Ventilator-associated Pneumonia in Evidence-Based Practice – Health System Example

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"Ventilator-associated Pneumonia in Evidence-Based Practice" is an engrossing example of a paper on the health system. Ventilator-associated pneumonia (VAP) is one of the major causes of morbidity and mortality in hospitals due to the risks of infection associated with the use of mechanical ventilators, as well as the rise of resistant strains of several pathogenic bacteria to broad-spectrum antibiotics. Using VAP as an example that shall be given evidence-based solution using the PICOT acronym (P-patient, I-intervention, C-comparison intervention, O-outcome, and T-time), possible solutions for the underlying problem of VAP among severely immune-compromised patients are explored.

By finding out which treatment options are available to use, practitioners can find a solution that would be the most effective one based on their needs. Research utilization (RU) is the use of research output into practice (Keele, 2011). The practice of using research evidence in the field of nursing was able to create several models by which research output is integrated into the nursing system (Stetler, 2001). Evidence-based practice (EPB) is based on the use of evidence to simplify methods in medicine and nursing by supporting the best practices and the removal of the worst, cutting costs and time in serving patients (Stillwell, Fineout-Overholt, Melnyk, & Williamson, 2010; Keele, 2011). Acquired infections in hospitals are one of the main causes of morbidity and mortality among patients, and critically-ill patients are most susceptible, most especially those under mechanical ventilation (Hunter, 2006).

Most infections occur in the lungs since there are no filtration systems used when patients are under tubed inhalation. Ventilator-assisted pneumonia, or VAP, is a high-risk parenchymal lung infection that most often besets patients under tubed respiration, and is caused by pathologic bacteria such as Staphylococcus aureus, Pseudomonas aeruginosa, and some Enterobacteriaceae to name a few.

Patients that receive mechanical ventilation are the most susceptible to the disease, and mortality rates can reach 50-76% in some cases (Chastre & Fagon, 2002). Cardiothoracic patients, the severely immune-compromised, those in ICU as well as patients that are in a supine position during the first 24 hours of treatment are most susceptible to VAP, as well as severely ill patients who have been under mechanical ventilation, reintubated, and had a failed intubation (Kollef, 1993; Morehead & Pinto, 2000). Many methods of treatment are being used to treat VAP.

Uses of bronchoscopic techniques in order to collect lung specimens from patients are used, as well as the proper identification of the most predominant flora in the infected lungs in order to administer the proper antibiotic (Chastre & Fagon, 2002). However, is still time-consuming, and prevention methods can be the better solution. Through the use of EBP by identification of the components of the problem, a possible solution for hospital staff can be made.

PICOT is the acronym used in order to assess the problem by identifying: P- who the patients are; I- possible intervention; C- comparison to alternative interventions available; O- outcome; and T- time needed for the outcome to be achieved (Stillwell et al. , 2010). Foreground question What modifications can be made in order to prevent the onset of ventilator-associated pneumonia (VAP) to severely immune-compromised ICU patients? Patient or problem Severely immune-compromised patients in ICU suffering from ventilator-associated pneumonia (VAP) due to mechanical ventilation Interventions possible Minimal use of mechanical ventilation in patients or the use of broad-spectrum antibiotics to combat most pathogenic bacteria (Chastre & Fagon, 2002). Comparison intervention Use of silver-coated and antiseptic-impregnated endotracheal tubes (ETT) as well as the use of heat and moisture exchangers, since the use of mechanical ventilation itself is a cause of VAP (Acton, 2011). Outcome expected The decrease in the number of patients developing mild to severe VAP under hospital conditions, especially those under mechanical ventilation. Time Within the first four to five days results of the changes in ventilation methods can be assessed.  

References

Acton, Q. (2011). Ventilator-Associated Pneumonia: New Insights for the Healthcare Professional. Atlanta, GA: Scholarly Editions.

Chastre, J., & Fagon, J. (2002). Ventilator-associated pneumonia. American Journal of Respiratory and Critical Care Medicine, 165, 867-903.

Hunter, J. (2006). Ventilator-associated pneumonia. Postgraduate Medical Journal, 82(965), 172-178.

Keele, R. (2011). Nursing Research and Evidence-based Practice: Ten Steps to Success. Sudbury, MA: Jones and Bartlett Learning.

Kollef, M. (1993). Ventilator-associated pneumonia: a multivariate analysis. The Journal of the American Medical Association, 270(16), 1965-1970.

Morehead, R., & Pinto, S. (2000). Ventilator-associated pneumonia. Archives of Internal Medicine, 160(13), 1926-1936.

Stetler, C. (2001). Updating the Stetler Model of research utilization to facilitate evidence-based practice. Nursing Outlook, 49(6), 272-279.

Stillwell, S., Fineout-Overholt, E., Melnyk, B., & Williamson, K. (2010). Asking the clinical question: a key step in evidence-based practice. American Journal of Nursing, 110(3), 58-61.

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