The Clinical Issue and Research Questions Using PICOT

Ventilator-Associated Pneumonia (VAP) 

Description and Background Information about VAP 

VAP is a sickness that occurs to patients who get ventilation artificially while admitted in the ICU. There are several bacteria linked with the transmission of the infection, and they include Acinetobacter baumanii, Klebsiella pneumoniae, Serratia marcescens, Stenotrophomonas maltophilia, Staphylococcus aureus, and Pseudomonas aeruginosa (Bouadma et al., 2015). The hospital-based infection has adverse impacts that comprise of high morbidity for patients in the ICU and consequent mortality. The therapeutic procedure for these patients who are already admitted in the Intensive Care Unit is very costly because of the prolonged periods of stay. 

The infection does not affect all the patents in the ICU but is prevalent to those that are use antibiotics for extended periods or those using artificial ventilation. The prolonged use of antibiotics leads to an increased rate of multidrug resistance and hence, makes the patients vulnerable to VAP infection (Kalil et al., 2015). Due to high mortality rates linked with the disease, many have been left wondering whether the cause has been due to primary or secondary infection by the VAP infection. 

The infection is believed to be one of the severest causes of death amongst patients with prolonged stay in the ICU as they have high chances of contracting the condition, especially when they are under artificial ventilation. The hospital-based condition is known to manifest itself after 2-days or longer of the patient’s exposure to artificial ventilation. Oropharyngeal excretions trickled down the trachea, of critically bed-ridden patients and intubated, causing an accumulation of the secretions at the endotracheal cuff. They then move to the inferior respiratory region, where they establish into VAP (Maurya et al., 2016). Medical scientists are trying to prevent the secretions from crossing into the inferior respiratory area to control the proliferation of the condition. Moreover, the scientists are educating nurses on the best practices that can assist in the control of VAP, and thus, reduce the time of patient admittance in the ICU 

Significance of VAP to Nursing Practice 

Some patients fail to get intensive interventions from nurses, an aspect that raises several challenges. The nurses failed to administer intensive care due to dispersed functions that pose problems in the comprehensive assessment of patients in the ICU for diagnosis of other sicknesses ( Thoma, Sprague, Voineskos, & Murphy, 2019 ). Additionally, the nurses have failed to work as a team, and therefore, have reduced the ratio of staff to the patient making the resources assigned to usual diagnostic practices less. With lesser resources, the nurses plan poorly to decrease infections associated with VAP due to bundled approaches. And because of the bundled approaches, simple, evidence-based interventions such as checking on oral hygiene look like an overwhelming practice. Thus, the nursing team will not be able to provide the other patients with needed care, and subsequently, increasing the chances of the patients catching Ventilator-Associated Pneumonia . 

PICOT Research Question 1 

For patients with Ventilator-Associated Pneumonia does the maintenance of the patient's oral hygiene decrease the bacterial colonization of the aerodigestive tract compared with lack of oral hygiene within a four week tracking period? 

PICOT Research Question 2 

Are patients who have Ventilator-Associated Pneumonia at high risk of contracting secondary infection compared with patients without the condition within the Intensive Care Unit? 

PICOT Research Question 3 

Are patients who have intubation in the ICU at an increased risk of contracting VPU compared with patients who have face masks on? 

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. 

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. 

Maurya S., Mishra S. B., Azim A., Baronia A. K., & Gurjar M.(2016) Management of adults with hospital-acquired and ventilator-associated pneumonia: 2016 clinical practice guidelines by the Infectious Diseases Society of America and the American Thoracic Society. American journal of infection control ,    44 (11), 1422-1423. 

Thoma, A., Sprague, S., Voineskos, S. H., & Murphy, J. (2019). Developing a Surgical Clinical Research Question: To Find the Answer in Literature Search or in Pursuing Clinical Research. In  Evidence-Based Surgery  (pp. 17-22). Springer, Cham.