Hospital-acquired diseases are frequent incidents as the conditions in which patients are located contribute to their development significantly. Most patients have weakened immunity due to injuries or illnesses that are the causes of their hospitalization. At the same time, they are surrounded by hundreds of other people with other ailments. Even patients who cannot leave their rooms are also exposed to external factors because medical personnel carries germs and bacteria on their clothes and hand. Ventilator-associated pneumonia (VAP) is a leader in hospital-acquired infections as respiration devices create an environment for the growth of bacteria and this disease is especially dangerous (Lyons & Kollef, 2018). Nowadays, the cases of VAP are significantly lower than decades ago because nurses use preventive measures to decrease the risks of infection. However, the problem of inappropriate care for patients who need artificial ventilation of lungs still exists and causes pneumonia, which has to be eliminated.
There are many diseases that a patient can get in the hospital, but some of them are easily transmitted, while others are less spreadable. Ventilator-associated pneumonia arises due to the wrong use of medical devices, such as catheters, improper oral cleaning, and non-compliance with hygiene rules by patients and medical personnel (Boev & Kiss, 2017). The consequences of infection can be a more prolonged treatment of the patient and their depressed state, as well as the occurrence of injuries and even death.
However, there is still a lag in the literature about the prevention of these diseases. Scientists study pneumonia as part of hospital-acquired infections, for example, Salem (2019) and Bashar (2019), or evaluate the knowledge of nurses on this topic as Rafieia, Rahimia, Shafaeia, and Ommatmohammadi (2020). Lyons and Kollef (2018) study the preventive measures of VAP in detail; however, they emphasize direct care but not a general strategy. Thus, there is a need to identify health strategies that reduce the incidence of VAP, since this disease can be avoided mostly by professional skills and the care of nurses.
The role of nurses is crucial in preventing ventilator-associated pneumonia as they perform primary care for patients and should monitor the risks and treatment of patients. For this reason, every advanced nurse has to know and use strategies that can improve his or her direct care and performance of his or her colleagues and subordinates. Consequently, competencies of advanced nurses are necessary for this purpose, since their work is vital for the treatment and rehabilitation of patients and organizational skills are sufficient and useful for building collaboration within the staff.
Possible Strategies for VAP Prevention
There are several strategies for reducing the number of hospital-acquired VAP cases that advanced nurses can apply by using their professional skills. According to the Royal College of Nursing (2018), the core competencies of an advanced nurse are direct care, leadership, and collaborative practice, improving quality and developing practice, developing self and others. Consequently, the strategies can include refreshing and gaining knowledge through collaboration, developing new methods of prevention and control, leading subordinates, and testing nurses’ skills for the prevention of VAP.
The first strategy is justified by the fact that most of the nurses are not familiar with the basic rules for taking care of patients who need artificial ventilation of lungs. According to a study by Rafieia et al. (2020), not a single nurse answered all questions about preventing VAP correctly. In addition, Salem (2018) his study, determined that although most nurses had a good understanding of such simple methods of preventing infection as washing hands and using sterile gloves, most of them neglected the rules for various reasons. Consequently, the participation of medical personnel in seminars on this topic is a necessity to reduce the incidence of hospital-acquired diseases.
Hospital management and advanced nurses also should encourage colleagues to improve prevention methods by helping them to promote their ideas and share them at medical conferences. The promotion of collaborative work of different specialists is also a beneficial strategy, since it creates conditions in which representatives of different healthcare areas and levels develop a better way for patient care. Leadership also is the most effective and convenient way of influence, since senior professional nurse can encourage her or his colleagues to be more responsible in their direct care and interaction with patients (Royal College of Nursing, 2018). Training should also be provided for junior staff by advanced nurses to ensure their knowledge of the necessary measures to prevent infections, including pneumonia.
Senior nurses also need to monitor the implementation of hygiene rules and the use of medical instruments to help fill up the knowledge of newcomers. In addition, Salem (2018) emphasized that some employees know the rules but ignore them due to negligence, limited time, or other reasons; thus, implementation fines for the violation of standards can be useful. No-pay policy for hospital-acquired infection also can be beneficial, since the same method for hospital-acquired falls had a positive impact on nurses’ work (Fehlberg et al., 2017). However, these changes are beyond advanced nurse’s authorities; hence she or he can only initiate them and control other nurses by warnings or administrative measures.
Strategic Focus
The most appropriate strategy for the elimination of hospital-acquired cases of ventilator-associated pneumonia is conducting seminars and training for nurses. This method is available for any advances nurses, since it requires only attention and interest of personal but do not bring additional costs. It also ensures that staff is familiar with the rules of patient care for the prevention of VAP, and these seminars provide an opportunity to exchange observations and discus unclear nuances.
The obligatory program of these seminars is to identify the main steps of patient care and understand their needs. Patients are admitted to a hospital with various diseases and different states of health; hence, it is impossible to write a uniquely clear guide for all nurses. However, there are general steps and recommendations that must be followed to protect patients from ventilator-associated pneumonia.
The first step after hospitalization, in any case, is an examination of a patient by a doctor and determination of diagnosis and treatment. The nurse should use the information provided by the physician and his or her prescriptions, as well as evaluate the patient’s behavior according to general and individual characteristics. Based on these characteristics, the nurse can assess the risks of developing complications and acquiring diseases. For example, a history of lung infections or a weakened immune system due to other disorders or age can reduce the body’s resistance to new conditions. Thus, these features have to be considered for the determination of preventive procedures. This step is necessary to anticipate all possible complications, but at the same time not to overload the patient’s body with unnecessary means and medicines.
The next step is the selection of the necessary preventive measures appropriate to certain risks. First, the nurse should advocate using non-invasive methods of ventilation as this change reduces the likelihood of infection (Bashar, 2019). Enteral feeding is also more beneficial for the patient than parenteral, so the nurse should offer the physician alternative method if possible (Bashar, 2019). However, if these options are not available, then several procedures can help reduce the likelihood of bacteria spreading. Among them, the location of the patient’s head on the bed at an angle of 30-45 degrees, daily oral cleaning with chlorhexidine, digestive antibiotics, regular bathing, prevention of wounds, and ulcers (Boev & Kiss, 2017). All these basic methods should be explained to nurses and discussed by them.
In addition, there are general guidelines for patient safety. Among basic rules are washing hands, using sterile instruments, disinfecting punctures, wearing a medical uniform and mask, and avoiding work if a nurse has infectious and respiratory diseases (Boev & Kiss, 2017). These steps are the most important in the treatment of patients and almost completely depends on the competence and professional skills of a nurse.
Therefore, regular seminars at which senior and junior nurses will discuss preventive measures will allow them to obtain and refresh knowledge. In addition, not only theory should be presented at trainings but also practical aspects, for example, catheter change, as well as colleagues can share their unusual cases. This practice will improve both collaboration and quality of direct patient care, but it does not take much working time.
Outcome of Strategy in the Prevention of Hospital-Acquired VAP
There are several methods to evaluate the usefulness of training for reducing the incidence of VAP. The first method is to check the theoretical knowledge of nurses by using questionnaires. This method is easy to implement, since nurses can use ready-made questions for tests from scientific research. For example, Rafieia et al. (2020) create nine categories of items for their study that cover necessary preventive measures. These tests can also be expanded and improved for more detailed assestment.
Another method is to check patients who need ventilation and their prescriptions and compare them with basic preventive measures and steps. This method is more accurate as it directly shows the work of a nurse; however, it requires considerable time for understanding each case and daily monitoring. Therefore, the main indicator of the success of the methods is the statistics on hospital-acquired VAP. The ratio of data on patients who need ventilation and cases of acquired pneumonia gives a clear idea of ​​the current situation, and its comparisons with data from previous months show the progress. Consequently, the success of such short-term strategy as conducting medical seminars can be measured simply, and an assessment of knowledge will help to determine the gap between theory and practice.
Conclusion
Therefore, the role of an advanced nurse in reducing the cases of ventilator-associated pneumonia in a hospital is one of the most significant among all medical personnel. The rehabilitation of the patients and the likelihood of their effective treatment depend on the responsibility and skills of this employee, since she or he performs practical care and affects theoretical medical knowledge. Consequently, the primary strategy for prevention VAP is conducting training and seminars for staff by advanced nurses, since it ensures their understanding of preventive measures. This strategy is also easy to implement and measure its success; thus, it is available for any hospital. In addition, seminars help to improve the quality of care of all nurses, regardless of their qualifications and professional experience, through collaborative discussion and decrease the level of hospital-acquired diseases.
References
Bashar, F. J. (2019). Methods of Preventing Hospital Acquired Infection. Advances in Bioscience and Clinical Medicine, 7(3), 13-19.
Boev, C., & Kiss, E. (2017). Hospital-Acquired Infections. Critical Care Nursing Clinics of North America, 29(1), 51–65.
Fehlberg, E. A., Lucero, R. J., Weaver, M. T., Mcdaniel, A. M., Chandler, M., Richey, P. A., … Shorr, R. I. (2017). Impact of the CMS no-pay policy on hospital-acquired fall prevention related practice patterns. Innovation in Aging, 1(3), 1-8.
Lyons, P. G., & Kollef, M. H. (2018). Prevention of hospital-acquired pneumonia. Current Opinion in Critical Care, 24(5), 370–378.
Rafieia, H., Rahimi, S., Shafaei, M., & Ommatmohammadi, M. (2020). Emergency nurses’ knowledge about ventilator-associated pneumonia. International Emergency Nursing, 48(2020), 1-4.
Royal College of Nursing. (2018). Advanced level nursing practice. Section 2: Advanced level nursing practice competencies. London, England: Royal College of Nursing.
Salem, O. A. (2019). Knowledge and practices of nurses in infection prevention and control within a tertiary care hospital. Annals of Medical & Health Science Research, 9, 422-425.