DQ Prevalence of ventilator associated pneumonia

Often health care organizations form comities that have the sole focus of quality improvement. These comities perform studies and audits that ensure that the standards, within their organization, are congruent with guideless set by regulatory organizations, certification boards, and professional organizations (Melnyk & Fineout-Overholt, 2015). Examples of audit criteria may be the prevalence of intensive care unit (ICU) acquired pressure ulcers, prevalence of ventilator- associated pneumonia (VAP), or the number of patients who acquire blood stream infections from the insertion of a central line. The committee then follows up with the unit standards and guidelines to ensure they are in accordance with the national standards.

This author will be focusing on the prevalence of ventilator associated pneumonia (VAP) in ICU patients. The standards currently set in this author’s ICU, to prevent VAP, include keeping patients head of bead (HOB) at 30 degrees, suctioning the oral and airway passages prior to laying down or turning the patient, the use of antiseptic mouth wash every two hours, and replacement of respiratory tubing daily. These guidelines were adopted by the organization after reviewing data that was collected from studies performed by accrediting bodies.

One of the accrediting bodies, that sets standards for health care organizations, is the American Association for Respiratory Care (AARC). Their guidelines are founded on evidence- based practice, and pertain to the management of ventilated patients and the prevention of VAP (Care of the Ventilator Circuit and Its Relation to Ventilator-Associated Pneumonia, 2013). Data collected via a systematic review of literature, obtained from PubMed, was used to collect data and form guidelines. In addition, a quantitative analysis was performed.

Although the guidelines do not mention a specific number of days a closed ventilator circuit is good for, AARC recommends that the circuit be changed frequently (Care of the Ventilator Circuit and Its Relation to Ventilator-Associated Pneumonia, 2013). In addition, AARC states that passive humidifiers need to be changed every 48 hours to prevent bacterial growth (Care of the Ventilator Circuit and Its Relation to Ventilator-Associated Pneumonia, 2013). Finally, AARC states that closed suction catheters should be utilized and do not need to be changed daily, although the safe appropriate length of use is unknown (Care of the Ventilator Circuit and Its Relation to Ventilator-Associated Pneumonia, 2013). Given the information provided, it appears that this authors institution is in compliance with the standards set forth by AARC.

Another way healthcare institutions can prevent VAP is by adopting a bundle that has been backed by an institution through evidence- based practice. Bundles are a set of guidelines and standards that are used simultaneously. This author reviewed another study that utilized a descriptive retrospective longitudinal study, using a quantitative approach, the determine the effectiveness of VAP bundles (Rodrigues, Fragoso, Beserra, & Costa Ramos, 2016). This particular study concluded that the bundle being used led to an increase in ventilator associated pneumonia and increased mortality rates by 50 percent.

This is an example as to why VAP bundles and guidelines need to be evaluated by an accrediting institution and appropriately modified.

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