Problem Identification
Reducing the risk of ventilator-acquired pneumonia is one of the most prevalent topics in medical circles. Ventilator-acquired pneumonia usually takes place a short time after endotracheal intubation. VAP is a subtype of hospital-acquired pneumonia that includes pneumonia in hospitalized patients. Compared to other types of nosocomial pneumonia, it is frequently linked to more bacteria with heightened resistance and worse consequences. To reduce the risk of ventilator-acquired pneumonia, this policy proposal will concentrate on the most suitable adjustments in oral hygiene care and positioning/mobility of bed and patient.
Review of Scientific Evidence
Evidence-Based Nursing Strategies to Prevent Ventilator-Acquired Pneumonia
There have been several scientific studies that support the idea that the improvement of dental sanitation can mitigate the probability of ventilator-acquired pneumonia. Poor oral hygiene is seen as a contributing factor to infection. Professional oral care combines brushing teeth, mucous membranes, dentures, mouthwash, and dental visits, while regular oral care is less intensive (O’Keefe-McCarthy, 2006). A study has examined the impact of using the oral dental plaque antiseptic (2% Chlorhexidine gel) on the growth of plaque colonization and the occurrence of VAP in a single-masked, randomized control trial (O’Keefe-McCarthy, 2006).
Throughout the ICU stay, the treatment group received three applications daily. The primary findings showed that the treatment group’s reported VAP rate and tooth plaque index were significantly reduced in the trial (O’Keefe-McCarthy, 2006). The study has shown that people with poor oral hygiene carry respiratory infections on dental plaque and the buccal mucosa that have led to VAP in various compromised patient populations trials (O’keefe-McCarthy,2006). Thus, propaganda of proper oral hygiene will reduce the growth of dental plaque in the population, which could prevent the occurrence of VAP.
Reduction in the Incidence of Ventilator-Associated Pneumonia
Moreover, proper oral care done by hospital professionals has been shown to affect the rate of VAP infection. A study was conducted where respiratory therapists (RT) were instructed to perform oral care for patients alongside caregivers (Arroliga et al., 2012). Before that, the adherence to oral care among intubated patients was relatively low, only 33% (Arroliga et al., 2012).
However, the adherence rate for oral care increased to 100%. It stayed at 97% throughout the trial period when the RTs began providing oral care to every intubated patient admitted to the ICUs (Arroliga et al., 2012). Because they are accustomed to working with the oral endotracheal tube, RTs were comfortable performing oral care (Arroliga et al., 2012).
The study hypothesized that this would make it simpler for RTs to provide oral care. When the RTs performed oral care among patients, there was a significant reduction in cases of VAP (Arroliga et al., 2012). Thus, medical professionals are needed in the case of patients in the ICU to provide them with proper oral care and reduce the rate of ventilator-acquired pneumonia.
Reducing the Risk of Ventilator-Acquired Pneumonia Through Head of Bed Elevation
Furthermore, better positioning and mobility of patient beds are beneficial in reducing the risk of VAP. A study by Libby Keeley aimed to investigate whether raising the head of the bed by 45 degrees can decrease the prevalence of VAP (2007). A quantitative randomized controlled trial was used in the study. Adult ventilated patients using the procedure were randomly assigned to either the 45-raised head of the bed (treatment group) or the 25-raised head of bed (control group) (Keeley, 2007).
The result of the study has shown that in the patients who were nursed with their heads raised at 45 degrees, there was a tendency towards a decline in VAP cases among patients (Keeley, 2007). However, careful measurements are needed to position the head precisely 45 degrees, as nurses overestimate the degree of bed head elevation (Keeley, 2007). Thus, medical workers should be instructed to elevate their patients’ heads to 45 degrees, as it is proven that this will reduce the risk of ventilator-acquired pneumonia.
Policy Proposal
To decrease the rate at which VAP occurs in hospitals, several policies need to be adopted. As studies have shown, the infection has proven to be exacerbated by poor oral hygiene. Thus, both two distinct methods should be used in this case. Firstly, the propaganda of oral hygiene with oral dental plaque antiseptic should be widespread in hospitals, informing the general public and patients of its effects on mitigating VAP risk. Secondly, to treat patients in the ICU, it is necessary to provide them with professional oral care.
RPs should assist them in this procedure, as it has proven to be effective at increasing adherence to oral hygienic procedures, thus improving patients’ oral hygiene and mitigating the risk of VAP. Raising the bed heads of patients also has a positive effect on the VAP rates in hospitals. Instructing nurses to raise the bed heads to 45 degrees will be beneficial in combating ventilator-acquired pneumonia. To summarize, adopting the abovementioned practices will allow a quick decrease in VAP rates with minimal funding and effort for medical workers.
References
Arroliga, A. C., Pollard, C. L., Wide, C. D., Pellizari, S. J., Chebbo, A., Song, J., Ordner, J., Cormier, S., Meyer, T. (2012). Reduction in the incidence of ventilator-associated pneumonia: a multidisciplinary approach. Respiratory Care, 57(5), 688-696. Web.
Keeley, L. (2007). Reducing the risk of ventilator-acquired pneumonia through head of bed elevation. Nursing in Critical Care, 12(6), 287-294. Web.
O’Keefe-McCarthy, S. (2006). Evidence-based nursing strategies to prevent ventilator-acquired pneumonia. Dynamics, 17(1), 8-11. Web.