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Problem Statement
Statistically, five to ten critically ill intubated patients develop VAP in the United States ICU settings. Thus there is a need to institute this protocol in our hospital to decrease the risk of VAP. This is critical because secondary infections in these patients increase the risk of death. Furthermore, the diagnosis of VAP in critically ill patients serves as an economic setback as this means prolonged hospitalization and more critical care intervention.
Real-Time Solution
It will involve the identification of the risk factors for the development of VAP through a collection of data via flow sheets by the physicians and the nurses.
Furthermore, documentation of the findings, sensitization of the staff of the need to adopt the VAP protocol, adoption of the VAP protocol, and outlining the methods of assessing the outcome and implementation of other measures to improve compliance with the VAP protocol will be initiated.
The beds will be elevated at between 30 to 40 degrees from the horizontal to reduce the production of gastric secretions subsequently leading to a reduction in VAP cases. Mobilization of resources will be required in the training of staff as this will be the key to the successful implementation of the program.
Implementation of the Vent Bundle
To successfully implement this protocol, in our hospital set-up, there is a need to look at the overall plan, the resources required for implementation, the ways to be used to motivate the health care workers to adopt the change, the feasibility of the program, and methods of monitoring its implementation.
The above will be used in tandem with the overall methods used in the VAP prevention protocol. They generally include raising the beds head at an angle between 30 and 40 degrees, application of whole-body chlorhexidine-based medication to recommended areas of the body, thorough hand washing, adequate nutrition, and institution of early tracheotomy by the seventh day for patients having endotracheal tubes.
Other Measures
Then the physicians will be consulted for more information about VAP from the available cases. Subsequently, the health workers will work together as a team together with the nurses being involved in every process to ensure compliance with the VAP prevention protocol. The expected outcome will then be monitored through the VAP prevention protocol form.
Resources Required for Implementation
This includes decontamination of hands before and after handling the patient. This will entail the use of sterilized gloves, as this will reduce the incidences of VAP. Other measures involve the use of an antimicrobial soap during procedures that involve contact with body fluids and handwashing in between contact with various patients.
Monitoring of Program
Firstly, medical practitioners will be educated on the risk factors and how to prevent them since they play key roles in the daily management of the patients. Other alternatives to the use of antimicrobial soap could improve hand-washing frequency. The use of unit-based studies will ensure close monitoring of the progress.
Feasibility of the Plan
In total, staff will be monitored for compliance with handwashing practices and documentation of the use of gloves during oral and sub-glottic procedures
Evaluation of the Progress
Continuous monitoring of VAP occurrences and reporting of the progress will be done by the entire staff.
Anticipated Challenges
Thus, the adoption of this protocol will require that more staff members be employed to cope with increased daily duties.
New-nursing staff would need to be trained to ensure that this is entrenched in their practice.
Every stage will be looked at in detail by both internal and external qualified personnel and then radical measures proposed to correct the situation, which may include re-training of personnel, change of equipment, or change of the protocol.
Reasons for the failure should be published and research is done to prepare a new protocol.
If the plan will be deemed unsuccessful such that there is an increment in the VAP cases instead of reduction, an appropriate strategy will be followed in discontinuing the program with immediate initiation of workable protocols.
References
Bouadma, L., Deslandes, E., Lolom, L., Le Corre, B., Mourvillier, B., Regnier, B., et al. (2010). The long-term impact of a multifaceted prevention program on ventilator-associated pneumonia in a medical intensive care unit. Journal of Clinical Infectious Diseases, 51(10), 1115-1122.
Chastre, J. (2005). Conference Summary: Ventilator-associated pneumonia. Journal of Respiratory Care,50(7), 975-982.
Chinsky, D. (2002). Ventilator-associated Pneumonia: is there any Gold in these Standards? Chest, 122 (6), 1883-1885.
Craven, D., E. (2006). Preventing Ventilator-associated Pneumonia in Adults: Sowing Seeds of Change. Chest, 130 (1), 251-260.
Edwards, J.R., Peterson, K.D., & Andrus, M.L. (2007). National health-care safety network report. American Journal of Infection Control, 35(5), 290-301.
Escobar, G.J., Fireman, B.H., Palen, T.E., Gardner, M.N., Lee, J.Y., Clark, M.P., et al. (2008). Risk adjusting community-acquired pneumonia hospital outcomes using automated databases. American Journal of Managed Care, 14(3), 158-166.
Fields, L. B. (2008). Oral care intervention to reduce the incidence of ventilator-associated pneumonia in the neurological intensive care unit. Journal of Neuroscience Nursing, 40(5), 291-297.
Fulbrook, P., & Mooney, S. (2003). Care bundles in critical care: a practical approach to evidence-based practice. Nursing in Critical Care, 8(6), 249-255.
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