Evidence-based research and practice is needed to decrease morbidity and mortality associated with ventilation associated pneumonia (VAP). VAP effects 86% of critically ill patients occurring 48hrs after being intubated or on a mechanical ventilation machine. VAP is a nosocomial infection that effects critical care units in hospitals and because of how common this is evidence-based research concluded that oral hygiene is one of the key components in preventing VAP. The American Association of Critical-Care Nurses (AACN) created strict guidelines for oral hygiene as recommendations but not all hospitals follow this guideline. The mortality rate ranges from 0 to 50% with the exception of high risk pathogens reaching 76%. VAP’s are considered a preventable complication that leads to high health care costs.
Patients that endure life threatening illness often find themselves in the intensive critical unit (ICU) and depending on the severities of their illness may require intubated or on a mechanical ventilator. There are multiple protocols that hospitals adhere to in order to provide optimal treatment in taking care of patients who are at risk of developing VAP. Diagnoses of VAP requires nurses to properly document on their charts any newly developed manifestations as VAP occurs within a couple days. Diagnoses is finalized through clinical manifestations, lab work, ultrasound, computed tomography (CT) scan, and chest X-rays. With frequent checkups during these critical hours, providers can get ahead of VAP and treat in its early stages. VAP unfortunately has been misdiagnosed due to wrongful clinical manifestations, so careful precaution should be met. (Koeing & Truwit, 2006)
A survey study was conducted with 576 critical care nurses participating in over 8 hospitals that reached over 1000 ventilator days in 2009. The survey concluded 21 questions regarding three oral hygiene hospital guidelines: nursing policy, order set, and information bulletin. Nursing policy’s are comprehensive and detailed protocols for patients on ventilators to prevent or reduce VAP. Order sets are communication tools used between nurses and providers with minimal information and information bulletins are flyers with minimal oral hygiene. These nurses were asked to answer statistical and analyses type questions regarding oral hygiene in patients that had VAP. They answered accordingly to what guidelines the hospital provided on how they should perform oral hygiene on VAP patients.
Kiyoshi-Teo & Blegen (2015) researched the following:
They were asked to The American Association of Critical-Care Nurses (AACN) guideline 14 presents one of the most comprehensive lists of oral hygiene recommendations. Their recommendations are as follows: (1) brush teeth, gums, and tongue at least twice a day using a soft pediatric or adult toothbrush; (2) provide oral moisture to oral mucosa and lips every 2 to 4 hours; and (3) use an oral chlorhexidine gluconate (0.12%) rinse twice a day during the perioperative period for adult patients who undergo cardiac surgery. (p. 310)
The survey demonstrated that nursing policy’s when compared to bulletin information and order set oral hygiene guidelines had fewer VAP incidents. This could be that hospitals who adopted nursing policy’s provided nurses more awareness and proper guidance than those who adopted bulletin information or order set.
Hospitals adopting nursing policy’s over other oral hygiene guidelines show promising preventative measures as well as diminishing mortality and morbidity. More evidence-based research and practice is required to raise awareness to the nursing policy so that all hospitals are aware and required to implement.
VAP is a nosocomial infection that effects critically ill patients occurring in 48hrs. VAP is often misdiagnosed leading to death in more than those with VAP and not treated with antibiotics right away. The AACN has the most detailed guidelines in preventing VAP and this being similar to nursing policy’s can prevent or reduce the number of VAP patients. VAP’s are considered a preventable complication that unfortunately leads to thousands of dollars in health care costs.
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