Clinical Nursing Practice Problem
Hospital-acquired illnesses (HAIs) are a significant threat to public health. They also undermine the perceived efficacy of the healthcare system. While all patients come to hospitals to treat their illnesses, in some cases, a hospital visit leads to the deteriorated well-being of individuals. Among HAIs, the most relevant illness today is ventilator-associated pneumonia. Due to the coronavirus outbreak, many hospitals are experiencing a shortage of ventilators. Because of the high number of admitted patients, these ventilators may be used for a number of individuals within a single day. In such a situation, there is a higher risk of acquiring VAP (Metersky et al., 2016). Therefore, hospitals need to develop measures to prevent this illness. There are several methods hospitals may address the issue of VAP, and their efficacy levels vary. However, none of them, when used in isolation, is the ultimate solution to the problem and results in significant declines in the number of VAP cases. Therefore, it is vital to approach VAP in a comprehensive manner, using a combination of processes and procedures.
Evidence Retrieval Process and Summary
Before conducting any tests, it is essential to analyze the current evidence on the topic. Scientific evidence includes testing both individual prevention methods and prevention bundles. The available literature suggests that there are 65 known approaches for mitigating the impacts of VAP, but it would not be efficient if a healthcare facility applied all of them (Speck et al., 2016). Also, it would be financially infeasible to incorporate all of the approaches into current processes. Therefore, scientists and health professionals have tried different combinations of bundle elements. Burja et al. (2018) evaluated the efficacy of subglottic suctioning, oral care, management of endotracheal cuff pressure, and daily assessment for intubation. It is critical to be aware of the results of such studies because they allow researchers to focus on methods and combinations that have not yet been studied. The work of Burja et al. (2018) is well-designed, and the results are easy to interpret. The authors evaluated the efficacy by measuring VAP incidence prior to introducing the VAP prevention bundle, and after the methods were incorporated into the hospital’s process.
Implications of the Evidence
Burja et al. (2018) evaluated the effect of the prevention bundle on intensive care unit mortality, how long patients stay in intensive care, and how long patients are subject to mechanical ventilation and the incidence rate of VAP. The prevention bundle they chose did not result in significant improvements in the first three measures. Mortality rates, both in the intensive care unit and throughout the hospital, stayed at the same level as before. Also, the length of stay did not differ after applying the prevention bundle. Early VAP incidence rates also stayed the same; a significant difference, however, was identified in late VAP. It means that the prevention bundles can be effective but more research is required to identify the most favorable combination of methods. Therefore, it is imperative that the committee contributes to this research.
Burja, S., Belec, T., Bizjak, N., Mori, J., Markota, A., & Sinkovič, A. (2018). Efficacy of a bundle approach in preventing the incidence of ventilator-associated pneumonia (VAP). Bosnian Journal of Basic Medical Sciences, 18(1), 105-109.
Metersky, M. L., Wang, Y., Klompas, M., Eckenrode, S., Bakullari, A., & Eldridge, N. (2016). Trend in ventilator-associated pneumonia rates between 2005 and 2013. Jama, 316(22), 2427-2429.
Speck, K., Rawat, N., Weiner, N. C., Tujuba, H. G., Farley, D., & Berenholtz, S. (2016). A systematic approach for developing a ventilator-associated pneumonia prevention bundle. American Journal of Infection Control, 44(6), 652-656.