Oral Care with Chlorhexidine
Ventilator Bundle and Oral Care Procedures
Ventilator Associated Pneumonia (VAP) is a healthcare acquired infection of concerning risk to patients who require mechanical ventilation. In fact, VAP is the most common nosocomial infection in patients who are mechanically ventilated (Barclay & Vega, 2005). The American Association of Critical Care Nurses (AACN) has recommended steps for the reduction of VAP and, when implemented together, are referred to as the “Ventilator Bundle”. These steps are based on best practice guidelines from the Centers for Disease Control and Prevention (CDC) and include head of bed elevation 30 to 45 degrees, continuos removal of subglottic secretions, change of ventilator circuit no more than every 48 hours and washing of hands before and after patient contact (AACN, 2008). In The Guidelines for Preventing Health Care Associated Pneumonia, 2003 the Centers for Disease Control and Prevention (CDC) also makes a key recommendation for the development of oral hygiene programs that may include the use of an oral antiseptic agent (CDC, 2004).
Oral Care Procedure in Need of Change
While oral care is present in many critical care unit’s ventilator policies and used in conjunction with the ventilator bundle, there is wide variance. In a 2007 cross sectional survey of critical nurses, 50% reported having oral care protocols in place within their hospitals but revealed variances in practices (Cason, Tyner, Saunders & Broome, 2007). In 2005 Peace Health St, Joseph’s Medical Center, a 243 bed rural hospital in Bellingham, WA formed a comprhensive ventilaor bundle that included oral care. The basis for the practice was determined by a multidisciplnary team that was formed to...
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...xidine. Retrieved from http://www.ihi.org/knowledge/Pages/Changes/DailyOralCarewithChlorhexidine.aspx
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Koeman, M., AJA, Hak, E., Joore, H., Kaasjager, K., de Smet, A., &, ... Bonten, M. (2006). Oral decontamination with chlorhexidine reduces the incidence of ventilator- associated pneumonia. American Journal Of Respiratory & Critical Care Medicine, 173(12), 1348-1355.
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Hospital-acquired infections (HAI) are preventable and pose a threat to hospitals and patients; increasing the cost, nominally and physically, for both. Pneumonia makes up approximately 15% of all HAI and is the leading cause of nosocomial deaths. Pneumonia is most frequently caused by bacterial microorganisms reaching the lungs by way of aspiration, inhalation or the hematogenous spread of a primary infection. There are two categories of Hospital-Acquired Pneumonia (HAP); Health-Care Associated Pneumonia (HCAP) and Ventilator-associated pneumonia (VAP).
Respiratory assessment is a significant aspect of nursing practice. According to the National Institute for Health and Care Excellence, respiratory rate is the best indicator of an ill patient and it is the first observation that will demonstrate a problem or deterioration in condition (Philip, Richardson, & Cohen, 2013). When a respiratory assessment performed effectively on a patient, it can result in upholding patient’s comfort and independence in progress of symptom management. Studies have acknowledged that in spite of the importance of the respiratory rate (RR) it is documented rarely than the other vital signs in the hospital settings (Parkes, 2011). This essay will highlight the importance of respiratory assessment and discuss why nurses
Ventilator Associated Pneumonia (VAP) is a very common hospital acquired infection, especially in pediatric intensive care units, ranking as the second most common (Foglia, Meier, & Elward, 2007). It is defined as pneumonia that develops 48 hours or more after mechanical ventilation begins. A VAP is diagnosed when new or increase infiltrate shows on chest radiograph and two or more of the following, a fever of >38.3C, leukocytosis of >12x10 9 /mL, and purulent tracheobronchial secretions (Koenig & Truwit, 2006). VAP occurs when the lower respiratory tract that is sterile is introduced microorganisms are introduced to the lower respiratory tract and parenchyma of the lung by aspiration of secretions, migration of aerodigestive tract, or by contaminated equipment or medications (Amanullah & Posner, 2013). VAP occurs in approximately 22.7% of patients who are receiving mechanical ventilation in PICUs (Tablan, Anderson, Besser, Bridges, & Hajjeh, 2004). The outcomes of VAP are not beneficial for the patient or healthcare organization. VAP adds to increase healthcare cost per episode of between $30,000 and $40,000 (Foglia et al., 2007) (Craven & Hjalmarson, 2010). This infection is also associated with increase length of stay, morbidity and high crude mortality rates of 20-50% (Foglia et al., 2007)(Craven & Hjalmarson, 2010). Currently, the PICU has implemented all of the parts of the VARI bundle except the daily discussion of readiness to extubate. The VARI bundle currently includes, head of the bed greater then or equal to 30 degrees, use oral antiseptic (chlorhexidine) each morning, mouth care every 2 hours, etc. In the PICU at children’s, the rates for VAP have decreased since the implementation of safety ro...
Ventilator-associated pneumonia (VAP) remains to be a common and potentially serious complication of ventilator care often confronted within an intensive care unit (ICU). Ventilated and intubated patients present ICU physicians, nurses, and respiratory therapists with the unique challenge to integrate evidence-informed practices surrounding the delivery of high quality care that will decrease its occurrence and frequency. Mechanical intubation negates effective cough reflexes and hampers mucociliary clearance of secretions, which cause leakage and microaspiration of virulent bacteria into the lungs. VAP is the most frequent cause of nosocomial infections and occurs within 48 hours of intubation. VAP is a major health care burden with its increased morbidity, mortality, longer ventilator days and hospital stay, and escalating health care cost.
Craven , D., & Hjalmarson, K. (2010). Ventilator-associated tracheobronchitis and pneumonia: thinking outside the box. Clinical Infectious Diseases: An Official Publication Of The Infectious Diseases Society Of America , 1, p.S59-66. Retrieved from http://ehis.ebscohost.com/eds/detail?sid=44b983f2-9b91-407c-a053-fd8507d9a657@sessionmgr4002&vid=9&hid=116&bdata=JnNpdGU9ZWRzLWxpdmUmc2NvcGU9c2l0ZQ==
The nursing discipline embodies a whole range of skills and abilities that are aimed at maximizing one’s wellness by minimizing harm. As one of the most trusted professions, we literally are some’s last hope and last chance to thrive in life; however, in some cases we may be the last person they see on earth. Many individuals dream of slipping away in a peaceful death, but many others leave this world abruptly at unexpected times. I feel that is a crucial part to pay attention to individuals during their most critical and even for some their last moments and that is why I have peaked an interest in the critical care field. It is hard to care for someone who many others have given up on and how critical care nurses go above and beyond the call
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This literature review will analyze and critically explore four studies that have been conducted on hand hygiene compliance rates by Healthcare workers (HCWs). Firstly, it will look at compliance rates for HCWs in the intensive care units (ICU) and then explore the different factors that contribute to low hand hygiene compliance. Hospital Acquired infections (HAI) or Nosocomial Infections appear worldwide, affecting both developed and poor countries. HAIs represent a major source of morbidity and mortality, especially for patients in the ICU (Hugonnet, Perneger, & Pittet, 2002). Hand hygiene can be defined as any method that destroys or removes microorganisms on hands (Centers for Disease Control and Prevention, 2009). According to the World Health Organization (2002), a HAI can be defined as an infection occurring in a patient in a hospital or other health care facility in whom the infection was not present or incubating at the time of admission. The hands of HCWs transmit majority of the endemic infections. As
The Cumulative Index to Nursing and Allied Health Literature (CINAHL) was used to find peer-reviewed articles, using query terms such as: aspiration pneumonia, ventilator, and prevention. In addition, the TWUniversal search engine was utilized to find peer-reviewed articles, with the key words: aspiration pneumonia, ventilator, and enteral.
American Association of Nurse Anesthetists. Professional Aspects of Nurse Anesthesia Practice. Philadelphia: F. A. Davis Company, 1994. Print.
Prevention of hospital-acquired infections: review of non-pharmacological interventions. Journal of Hospital Infection, 69(3), 204-219. Revised 01/20 Haugen, N., Galura, S., & Ulrich, S. P. (2011). Ulrich & Canale's nursing care planning guides: Prioritization, delegation, and critical thinking. Maryland Heights, Mo. : Saunders/Elsevier.
The many concepts are very complex and have many dimensions. Concepts developed by Leininger, Watson, Gaut, Benner and Wrubel, Ihde, and many more were discussed and how they relate to ICU nurses and their caring practices. It is stressed in this article that ICU nurses have an important role of making sure they have insight into their specific behaviors so that nursing practices can be developed. Once these nursing practices are developed, ICU nurses can successfully care for their critically ill patients. Wilkin (2003) claims that caring is a, “dual component of attitudes/values and activities, which create an ongoing challenge for the ICU nurses” (p.
Grossbach, I., Stranberg, S., & Chlan, L. (2011). Promoting Effective Communication for Patients Receiving Mechanical Ventilation. Critical Care Nurse, 31(3), 46-61. doi: 10.4037/ccn2010728
Although students were not allowed in the recovery unit, I was able to talk to one of the recovery nurses. I learned that a nurse’s duty of care includes monitoring the patient’s vital signs and level of consciousness, and maintaining airway patency. Assessing pain and the effectiveness of pain management is also necessary. Once patients are transferred to the surgical ward, the goal is to assist in the recovery process, as well as providing referral details and education on care required when the patient returns home (Hamlin, 2010).
QSEN is started as an initiative to give future nurses the quality education necessary to provide the quality care and safety for the community (Potter, Perry, Stockert, Hall, & Ostendorf, 2017). This nursing care ties in with the standard of care in competency because QSEN is providing the level of education needed for future nurses to be competent to provide the appropriate care for patients. Nursing process is break down of the care and treatment a patient is given depending on their illness in 5 stages of assessment, nursing diagnosis, planning, implementation and evaluation. The standard of care that can be defined by this nursing care is available information given. Nurses assess patients based on the chief complaint that patients give. The importance of this correlation is the rapport that is builds between nurse and patient. For example, if a patient does not disclose recreational use of opioids and the nurse gives them a sedative, such as propofol, for a procedure, the patient’s respiratory system will decline immediately. This is an example of lack of information given in which the nurse was not able to give the appropriate care and treatment. Last but not least, is the nursing care established on evidence-based practice. An example of this is the use hand sanitizers before and after enter a patient’s room. This practice has become a policy at many facilities to decrease infection. This correlates with the standard of care of following approved