Introduction/Background
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...
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... have shown that by increasing education or explaining rationale to clinicians, they are more likely to follow protocol.
In order to begin a culture that allows those at risk for VAP to be especially made certain they are following safety standards closely, education on those who are at high risk needs to be implemented. High-risk patients will also be alerted on the main screen on a banner in EPIC, making sure extra precautions are being taken. The charge nurse will determine the patient as high risk.
After the education plan is implemented, hopefully there is a positive outcome in education. A long-term goal is to see if the high risk patients rate of VAP occurrence decreases.
Overall, VAP is a preventable infection and by increasing education, surveillance and adding to the VARI standards for the standards that are missing, the rates will continue to decrease.
“The specific age-related changes include loss of elastic recoil, stiffening of the chest wall, inefficiency in gas exchange, and increased resistance to airflow (Ebersole & Hess, 1998, p. 72).” As the individuals gets older their gas exchange in the respiratory system declines. Therefore, natural aging makes them more prone to respiratory problems and infections. It also makes them become fatigue much quicker while performing daily ADL’s.
...y infections that could cause short term or long term unneeded damage. For this reason doctors and health care professionals are recommending that all people of all ages to get theses vaccines (University of Maryland Center, 2014). Other ways to prevent this disease are to simply keep clean and be aware of good hand hygiene (University of Maryland Center, 2014). By washing your hands with antimicrobial soap and warm water with friction, most bacteria are killed. Doing this prevents organisms from potentially getting inside your body.
Safety is focused on reducing the chance of harm to staff and patients. The 2016 National Patient Safety Goals for Hospitals includes criteria such as using two forms of identification when caring for a patient to ensure the right patient is being treated, proper hand washing techniques to prevent nosocomial infections and reporting critical information promptly (Joint Commission, 2015). It is important that nurses follow standards and protocols intending to patients to decrease adverse
Peters-Golden, M. Pneumonia (Chapter 15). 2010. Breathing in America:Diseases, Progress, and Hope: p.155. Retrieved from http://www.thoracic.org/education/breathing-in-america/resources/chapter-15-pneumonia.pdf
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).
However, increasing antibiotic resistance patterns among intensive care unit pathogens, cultivated by empiric-broad spectrum antibiotic regimens, characterizes the variable concerns. Recent literature point that antibiotic use before the development of VAP is associated with increased risk for potentially resistant gran-negative infections and Methcillin-resistant Staphylococcus auereus (MRSA)
Sacristán, J. (2011, April 25). Exploratory trials, confirmatory observations: A new reasoning model in the era of patient-centered medicine. . Retrieved May 23, 2014, from http://www.biomedcentral.com/1471-2288/11/57
Also, the hospital acquired infection (HAIT) CAUTI is a challenge to the healthcare team and compromises patient’s health. However, to decrease the risk of CAUTI’s in ICU patients, it is imperative to provide a multifaceted approach, utilizing bundles. Blanck describes the setting as a 20 bed ICU intervention group and the pre-and post-indwelling catheter care is performed by utilizing the prevention bundle and bedside checklist. Also, survey record is utilized for the control group and comparison of data is then completed. Moreover, the development of a nursing practice protocol and implementation of protocol will be
The idea behind conforming to evidenced based practices is that research is the most likely tool to improve patient
Liam is a previously healthy boy who has experienced rhinorrhoea, intermittent cough, and poor feeding for the past four days. His positive result of nasopharyngeal aspirate for Respiratory Syncytial Virus (RSV) indicates that Liam has acute bronchiolitis which is a viral infection (Glasper & Richardson, 2010). “Bronchiolitis is the commonest reason for admission to hospital in the first 6 months of life. It describes a clinical syndrome of cough tachypnoea, feeding difficulties and inspiratory crackles on chest auscultation” (Fitzgerald, 2011, p.160). Bronchiolitis can cause respiratory distress and desaturation (91% in the room air) to Liam due to airway blockage; therefore the infant appears to have nasal flaring, intercostal and subcostal retractions, and tachypnoea (54 breathes/min) during breathing (Glasper & Richardson, 2010). Tachycardia (152 beats/min) could occur due to hypoxemia and compensatory mechanism for low blood pressure (74/46mmHg) (Fitzgerald, 2011; Glasper & Richardson, 2010). Moreover, Liam has fever and conjunctiva injection which could be a result of infection, as evidenced by high temperature (38.6°C) and bilateral tympanic membra...
Providing access to a brief rationale with the recommendation may increase acceptance of reminders and at the same time educate the care provider.
“Viral Pneumonia: Medline Plus.” Nih.gov. 26 February 2014. National Institutes of Health. 23 March 2014 .
November 16 2002, A farmer in Guangdong province within southeastern China, entered a local hospital with an illness that was believed to be an extreme case of atypical pneumonia. Later, more and more patients begin arriving at hospitals across the globe with a serious illness that displayed all the signs and symptoms of what could have been atypical Pneumonia. The only difference was that these pneumonia cases were suddenly more severe than most cases throughout history. Soon after, these flu-like cases caught the attention of the World Health Organization (WHO). Due to the severity of these cases and how furiously infection took over, WHO established a global alert to all hospitals to be aware of a severe form of pneumonia that appears to
The clinical problem that I chose to talk about and will like to present is about surgical site infection. I wanted to address this issue because in the recent year’s, surgical site infections has become a huge problem that is embedded in our common healthcare practices despite the precautionary improvements that were achieved in the healthcare industry. The Centers for Disease Control and Prevention estimates that “500,000 surgical site infections occur annually and account for 3% of surgical mortality, prolonged lengths of hospital stay, and increased medical cost.” (Diaz, Newman, 2015, P.63). With this being said, nurses have the potential of preventing surgical site infection by following guidelines to meet the patient safety. Identifying
Reducing healthcare associated infections (HAI) or nosocomial infections is an ongoing challenge for healthcare facilities. As healthcare changes from a fee-for-service billing system to a value-based or outcome-based billing system, it will be essential for healthcare providers to minimize hospital acquired infections and hospital readmissions to maintain a healthy bottom line. Sifri, Burke and Enfield’s (2016) article asserts “despite important reduction in certain HAIs, the nation has not yet reached the goals for HAI reduction set by the Department of Health and Human Service’s 2009 National Action Plan to Prevent Healthcare associated infections” (p. 1565). Healthcare providers have known for years that pathogens such as Methicillin-resistant Staphylococcus Aureus (MRSA), B-lactamase producing Enterobacteriaceae (ESBL), and Vancomycin-resistant Enterococcus (VRE) are examples of pathogens that remain viable on surfaces for extended periods of time. Patients are consistently shedding bacteria, contaminating bed linens, gowns and hard surfaces. As a result, the bacteria can be transferred from patients to healthcare workers and medical equipment. Some of the pathogens can remain viable for days, weeks and even months on hard surfaces. Clostridium difficile can survive for months in an untreated environment.