Hitherto, the most shared and recurrent health-care related infection in the intensive care unit is Ventilator-associated pneumonia (VAP). This is because the disease is linked with sensitive indisposition, mortality, prevalence, and the duration of stay in the healthcare setting (Keyt, Faverio, & Restrepo, 2014). The disease is also argued to be connected with various clinical aftermaths in the sense that lengthy mechanical ventilation, multi-drug resistance, several uses of antibiotic drugs, and extended stay in intensive care units can result in increased cost of health care and other clinical manifestations. Similarly, this is issue somewhat controversial in a sense that it remains unclear whether most of the patient of VAP or die with VAP due to its augmented mortality rate. In this case, Cooper and Haut (2013) notes that the Center for Disease Control and Prevention have presented that the most efficient and adaptive intervention of dealing with VAP infection is through prevention. However, little research and literature have been conducted suggesting the most appropriate plan and nursing strategies that should be used to assure health promotion and maintenance of health in ICU. This investigation, therefore, addresses prevention as the most appropriate intervention for Ventilator-associated pneumonia when it comes to health promotion and maintenance of patient health in the intensive care unit.
Description of the Clinical Issue and how it relates with one NCLEX-RN examination blueprint
Ventilator-associated pneumonia is a developed pneumonia in health care setting that formulates in the patient that is treated with the mechanical ventilation for more than 48 hours (Cooper and Haut, 2013). Initially, patients present no signs of lower respiratory infection before they are ventilated. In this case, under the observation, the patient starts to demonstrate a decline in value in respiratory status, which can lead to several clinical manifestations. Some of the clinical consequences can be associated VAP as reported by CDC include a rise in the body temperature, adenoidal broadening together with drawing in of the chest, transient cessation of respiration, and cough in children. On the other hand, Kalanuria, Zai, & Misrki (2014) suggest that VAP bestows to almost half of the patients admitted to a hospital acquired pneumonia, which tends to be the second most nosocomial infection in the ICU. Separately, the disease is associated with varieties of unresolved clinical problems such as increased stay in ICU, higher morbidity, mortality, and increased medical cost of care (Lim, Kim-Peng, et al., 2015). Additionally, these factors linked with VAP suggest that the management and diagnosis of VAP in the contemporary clinical protocol have become unmanageable for the cannulated patient. Consequently, VAP affects every patient population, more so those that are mechanically ventilated. In effect, VAP poses grievous health aftermaths in both blunted cannulated child and adult patient in ICUs (Kalanuria, Zai, & Misrki, 2014).
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Proposed Solution, Goals, and Barriers
Prevention is the most efficient solution for dealing with VAP in ICUs (Cooper and Haut, 2013). This is because up to modern times, healthcare setting or organizations have not suggested a universal accepted, gold-standard problem-solving criterion for VAP. However, as argued by Kalanuria, Zai, & Misrki (2014) various clinical and nursing interventions have been recommended with the intent of treating the disease, but have not precisely acknowledged the infection. Therefore, one of the most shared and obvious ways to achieve prevention of ventilator-associated pneumonia is reducing the exposure of mechanical ventilation in ICU by replacing it with non-mechanical ventilation (Lambert, Marie-Laurence et al., 2013). In this intervention, using non-mechanical ventilation enhances the effectiveness and limits the duration and colonization of the airways. The goals of using noninvasive pressure ventilation are to lower the risk of VAP. It is also beneficial for a patient with acute exacerbation chronic obstructive pulmonary disease (Keyt, Faverio, & Restrepo, 2014). Additionally, looking at the research conducted by Branch-Elliman, Wright, & Howell (2015) the use of probiotic in the inhibition of VAP is the second significant in the sense that it is a low-cost strategy. The essential goal of using probiotics is to stop VAP through plummeting the colonization. Moreover, the interventions to expand oral hygiene and remove the traces of mucus and bacteria between the teeth cavity that allows for the growth of dental caries will minimize the risk of VAP. However, the use of probiotic and non-mechanical ventilation has barriers in the that they probiotics can result in other clinical problems (Lim, Kim-Peng, et al., 2013).
Furthermore, the aforementioned nursing strategies should be aggregated, in what is referred to as a “care bundle.” Focusing on the ethical consideration when developing this prevention plan, clinicians should comprehend the content of VAP care package by distinguishing the diversities of strategies (Lambert, Marie-Laurence et al., 2013). This is because, some of the prevention measures are provocative and the number of elements in the care bundle should be determined to increase health promotion and maintenance of patient health in the ICU (Lambert, Marie-Laurence et al., 2013). On the other hand, to promote health and maintenance of patient health in ICU, healthcare providers should engage in a culture of care while educating themselves, maintaining collective cleanliness, and the use of defensive machines and procedures of microbiological observation (O’Grady, Murray, & Ames, 2012). And it is for this reason; the care bundle is efficient in preventing VAP as it addressed the implementation of guidelines gap. On the other hand, even though prevention of VAP through the use of bundled care entail several clinical measures that promote health and maintenance of attention, the interventions have not yet been validated to suggest which strategies should be included in such bundles and whether they will improve clinical results.
Benefits
Granting that the solution mentioned above in preventing VAP is not validated to be useful, clinicians who are getting patient that request mechanical aeration should contribute in programs that are designed to prevent and maintain VAP. Similarly, to enhance the likelihood of efficacy and cost effectiveness much efforts should be directed to the physiognomies of the particular healthcare setting. For example, several replicas can be derived from the ways of preventing VAP. To start with, replacing mechanical ventilation with noninvasive pressure ventilation is beneficial as it reduces the prolonged stay in ICU. It also promotes the health of the patient with acute aggravation chronic obstructive pulmonary disease. On the other hand, it is argued by Branch-Elliman, Wright, & Howell (2015) that probiotic is low-cost program and effective way of preventing VAP. Suggestively, use of care bundle in VAP prevention has shown a significant reduction in VAP rates, antibiotic use, and prolonged stay in ICUs (Kalanuria, Zai, & Misrki, 2014; O’Grady, Murray, & Ames, 2012).
Conclusion
Ventilator-associated pneumonia is a frequent disease that occurs to a patient in the intensive care unit. Additionally, the infection is connected with high illness, death, and a lengthy stay in the ICU. In effect, the infection continues to pose grievous clinical outcomes. Hence, the appropriate intervention entails preventing the disease that includes specific measures and strategies that have been described in this investigation to improve the patient outcomes; therefore, enhancing health promotion and maintenance of health in the intensive care unit. In this case, the paper recommends medical providers to practice multidisciplinary approaches and strategies such as the use of noninvasive pressure ventilation, probiotics, and the combination of care bundle to prevent ventilator-associated pneumonia in intensive care.
References
Branch-Elliman. W., Wright, B. S., & Howell, M. (2015). Determining the Ideal Strategy for Ventilator-associated Pneumonia Prevention: Cost Benefit Analysis. American Journal of Respiratory and Critical Care Medicine, 192(1); 57-63. DOI: 10.1164/rccm.201412-2316OC
Cooper, B. V. & Haut C. (2013). Preventing Ventilator-Associated Pneumonia in Children: An Evidence-Based Protocol. The Journal of high acuity, progressive, and critical care nursing, 33(3); 21-29. DOI: 10.4037/ccn2013204
Kalanuria, A. A., Zai, W., & Mirski, M. (2014). Ventilator-associated pneumonia in the ICU. Critical Care , 18 (2), 208. http://doi.org/10.1186/cc13775
Keyt, H., Faverio, P., & Restrepo, M. I. (2014). Prevention of ventilator-associated pneumonia in the intensive care unit: A review of the clinically relevant recent advancements. The Indian Journal of Medical Research , 139 (6), 814–821.
Lambert, M.-L., Palomar, M., Agodi, A., Hiesmayr, M., Lepape, A., Ingenbleek, A., … Frank, U. (2013). Prevention of ventilator-associated pneumonia in intensive care units: an international online survey. Antimicrobial Resistance and Infection Control , 2 , 9. http://doi.org/10.1186/2047-2994-2-9
Lim, K., Kuo, S., Ko, W., Sheng, W., Chang Y., Hong, M., Sun, C., Chen, Y., & Chang, S. (2015). Efficacy of ventilator-associated pneumonia care bundle for prevention of ventilator-associated pneumonia in the surgical intensive care units of a medical center. Journal of Microbiology, Immunology, and Infection, 48(7); 316-321. DOI: http://dx.doi.org/10.1016/j.jmii.2013.09.007
O’Grady, N. P., Murray, P. R., & Ames, N. (2012). Preventing Ventilator-Associated Pneumonia: Does the Evidence Support the Practice? JAMA : The Journal of the American Medical Association , 307 (23), 2534–2539. http://doi.org/10.1001/jama.2012.6445
