People around the world suffer from various diseases that they acquire when exposed to other methods of treating other illnesses. Ventilator associated pneumonia (VAP) is a type of a disease that most people suffer from as a result of exposure to other methods of treating ailments ( Chastre & Fagon, 2002) . Studies have shown that this problem is common among patients using ventilators to treat respiratory and chest conditions. The disease occurs due to the use of mechanical intubation, which inhibits effective cough reflexes and prevents adequate mucociliary clearance of secretions from the lungs. The prevention of the secretions causes leakage and microaspiration of virulent bacteria into the lungs. The bacteria then cause VAP in critically ill and generally ill patients. Moreover, it is also clear that VAP is caused by infections of the upper respiratory and other lethal bacteria that affect the lungs. Research has also revealed that VAP is a major health problem in both general and critically ill patients and it interferes with health safety. The nurses and healthcare providers dealing with patients in the ICU have to deal with the issue of VAP on a daily basis. Longer stays in the ICU further worsen the situation (Koeman et al., 2006). Furthermore, the rate of infection of VAP takes place within 48 hours of admissions and present high morbidity and mortality rates among all patients.
Despite all the negative effects of VAP infections, nurses and health providers can use various methods to help prevent VAP infections. They can utilize diverse medical procedures in treating VAP in both critically ill and general patients. Further research has shown that VAP is a nosocomial infection that causes high mortality, morbidity, and costs the health care system highly regarding treatments. Therefore, it is no doubt that nurses and other healthcare professionals should use evidence-based practices to help prevent VAP infections and treat the condition not only in critically ill patients but also among the general populations.
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Problem
The problem under investigation in this study is the high rates of mortality morbidity, and infections of VAP among general and critically ill patients in the country (Collard, Saint, & Matthya, 2003). It is clear that the rate at which patients using ventilators get infected with VAP is very high. The high rates of infection have also led to increased morbidity and mortality rates among the patients. Similarly, it is also clear that clinical nurses dealing with patients in the ICU have to deal with the issue of VAP more often and this present challenges not only in the form of medication but also in medical costs across the hospitals. VAP also leads to inability to ensure adequate health and patient safety for critically ill patients, making health outcomes less effective for these patients.
Moreover, many nurses do not seem to appreciate the use of evidence-based practice to help prevent infections and treatments of VAP. Therefore, it is important to come up with a research study that will shed more light in the effective uses of EBP in preventing and treating VAP among both critically ill and general patient populations. The study should also aim to provide practical EBP strategies that nurses and other health providers can use to ensure effective treatment and prevention of VAP and reduce the high rates of infections, morbidity, and mortality (Koeman et al., 2006).
Purpose
The purpose of this research study is to present effective and practical evidence-based practices that nurses and health professionals can use to prevent and treat VAP in critically ill patients and the general populations, using mechanical intubations to treat respiratory and other infections ( Chastre & Fagon, 2002) . The study also aims to provide an EBP that can be used to reduce morbidity and mortality rates among patients with VAP through prevention and treatments.
Question
The main question of the study is what evidence-based practice methods can be used by nurses and other healthcare providers to help in the treatment and prevention of ventilator-associated pneumonia among patients?
Literature Review
A research study by Chastre and Fagon (2002) has reported that VAP is a nosocomial problem experienced by about 8 to 25% of critically ill patients and those patients using ventilator procedures as methods of medication. The study further states that many patients having VAP also suffer from some infections of the skin, lungs, and urinary tract. The authors also state that the mortality and morbidity rates of VAP among critically ill patients is high and ranges from 20 to 50%. The rates can sometimes reach as high as 76% in some specific conditions made with lung infections caused by high risk pathogens (Chastre & Fagon, 2002). The study further reports that enterobacteriaceae, taphylococcus aureus, and pseudomonas aeruginosa cause VAP infections . They provide a statistical analysis of their findings and report that VAP is responsible for about 20 to 50% of patient deaths. The article reports further that the number of deaths can rise to 75% in patients with lung infections originating from high risk pathogens. Moreover, the article states that the general morbidity, mortality, and incidence rate or rate of occurrence in the general population is about 50% for ICU patients while 65% due to infections by high risk pathogens.
Moreover, Muceder, Dodek, Keanan, Fowler, Cook and Heyland (2007) report that VAP is a problem that many patients using ventilators have to deal with more often. The authors state that the issue is more critical in critically ill patients in ICU and is also available among patients in the general population who use mechanical ventilators. The authors also report that there exist some successful evidence-based practices that can be used to prevent the patients from acquiring VAP. Moreover, the authors also state that it is important for nurses and health practitioners to use EBP to help in treating and preventing the condition.
Another research study by Okeefe-McCarthy, Santiago, and Lau (2008), reports that VAP is a medical problem that has brought about various problems in clinical safety in the general and critically ill patients in ICU. The authors used research to show that VAP is an infectious condition responsible for 90% of nosocomial infections among critically ill patients. They state that VAP occurs within 48 hours of admission of new patients into the ICU. The authors report further that the mortality, morbidity, and infection rates of VAP among ICU patients take place within 48 hours of admission. They stated further that the infection rates in the general population is almost as high and requires the use of effective procedures to treat and prevent. Similarly, Rose and Crumpler (2007) conducted a research study and found out that VAP is a medical issue that affects ICU patients in many hospitals. They also stated that most of the patient contracted the illness immediately after being hospitalized.
Similarly, a study by Koeman et al., (2006) also reports that VAP is the most commonly occurring nosocomial infection, which is associated with high morbidity and mortality rates in the general population of patients using ventilators as a method of treating respiratory diseases. The authors observed that many patients in ICU and those in general wards using ventilator from various respiratory and chest conditions are at high risks of contracting VAP. In the same note, Craven and Hjilmarson (2012) conducted a research study that showed that mechanical ventilations and intubation enable these procedures to be more likely to contract VAP. The authors report that the general population patients are 6 to 20 times more likely to develop VAP infections, which relates to 20 to 40 percent mortality rates among these patients. The article reports that the rate at which critically ill patients become infected with the condition is also very high. As such, they propose that nurses and health providers dealing with such patients should use effective methods to aid the prevention and treatment of VAP to improve patient safety and health service provisions in the institutions.
Collard, Saint, and Matthya (2003) also conducted a study that showed that VAP is the most common cause of morbidity and mortality among critically ill patients. The article gives general cases of the morbidity, mortality, and incidence rate of occurrence only for critically ill by reporting that about 50% of ICU patients are at high risks of developing VAP during treatments. They also state that most people using ventilators are at high risks of acquiring VAP if they use the machines for longer period. The article showed through research that the overall VAP infection rate among critically ill patients was approaching 40%. They stated that the rate might be as high as 50% or 60% among patients who stay in intensive care for more than 5 to 7 days. The study further stated that respiratory tract infections contributed 30% to 60% of VAP infections among all critically ill patients. Their study also showed that the incidence of pneumonia acquired in the intensive care unit falls in the range of 10 to 65 percent of the patients.
Moreover, Rello, Sa-Borges, Correa, Leal, and Baraibar (1998) also stated that VAP is one issue that affects patient safety and complicates medication in critically ill patients. All the above studies show the critical natures of VAP among the critically ill patient as well as the patients in the general population that use mechanical ventilation to treat upper respiratory and chest problems.
Theory
Researchers in the nursing field can use many theories to implement a proposed project. However, this study found out that the best theory that nurses can use is the planned change theory. Mitchell (2012) states that the theory of planned change is a phenomenon that requires the nurses, clinicians, and health practitioners to make a calculated, collaborative, and purposeful approach to bringing the expected changes in their medical institutions. The author states that the health providers should use the expertise of change agents to help them implement the right changes that will bring success among their patients and the entire organization. Moreover, Mitchell (2012) states that the planned change theory also requires the nurses and health practitioners to use evidence-based practices to help them implement the intended project because evidenced base practices make room for continuous improvement.
Theory of planned change is important because it makes it possible for the nurses to use the expertise of change agents who are fellow experienced nurses or clinical professionals who have effective knowledge in implementing the evidence-based approaches proposed for the prevention and the treatment of VAP. Moreover, planned change requires the nurses to make calculated moves that will allow them to use EBP in implementing the recommended change in the project. The ability to make calculated moves also provides the health professionals with the possibilities for evaluating the process as they continue to ensure that they record and analyze the positive and negative impacts of the proposed changes. This also makes it possible for them to create room for making any necessary adjustment to ensure success of the project.
Similarly, planned change is important for implementing evidence-based practices that nurses and health professional can use to help them in preventing the occurrences and treatment of VAP in both critically ill patients and patient in the general public populations. This is because it makes it possible for the health professionals to ensure they make a purposeful implementation of the project. A purposeful project is a type of project that aims to explain the purpose and benefit of each recommended course of action. Therefore, planned change will ensure that the health providers come up with a method that is effective and beneficial for all patients. Planned change thererefore is also important in this project because it makes it possible for the health provider to analyze the needs of each patient and implement the project while tailoring the implementation and using the procedures that meet the medical needs of their clients.
Moreover, planned change theory also ensures that the nurses are able to effectively use evidence-based practices in the course of implementing the proposed project. Therefore, planned change will make it possible for the researcher to make use of evidence based methods in implementing the proposed course of action in preventing and treating VAP among critically ill and general patients. On the same note, using planned change will also ensure that the researcher can plan to involve other professionals such as public health officials and other medical practitioners in the organization who deal with patients in ICU on a daily basis.
Proposed Solutions
Several studies have shown that evidence-based practices are the most effective methods to be used in solving medical issues (Maite, Carmen, Emily, Marin, and Jordi, (2003). These authors investigated the ability of nurses to use evidence-based practices in helping to prevent VAP infections and treat the condition in general and critically ill patients and found out that by regular practices, the nurses were able to use evidence-based practices to help solve the situation.
One evidence-based practice that nurses and health providers can use include oral hygiene among patients in all populations. For example, Rose and Crumpler (2007) state that nurses in many organizations view the use of oral care in preventing VAP as a comfort measure with low priority. The authors report that the nurses prefer the use of foam swabbing as opposed to the use of toothbrushes. Therefore, they studied the effectiveness of using oral hygiene in reducing the ability of critically ill patients to contract VAP using 11 patients and reported a 50% decrease in the infection of VAP among the population. This study showed that effective oral care admissions and frequent brushing of patient teeth produced positive results in VAP prevention.
Maite, Carmen, Emily, Marin and Jordi (2003) have stated that nurses should adhere to the use of EBP in preventing the VAP infections among patients. The study showed that the ability of the nurses to adhere to the proposed use of EBP in reducing the rate of infection among ICU patients is important. According to Dodeck et al., (2003), some of the proposed practical guidelines for reducing the prevention of VAP included the need to use orotracheal route of intubation when dealing with patients in ICU. The nurses should also aim to change ventilator circuits for every new patient in the health organization. However, should the circuits be soiled, the nurses and health providers should make use of closed endotracheal suction systems, which should also be changed for every new patient. They must also use the systems as clinically indicated (Dodeck et al., 2003).
Moreover, in the absence of any contraindications after changing the ventilator circuits, the nurses should also use moisture and heat exchangers. They should also ensure that they change the moisture and heat exchangers on a weekly basis to ensure hygiene and prevent VAP infections among patients in ICU or those using mechanical ventilators. Moreover, they can also make use of semi-recumbent positioning when the patient does not show any contraindications. At a later date, the nurses and health professionals should change the moisture and heat exchangers as well as the ventilator system to prevent VAP infections. Moreover, research shows that the ability to consider using kinetic beds and subglottic secretion drainage systems also make it possible for the nurses to reduce VAP infections and the morbidity and mortality rates among critically ill patients.
Mucederes et al., (2008) also states that some other methods that nurses and health professionals can use include utilizing nonquantitative cultures with endotracheal aspirates as the initial diagnostic methods for VAP. Should they suspect the presence of VAP, then the health professionals and nurses should use empiric antimicrobial therapy as opposed to delayed or culture directed therapy in treating the condition. The authors also report that the health providers can also use single-agent antimicrobial therapy for every potential pathogen found in the culture. Moreover, the authors report that the choice of antibiotics to be used should depend on each patient’s needs and the local resistance patterns of every region.
Sedwick, Lance-Smith, Reeder, and Nardi (2012) state that if the nurses adhere to the use of the proposed EBP methods, then they have the chance of reducing VAP infections by 90%. The authors proposed that nurses and health professionals should use ventilator bundle developed from the health institute and expand it to include protocols for hand washing and mouth care among patients in the hospitals. They also stated that nurses and care providers should use subglottic suctioning, head of bed alarm, and an electronic compliance feedback tool to indicate the frequent applications of these methods. The study indicates that complying with these methods makes it possible for the nurses to prevent VAP infections by 90%. Moreover, these methods led to an increase of 96% in effective care protocol among nurses.
Just like other medical conditions, nurses and doctors can also use various diagnostic methods to diagnose VAP in general and ICU patients. A study by Puggin, Aukenthaler, Jansen, Mili, Lew and Sutter (1991) states that nurses and health professionals can use bacteriologic analysis of the bronchoscopic fluid. The authors report that the nurses should be able to use this method effectively to diagnose the presence or absence of VAP in both ICU and general patients.
On the same note, Okeefe-McCarthy, Saniago, and Lau (2008) also state that some other evidence-based practice that nurses and health professionals can use include VAP bundle practice protocols, which has been proved to reduce the rates of VAP infections among critically ill patients. Specifically, the authors report that the use of bundled practices was effective because it led to a lesser length of stay in the ICU, ventilator days and mortality rates among patients. This also leads to a decreasing number of patients contracting VAP while in intensive care. Moreover, the authors also reported a strong association in the reduction of VAP by the use of the bundle's process. This also followed the abilities of the nurses and the health practitioners to adhere to the VAP bundles protocol in the treatment of the condition among patient.
Allan et al., (1999) states that nurses should use protocol directed sections to prevent the rate of infections of VAP among ICU patients. They used 59 patients to conduct the study and reported an 80% success rate. They also noted that the use of this method leads to reduced length of stay in ICU, the need for tracheostomy for critically ill patients with acute respiratory failure, and the duration of using mechanical ventilation to treat the respiratory issue. The use of the study showed that ability of nurses to use the method makes it possible for them to reduce the rate of infection of VAP among critically ill patients.
Moreover, Elly et al., (2001) states that healthcare professionals can make use of protocol-based care for critically ill patients. They state that protocol based procedure for treating VA is importance because it makes it possible for nurses and health professionals to make use of available evidence base practices when dealing with critically ill patients.
On the same note, Collard, Saint, and Matthya (2003) also states that nurses and health care providers can make use of selective digestive tract decontamination to help prevent the development of VAP among patients. On the same note, the authors also state that health professionals could use semi-recumbent positioning of the patient in various situation to help in preventing them from contracting VAP. Moreover, they could employ the use of sucralfate as opposed to H 2 -antagonists for stress ulcer prophylaxis in ensuring the critically ill patients do not get infected with VAP while in ICU. Moreover, the authors also state that the health providers may also use different methods in helping them to prevent the acquisition of the condition in a patient with the issue.
Implementation Plan
It is important for health practitioners in various health professionals to ensure that they implement the evidence-based practices found out in the research. Therefore, the first method of implementation will be to identify 20 patients in the ICU who use ventilation methods for acute respiratory failures or infections. The patients also need to be suffering from VAP or are at risk of contracting the condition at the time of the study. The first implementation method that the researcher will use is the administration of effective oral hygiene. The nurses will use foam swabbing in ten patients and oral cleanliness through using toothbrushes in other ten patients every day for two weeks. The nurses will have to report the findings on a daily basis. The rate of infections of VAP will be compared among the patients and results will be recorded.
Hand washing is another EBP method that the nurses and other health professionals will have to use in the prevention of VAP among patients. The nurses will select 20 patients from ICU and ensure that they attend to them by washing hands every time they attend to the patients. The rate of VAP infections will be measured after two weeks.
Antimicrobial therapy is another method that nurses should implement in the treatment of VAP. Therefore, the doctors and the nurse will have to initiate the use of antimicrobial, especially in new patients. The nurses will implement this by administering the right dosage of the drug to 10 patients in ICU and leave 10 to make it possible for them to measure the rate of effectiveness of using this therapy to treat VAP at the time of the admission. They should monitor the process for one week and report the necessary changes.
Similarly, the nurse will have to make use of orotracheal route of intubation for the ICU patient and have a control group of ten patients not using the method. The nurse and the health providers will have to monitor the effect of reduction of VAP infection rate in new patients. They will have to give the results after every two weeks.
Similarly, decontamination of digestive tract is another EBP that the nurses will use to prevent the contraction of VAP among ICU patients. The nurses will implement this method by decontaminating the digestive tract for each new patient arriving in the hospital on a weekly basis. They will also report the rate of VAP infection of lack of it. Decontamination of this instrument will be done for the first ten new patients while the next ten patients will not receive such services to help monitor the effectiveness of the procedure
The nurses will also implement the act of changing the heat moisture exchangers used by the patients in the ICU. Exchanging these machines on a weekly basis is also important in preventing VAP infections. As such, they will have to monitor and change the heat and moisture exchangers for new patients on a weekly basis for the first ten new patients and leave the second ten patients to act as control group. They should report the weekly success rates.
Similarly, changing the ventilator circuits systems is another practice that nurses will have to implement in the first ten patients for the first ten weeks to ensure that they prevent the new patients from contracting VAP. They will leave ten patients with the same ventilator circuit and compare the rate of VAP infections among these patients. The nurses should also take care of the methods of prescribing antibiotics in various sites to evaluate how early diagnosis of VAP and immediate prescriptions of antimicrobials help in the treatment of VAP among 10 patients within 2 weeks. The nurses will also apply the use of subglottic suctioning to help reduce the rate at which patient become infected with VAP. Finally, another important factor to implement with the aim to prevent and treat VAP infection among ICU patients is the requirement that nurses should adhere to the use of EBP in their daily routines. Therefore, the nurses will have to fill in an electronic fact sheet that shows the type of EBP they have used on a daily basis. The researcher will also measure the proactiveness and rate of adherence to EBP methods by nurses.
Disseminating Results
The above research and discussion have highlighted several research studies which show that ventilator-associated pneumonia (VAP) is a health problem that many critical care nurses have to deal with on a daily basis. The study has also clearly indicated that VAP is a clinical problem that affects patients using ventilators as a method of treating acute respiratory failures, chests, and other respiratory diseases. The people who suffer from VAP the most are the patients in the ICU. The above discussion has also provided several EBP strategies that nurses can use to prevent and treat VAP among the patients in ICU. It is important that the research findings and the implementation plan should be used as soon as possible to help prevent high rates f infection, improve treatments, and reduce the morbidity and mortality rates that occur among patients. To achieve the most effective result while using the proposed EBPs, it is paramount that nurse and health providers should be proactively involved in the daily use of the measure since it is the only way that they can report effective success with the proposed EBPs.
Therefore, based on the above evidence, I will present my finding to my school of medicine. I will also choose one hospital in my area, present the data to the MOH, and request that the nurses should implement the proposed plan in their areas of duty to help in preventing and treating VAP. Moreover, the research findings acts as an important EBP ground for current and future nurses and health care providers to help in preventing VAP among ICU patients. While implementing the plan, sections of nurses and health professionals will also use the proposed solutions, plan and finding in the general population (Puggin, Aukenthaler, Jansen, Mili, Lew, & Sutter, 1991) .
I will also present my findings to the public health professionals to inform them about my findings and present an urgent need for public health professionals dealing with VAP patients to us evidence-based practices in treating and preventing the condition to reduce morbidity and mortality (Ely, et al., 2001) .
As stated above, VAP is not only critical in ICU patient buts also in general population patients who use mechanical ventilators for the treatment of chest and upper respiratory problems. This study aims to use the proposed EBP not only in the ICU but also among general patients because I believe that public health awareness about EBP methods for preventing and treating VAP is important. It will reduce the mortality, morbidity, and rates of infection about the people in public who use ventilators to treat the upper respiratory issue in their homes. Public health professionals help in ensuring health and safety of the other patients in public. Therefore, they also need to make effective use of these methods. I will also ask health professionals in my school of nursing to work with public health officers to sensitize the population about the risk of acquiring VAP as well as appeal to the doctors to use current methods and procedures for preventing and treating the issue.
Conclusion and Summary
Several studies have shown that VAP is a nosocomial infection that affects critically ill patients and those in the general populations. VAP infections mostly affect those using ventilators to treat various respiratory problems. The infections are also associated with high mortality and morbidity rates among the patients. In fact, studies have shown that patients admitted to the ICU develop VAP within 48 hours and the disease is responsible for up to 60% of death of those using ventilators ( Collard, Saint, & Matthya, 2003) . Similarly, it is clear from studies that nurses can use various EBP methods to help in the prevention and treatment of VAP. Some EBP methods such as oral hygiene using toothbrushes, subglottic secretions, using kinetic beds, effective hand washing, changing ventilator circuits and heat and moisture exchanger system are some of the procedures that nurse can use to prevent.
Moreover, health nurses and caregivers, as well as public health practitioners, can use antimicrobial therapies in treating VAP in cases where the patients already have the problem ( Dodek et al., 2004) . The successful use of these methods depends on the ability of the nurses to adhere to the daily use of EBP in the ICH and general populations. Implementation of the proposed actions and plans will take place in a period of two weeks after with the first results will be collected. Use of EBP among nurse and public health providers should be a continuous act and should make use of planned change theory to ensure effective implementation.
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