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Ventilated Associated Pneumonia - PDF

   

Added on  2020-11-04

11 Pages3525 Words148 Views
Higher EducationHealthcare and ResearchStatistics and Probability
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RASMITA MAHARJAN SNPG917STUDENT NUMBER-6695723 ASSESSMENT TASK -3TittleTopic: Effective use of a Ventilator bundle to decrease the frequency of ventilatedassociated pneumonia in ventilated patient (VAP)IntroductionVentilator-associated pneumonia (VAP) is a respiratory infection that must have evolved morethan 48 h after intubation. It represents up to 47% of all pathogens in clients with ICU. About 9-27%ofallintubatedcaseshavebeenidentifiedand86%ofnosocomialpneumoniahavebeenrecord with VAP (Samra, Sherif & Elokda 2017). It is the most common nasocomial infection incritically ill patients and is associated with increased length of stay, higher cost of treatment anda greater mortality and morbidity rate in individual requiring mechanical ventilation.(Shitrit,Meirson, Mendelson & Chowers 2015).There are a few initiatives suggested for the preventionof breathing tube-Associated Pneumonia. The Institute of Healthcare Improvement has proposeda VAP package of strategy to reduce Ventilator Aspirated Pneumonia. The kit is a systematicapproach that facilitates the adoption of best guidelines and evidence-based care for all patients,thus improving health outcomes (Parisi, Gerovasili, Dimopoulos, Kampisiouli, Goga,Perivolioti, Nanas 2016).It is not unusual for patients of any age to be intubated electively oremergingly due to a variety of multisystem issues (Dumbre 2019). The usage of a artificalbreathing machine after intubation places patients at risk of acquiring VAP (Samra et al.,2017).Nurses ought to remain careful in the treatment of patients on a mechanical ventilator.Althoughthe best solution to minimising ventilator-associated pneumonia remains unknown, findings haveshown that informing health care professionals caring for patients on mechanical ventilation willminimise the risk of ventilator-associated pneumonia (Keyt, Faverio & Restrepo 2014). Nursesplay a vital role in avoiding certain nosocomial or hospital-acquired diseases, like VAP, throughintegrating treatment with other healthcare professionals (Cakan, Demirkıran & Yardımcı 2019.Preventing VAP in particular, using a structured, protocolized package, can help to streamlinethe treatment received, resulting in reduced period of hospital as well as ICU stay, cost controland, eventually, better outcomes (Rello, Lode, Cornaglia & Masterton 2010)1
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RASMITA MAHARJAN SNPG917STUDENT NUMBER-6695723 ASSESSMENT TASK -3Research QuestionWhat is the impact of the ventilator package on the reduction of the incidence of ventilatedinduced pneumonia in ventilated patients?Search summaryA number of online and internet-based search engines used in this project which includes librarydatabase, CINAHL, PubMed, Google scholar, MEDLINE etc. According to research questionthe following key concepts: ventilator-associated pneumonia, VAP bundle treatment andintervention are used in literature search.The years 2010 to 2020 were used in the selection ofarticles and other types of literature.Internet searches and keywords have been defined using thedescriptive topic heading search area and the subject heading has exploded. Method, wildcardsand phrases have been used depending on each database.Ventilator acquired pneumoniaVentilator aspiration pneumonia, VAP, kit, pack. Study was mainly focused on human, amongnurses and randomized controlled trial method were used . As for language inclusion, englishlanguage was considered. Finally, over 650 potentially relevant report were identified. Amongthem only 16 randomised control trail were checked and objectively examined after theelimination of depletes and obsolete articles.Review of EvidenceShahnaz, A., Bhardwaj, U., Tamang, E. K., & Dwivedi, S. (2018). A comparative study to assessthe competency among ICU nurses in using ventilator associated pneumonia bundle to preventventilator associated pneumonia in selected government and private hospitals of New Delhi.International Journal of Nursing Education, 10(3), 6. https://doi.org/10.5958/0974-9357.2018.00057.0A study was done to determine and evaluate the degree of competency in the usage of the VAPkit and assess the relation between expertise and skills among the competence of ICU nurseswith chosen demographic factors at selected Government and Private hospital of New Delhi . AQuantitative (Non Experimental) research Approach with comparative descriptive research2
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RASMITA MAHARJAN SNPG917STUDENT NUMBER-6695723 ASSESSMENT TASK -3design was adopted for the study. Structured questionnaire and structured observational checklistwas used. Through non probability purposive sampling technique, 60 ICU nurses were selectedamong them 30 nurses from government hospital (Safdarjung) and 30 nurses fromprivatehospital (Indraprastha Apollo) New Delhi, respectively were selected.The findings of theanalysis were enhanced after training sessions by the nurse on 8 of the 10 topics examined (Pfrom 0.03 to < .001).The places with the most important change is lifting the head of the bed (P< .001), elevation of the head of the foot (P=.009), oral therapy (P=.009), residual pressureregulation of the nasal gastric pipe (P=.008) Contraindications to the height of the head of thebed do not occur in the nurses' experience (P=.38). The strength of the study were try to coveredthe two different hospital of india. Furthermore, the study is limited to a survey of only 30 ICUnurses in chosen hospitals, which are limited to the generalisation of findings and no effort hasbeen made to determine the enforcement with the VAP inspection list in specified health carecenters owing to a short timeline for data collection.Gadani, H., Vyas, A., & Kar, A. (2010). A study of ventilator-associated pneumonia: Incidence,outcome, risk factors and measures to be taken for prevention. Indian Journal of Anaesthesia,54(6), 535. https://doi.org/10.4103/0019-5049.7264A randomised control study has been performed at the Intensive Care Unit ( ICU) tertiary carecentre at CMC Hospital, Ludhiana. The goal of the analysis was to objectively evaluate theoccurrence and result, define different danger factors and determine concrete steps that could beimplemented to deter VAP from occurring.A minimum number of 100 patients who were placedon artifical ventilator were randomly picked. Groups covered people of both sexes who had beenholding on a artificial breathing for longer than 48 h and who were > 15 years of age.Clientswho died or contracted pneumonia within 48 hours or who recovered from pneumonia at thetime of diagnosis and clients with ARDS were omitted from the survey. The level of relevancewas set at P<0.05.It was reported that 37 individuals had produced VAP.A questionnaire wasdeveloped and each individual selected to be included in the analysis was evaluated and trackedaccording to the questionnaire. Age, date of admission to ICU, date of introduction of artificialbreathing and mode of evaluation of the patients' airways, or tracheostomy, were reported.In the3
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RASMITA MAHARJAN SNPG917STUDENT NUMBER-6695723 ASSESSMENT TASK -3analysis, it was observed that those needing extended ventilator assistance (> 15 days) had aslightly higher rate of VAP (P-value, 0.001). Supine posture and stuporous comatose cases wereconsidered to be contributing factors for a high prevalence of VAP which were seen to bestatistically important (P-value, 0.003 which 0.0023, respectively). Out of the 37 patients thatacquired VAP, 10 (27.02 %) acquired early-onset VAP and 27 (72.97%) developed late-onsetVAP. The average mortality rate was 46%, while the mortality rate for VAP patients was 54%.The early-onset form mortality rate was estimated to be 20%. In the case of late-onset form,66.67% was noticed. Late-onset VAP has a very strong correlation (P=0.0234) in terms of deathrelative to early-onset pneumonia. The study were limited only to one hospital. Furthermore, thestrenghth of the study were excludation of the patient with diagnosed pneumonia.Osman, S., Al Talhi, Y. M., AlDabbagh, M., Baksh, M., Osman, M., & Azzam, M. (2020). Theincidence of ventilator-associated pneumonia (VAP) in a tertiary-care center: Comparisonbetween pre- and post-VAP prevention bundle. Journal of Infection and Public Health, 13(4),552-557. doi:10.1016/j.jiph.2019.09.015The purpose of this analysis was to apply the established package for prevention of VAP as aquality control method in the King's PICU Abdulaziz Medical City (KAMC) – Jeddah, Kingdomof Saudi Arabia (KSA) with a view to rising the amount of VAP incidents over a span of oneyear. A single-center, longitudinal analysis was performed between January 2015 and March2018 and assessed the occurrence of VAP before and after the introduction of the package. Thestudy provided a summary of two periods of review, the first was pre-bundle rollout fromJanuary 2015 to February 2017, and the second was post-bundle transition from March 2017 toMarch 2018.The study involved 141 infants, 95 from the pre-bundle team and 36 from thebundle section. VAP was formed in 35 per cent of the pre-bundle population compared to 31 percent of the bundle group (p = 0.651) with occurrence rates equivalent to 18 and 12 per 1,000ventilation days, respectively.For the statistical analysis, descriptive statistics such as mean,standard deviation ( SD), median, size, interquartile, or proportion were used depending on thecharacteristics and the choice of variables. The VAP event incidence was calculated as adifferent number per 1000 Artificial Respiratory Tube Day. Qualitative factors have beencalculated using chi-square Check or Fisher-Exact check, as appropriate. P-value (p) less than p-value 0.05 was considered to be statistically significant. Statistical research was carried out with4
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