PICOT Statement for Ventilator-associated Pneumonia

Population 

The targeted population for VAP intervention is the patients in ICU care. Typically, there are high chances of the infection occurring in other sections of the hospital, but there are many ways of preventing them. However, when it comes to the ICU, the patients have various weaknesses such as impaired physiology, slow immune response and multiple organ dysfunctions (Bouadma, Sonneville, Garrouste-Orgeas, Darmon, Souweine, Voiriot, & Argaud, 2015). In this regard, VAP infections in the ICU is estimated to have a mortality rate as high as 10%. Any ill patient who stays in mechanical ventilation for at least 48 hours is at risk of VAP infection. Therefore, the nursing intervention needs to emphasize this area by identifying an intervention of change. 

Nursing Intervention 

Evidence-based research point to the importance of frequent assessment of patients to prioritize responses, identify, and prevent infections. In this case, collaboration among the nurses and other practitioners will help in reducing cases of VAP infections (Osti, Wosti, Pandey, & Zhao, 2017). The intervention will help in having enough personnel to check on the patients. Additionally, the collaboration will help to foster healthy discussions on changing some of the practices to ensure that the patient reports the best outcomes. Reducing the barriers between the operations for the nurses and the other professionals in the ICU is the best bet to achieve some of the evidence-based practices to reduce VAP infections. 

First, bundling of interventions is the best way to ensure that the patient is exposed to various circumstances that will reduce VAP infections significantly. Since there are many options on the table, it will take the intervention of the various professionals to know how to combine the strategies to reduce VAP optimally. For instance, having the ET tube pressure below 25 cmH2O, keeping head at a 30 to 45 elevation; and offering mouth care every 4 hours has been known to prevent VAP effectively (Hill, 2016). This situation will only work smoothly in a hospital’s ICU setting of the various practitioners to give their opinion on what to prioritize. 

Second, the collaboration will aid in trying out new interventions that may have higher chances of success. For instance, there is evidence that minimal exposure to mechanical ventilation reduces the chance of VAP infection. Therefore, brainstorming will bring to the fore the various options that could be adopted to minimize the effects and duration of mechanical ventilation. For instance, it has been proven that using helmets instead of face masks lowers the intubation rates which in turn reduces chances of contracting VAP (Damas, Frippiat, Ancion, Canivet, Lambermont, Layios, & Lancellotti, 2015). Similarly, using ventilator-weaning strategies, the patient can come out of mechanical ventilation quickly. 

Patient Population Currently not receiving the Intervention 

The patients in the ICU that do not receive collaborative interventions from the nursing staff will face various challenges. First, the team will have divided tasks which will inhibit the all-around assessment of a patient to identify other infections (Hill, 2016). Secondly, the lack of collaboration reduces the number of staff designated to a patient; thus there will be minimal resources to carry out regular assessments and plan on bundling strategies to reduce VAP infections. Therefore, evidence-based interventions such as oral hygiene assessment after every four hours will be a challenging task to carry out. Therefore, the other patients are likely to receive divided attention from the staff thus increasing their chances of succumbing to VAP in case it strikes them. 

Implementation of the Intervention 

The nursing intervention will require meticulous planning as it will involve the reorganization of the duties of nurses and other experts in the ICU settings. The staff will have to re-plan their shifts to increase the frequency of assessments and schedule a frequent meeting to discuss on the patient’s’ status collaboratively (Osti, Wosti, Pandey, & Zhao, 2017). This process involves a culture change; thus the implementations process will have to go through the various stages of adopting change. Therefore, the minimum period for implementation will be three months while the maximum will be six. 

References 

Bouadma, L., Sonneville, R., Garrouste-Orgeas, M., Darmon, M., Souweine, B., Voiriot, G., ... & Argaud, L. (2015). Ventilator-associated events: prevalence, outcome, and relationship with ventilator-associated pneumonia.    Critical care medicine ,    43 (9), 1798-1806. 

Damas, P., Frippiat, F., Ancion, A., Canivet, J. L., Lambermont, B., Layios, N., ... & Lancellotti, P. (2015). Prevention of ventilator-associated pneumonia and ventilator-associated conditions: a randomized controlled trial with subglottic secretion suctioning.    Critical care medicine ,    43 (1), 22-30. 

Hill, C. (2016). Nurse-led implementation of a ventilator-associated pneumonia care bundle in a children’s critical care unit.    Nursing children and young people ,    28 (4). 

Kalil, A. C., El-Rabbany, M., Zaghlol, N., Bhandari, M., & Azarpazhooh, A. (2015). Prophylactic oral health procedures to prevent hospital-acquired and ventilator-associated pneumonia: a systematic review.    International journal of nursing studies ,    52 (1), 452-464. 

Osti, C., Wosti, D., Pandey, B., & Zhao, Q. (2017). Ventilator-Associated Pneumonia and Role of Nurses in Its Prevention.    Journal of the Nepal Medical Association ,    56 (208).