothesised that intermittent suctioning of sub-glottic secretions would prevent VAP. Methods: Group I (n = 50) patients were intubated with HiLo Evac™ endotracheal (ET) tube with facility for sub-glottic suctioning, and Group II (n = 50) patients were intubated with HiLo Contour™ ET tube without such facility. In the Group I, sub-glottic suctioning was performed every 2 h. Incidence of VAP, mean ventilator days, Intensive Care Unit (ICU) stay and mortality were compared. Qualitative variables were reported as percentages and were compared by Chi-square test or unpaired two-tailed, Fisher’s exact test, as appropriate, to analyse the significance of difference between the two groups. Results: The two groups were similar with respect to demographic characteristics. VAP was seen in 6% of patients in Group I and 22% of patients in Group II (P = 0.021). Both early- and late-onset VAPs were significantly reduced in Group I. Both ventilator days (8.0 vs. 6.45; P = 0.001) and ICU stay (8.33 vs. 6.33; P = 0.001) on the day of onset of VAP were significantly more in the Group I. Total ventilator days were significantly less (6.52 vs. 8.32; P = 0.006) with lower incidence of mortality (36% vs. 48%; P = 0.224) in the Group I. Conclusion: Intermittent sub-glottic suctioning reduces the incidence of VAP including late-onset VAP. [ABSTRACT FROM AUTHOR]

References

Guterres da Silva, S., Pereira do Nascimento, E. R., & Kuerten de Salles, R. (2012). BUNDLE TO PREVENT VENTILATOR-ASSOCIATED PNEUMONIA: A COLLECTIVE CONSTRUCTION. Texto & Contexto Enfermagem, 21(4), 837-844.

Abstract:

This article reports on a qualitative convergent care research, which was aimed at the collective construction of a bundle to prevent ventilator-associated pneumonia by nursing and physiotherapy professionals at the intensive care unit of a public teaching hospital in Santa Catarina. The data collection occurred from May to December 2011 and included individual interviews and discussion groups, with the participation of 25 and 14 professionals, respectively. For the data analysis, Morse and Field’s reference framework was adopted. The construction of the bundle was guided by the evidence-based practice criteria and consists of four preventive care acts: oral hygiene with 0.12% chlorhexidine; headboard elevated (30-45º); endotracheal cuff pressure between 20-30 cmH2O; and care with the aspiration of tracheal secretions. The implementation of these recommendations can support healthcare practice, contributing to reduce ventilator-associated pneumonia rates.

References

Soh, K., Davidson, P., Leslie, G., DiGiacomo, M., & Soh, K. (n.d). Nurses’ perceptions of standardised assessment and prevention of complications in an ICU.Journal Of Clinical Nursing, 22(5-6), 856-865.

Abstract:

Aims and objectives To describe nurses’ perceptions of evidence-based recommendations to prevent complications in a Malaysian intensive care unit. BackgroundVentilator-associated pneumonia, catheter-related blood stream infection and pressure ulcer are three frequent adverse events in the intensive care unit. Implementing evidenced-based practice is critical in prevention of these complications. Design A qualitative focus group study. Methods Focus groups were conducted with nurses in the intensive care unit of a regional hospital in Malaysia following evidence-based interventions. Focus group transcripts were analysed using the method of thematic analyses. Results Thirty-four nurses participated in eight focus groups. The main themes derived from the interviews: (1) nurses’ knowledge impacts on the change process; (2) initial resistance, ambivalence and movement to acceptance; and (3) hierarchical organisational structure can hinder the change process. Conclusion Enhancing nurses’ knowledge and attitudes of evidence-based practice, providing them with tools to monitor their clinical practice, and empowering them to change practice are likely to be important in influencing clinical outcomes. Increasing the emphasis on evidence-based practice in nursing curricula and engaging in cultural change processes in the workplace are necessary to improve clinical outcomes. Relevance to clinical practice These findings provide valuable information for implementing clinical practice improvement interventions.

References

O’Keefe-McCarthy, S., Santiago, C., & Lau, G. (2008). Ventilator-Associated Pneumonia Bundled Strategies: An Evidence-Based Practice. Worldviews On Evidence-Based Nursing, 5(4), 193-204.

Abstract:

Background: Ventilator-associated pneumonia (VAP) is an ongoing challenge for critical care nurses as they use current evidence-based strategies to decrease its incidence and prevalence. Mechanical intubation negates effective cough reflexes and impedes mucociliary clearance of secretions, causing leakage and microaspiration of virulent bacteria into the lungs. VAP is responsible for 90% of nosocomial infections and occurs within 48 hours of intubation. VAP is a major health care burden in terms of mortality, escalating health care costs, increased length of ventilator days and length of hospital stay.

Aim: (1) To provide a review of the literature on VAP bundle (VAPB) practices. (2) To describe the etiology and risk factors and define bundled practices. (3) To discuss an explanatory framework that promotes knowledge translation of VAPBs into clinical settings. (4) To identify areas for further research and implications for practice to decrease the incidence of VAP.

Methods: Electronic searches in MEDLINE, EMBASE, CINAHL, PsycINFO, and Cochrane Collaboration were conducted using keywords specific to VAP. The inclusion criteria were: (1) Studies were original quantitative research published in an English peer-reviewed journal for the years 1997 to 2007. (2) Each study included an examination of bundled practices. (3) The clinical outcomes of critically ill adults with VAP were assessed. The studies were identified from the bibliographies of key references. Six studies were accepted based on the inclusion criteria. Each contributing author conducted the review and analysis of selected studies independently. The findings were compared and contrasted by all authors to establish consensus.

Results: Evidence shows that VAPB practices decrease VAP rates. Bundled practices result in decreased ventilator days, intensive care unit length of stay, and mortality rates. A strong association was seen, with an increased clinician compliance with VAPB protocols with decreased VAP rates.

Conclusions and Implications: Methodologically robust randomized controlled trials are required to examine the efficacy of VAPBs and determine causality between VAPBs and clinical outcomes. Organizational commitment is needed to adopt a conceptual framework that promotes effective knowledge translation, incorporating factors of evidence, context, and facilitation of VAPBs into clinical settings. Instituting nurse-led intervention champion leaders to facilitate reliable and consistent implementation of VAPBs into practice is warranted.

References

Ali, K. J., Farley, D. O., Speck, K., Catanzaro, M., Wicker, K. G., & Berenholtz, S. M. (2014). Measurement of Implementation Components and Contextual Factors in a Two-State Healthcare Quality Initiative to Reduce Ventilator-Associated Pneumonia. Infection Control & Hospital Epidemiology, 35S116-23. doi:10.1086/677832

Abstract:

Objective: To develop and field test an implementation assessment tool for assessing progress of hospital units in implementing improvements for the prevention ofventilator-associated pneumonia (VAP) in a two-state collaborative, including data on actions implemented by participating teams and contextual factors that may influence their efforts. Using the data collected, learn how implementation actions can be improved and analyze effects of implementation progress on outcome measures.

Design: We developed the tool as an interview protocol that included quantitative and qualitative items addressing actions on the Comprehensive Unit-based Safety Program (CUSP) and clinical interventions for use in guiding data collection via telephone interviews.

Setting: We conducted interviews with leaders of improvement teams from units participating in the two-state VAP prevention initiative.

Methods: We collected data from 43 hospital units as they implemented actions for the VAP initiative and performed descriptive analyzes of the data with comparisons across the 2 states.

Results: Early in the VAP prevention initiative, most units had made only moderate progress overall in using many of the CUSP actions known to support their improvement processes. For contextual factors, a relatively small number of barriers were found to have important negative effects on implementation progress (in particular, barriers related to workload and time issues). We modified coaching provided to the unit teams to reinforce training in weak spots that the interviews identified.

Conclusion: These assessments provided important new knowledge regarding the implementation science of quality improvement projects, including feedback during implementation, and give a better understanding of which factors most affect implementation.