The Article Review

Summary

This study is designed to focus on the VAP development and oral health status event. It is important to note that many oral changes appear during the first 48 hours in the ICU. This has resulted to organism growth, abnormalities, and plaque.

Research elements

The research showed that required ventilation was 50% of a 12-bed unit averaging 1000 admissions per year. In this case, most f the patients were considered. However, a few patients were excluded due to the timing of the ventilation and other previous ventilations. For this reason, a study was conducted on different patients on different days. On the 1^st, 4^th, and 7^th day, the study was carried out using a baseline, assessment, culture, measurement, and visual scoring system. The findings from the study were then compared to patient’s variables in order to determine if there was an increase or decrease in the VAP. However, the findings showed conflicting issues. These conflicting issues were turned out in the fact that there were a number of risk factors such as demographics, illness severity, meds used, etc.

Results

The results from the findings showed that there was an increase in the dental plaque and number of oral organisms. The most outstanding impact was a decrease on salivary flow. This simply means that there was a correlation or relationship between increase of dental plaque and development of VAP as supported by the data from the experiment results.

Significance to nursing

It is not only important but necessary that professional healthcare givers should focus on oral care that is based on stimulation of salivary flow and plaque removal. However, many other alterations may be considered and incorporated if needed.

Summary

According to the research that has been conducted over the past 20 years, bacterial colonization of the oropharyngeal tract is one of the main factors that have expressive effects and largely impacts VAP. This study does not only analyze the implementations but also tries to find ways to reduce negatives in order to have better results in VAP.

Research Elements

Taged group consisted of health consumers over age 17 who were provided with a mechanical ventilation in a time limit of 48 hours in a medical ICU. The studies were carried out for two months consecutively. During the studies, the pre-intervention patients group (n=779) had no oral assessments, suctioning, or tooth-brushing factors or aspects. On the other hand, a study carried out during the intervention (group number 759) was done under the care of educated healthcare professionals with a master plan of uniform education and assessment tools. In this way, the treatment of the patients was carried out in every six hours and the cleansing of the oral tissue was carried out in every four hours. Additionally, the tooth-brushing was carried out two times daily. The results were, however, limited to the nonrandomized occurrences and the type of health consumers accepted, varying by seasons.

Results

A research finding on compliance with components protocol has shown an 80% increase. Similarly, Pre-intervention rate of VAP was 12 per 1000 ventilator days; for the post- intervention it has decreased to 8 per 1000. The results have shown a decrease of the duration of mechanical ventilation, length in MICU, and VAP rates.

Significance to Nursing

The research findings are very important. This is because they provide nurses with affirmation of amenability in oral care which greatly impacts the reduction of VAP. In the view of this, nurses can improve oral care and decrease the incidence of VAP by using research and education. After all, this will result in the decrease of mortality, morbidity, and the total cost.

Summary

The use of ventilator-associated pneumonia (VAP) can greatly increase mortality, time on a ventilator, time of staying in ICU and hospital plus the cost of medical treatment.

Research Elements

The research took place at a 350 bed/5 intensive care units hospital. During the study 18 beds and 3 ICUs were used. Two periods of pre-initiation VAP bindle time were compared: January-December 2006 and January 2007-December 2008 monthly bases to the VAP Bundle usage time.

During the research, there revealed an opposition linked with the resistant of health care givers. This perception greatly compromised patient care and became present and evident.

Results

The results of the findings showed a lessening in VAP rate up to 82% as opposed to 20% (during the first 3 months of study). This was caused by the VAP bundle implementation. Just after its implementation and the education of personnel, this forceful result became apparent and led to considerable savings of costs.

Significance to Nursing Practice

The results from this study are very important because gives persuasive information of reduction of VAP rate in the use of VAP bundle and adherence. To achieve such results, hospital managers have to train personnel, adopt a multidisciplinary program and teach healthcare professionals to follow a strict protocol.

Summary

Microbial colonization and dental plaque are essential aspects which are associated with respiratory disease and ventilator-associated pneumonia. In this case, the oral care intervention is not only important but also necessary in order to reduce patients’ risks. It is important to note that Oral-hygiene is of large importance with its intervention, standards, and frequency.

Research Elements

Five acute care hospitals were chosen for observational research study, upon approval of the review board, Those medical institutions consist of 8 ICUs and 253 patients; and the research carried out at randomized time blocks of 4 hours, 7 days of the week, for a total of 172 hours. Baseline data was obtained before implementation of education on oral cleansing protocol, followed by interventional data collection. Patients were supplied with all required oral care kits. There was also a condition that the 4 hour period of observation which influences the result of the true hourly frequency of oral care was not established.

Results

Oral cleansing was primarily via suction swabs during the initial stage of the research and interventions such as tooth brushing and moisturizing was not observed at the time. However, there has been a high increase through the period of intervention which has initiated and/or increased in suctioning, teeth brushing, swab cleansing, and moisturizing. This has helped to improve the care of mechanically intubated patients. Medical staff was encouraged to increase oral care by the education and implementation procedures.

Significance to Nursing

As pre-intervention nurses perceived that they were regular in oral care, comprehensive oral guidelines can assist in appropriate oral care performance among personnel. The later findings show also a lot of deficits.

Summary

There is a hypothesis that removal of oral secretion before patient position is changed can prevent and/or reduce pulmonary infection. Therefore a clinic trial study was performed in order to facts that oral secretions are the transmit route of pathogens.

Research Elements

Patients over age 17, were studied in a 48-bed ICU, with admission number of 1860, on a vent for more than 24 hours, and the results were included. In this study, the development of pneumonia within the first 48 hours was excluded. The data of suctioned for 10 seconds secretions processed. Secretions were also collected and tested in the lab before the position change.

Results

Control group - 24 of 159 patients had VAP, eight of them died.

Study group – only 5 of 102 patients had VAP, none of them died.

So, the effectiveness of the oral secretion is proved; and it helps to save costs and time of hospitalization of patients.

Significance to Nursing

Implementation of oral suctioning by nurses prior to position change could lead to less incidence of VAP. This, in turn, will decrease the level of morbidity, mortality, and the cost. And the study group is an approval to that.

Summary

According to the findings, a cross-sectional system of questioning is used to identify the gap between what is known about care giving process and what nurses’ report about the same. In this case, the objective of the study is to examine the practices of nurses in relation to providing care to adult patients with mechanical ventilation.

Research Elements

This particular cross-sectional was used in an anonymous survey which was performed by critical care nurses who attended education seminars and completed a 29 questionnaire over preventative and cross-contamination measures.  The results of the questionnaire were then compared to results from the observation made during the study and the research findings noted.

Results

According to the research findings, 82% of 1,200 nurses were compliant with the washing of hands and completed the study and research survey, 75% -of the nurses researched were wearing gloves whereas 50% - of the nurses had head elevations, lastly, 50% of the nurses were to reported perform adequate oral care. According to the study the CDC guidelines are not systematically or uniformly implemented among medical organizations. The research findings also show that there is a difference in the perception from the survey to the actual events. In hospitals with protocol, oral care practices are more proper than those without such protocol.

Nursing Significance

An implementation of oral care protocol may lead to the reduction in VAP. The necessity of this protocol is based on the study results that show that nurses in hospitals with oral care protocol reported better compliance in hand washing, maintaining head elevation, and other preventatives. Also, education, performance reviews, and placement of product will aid in success of nurse usage.

Summary

This research compiles  and entails all the current affirmation in confirming beneficial oral care on dental plaque, nosocomial pneumonia, and orpharyngeal colonization of patients receiving mechanical ventilation.

Research Elements

It is important to note that with the help of key words such as VAP, bacterial colonization, oral care, and critically ill patients, data bases of MEDLINE and CINAHL were searched. An inclusion of 7 randomized controlled studies was also carried out during the study. In this way, a large quantity of surveys and comparisons of studies researched was found and compared.

Results

The results from the study showed that the continual impact on dental plaque had incorporated the  toothbrushing process. However, this method is effective in infection, oropharyngeal colonization and prevention of VAP, including high-risk patients, was clorhexidine intervention.

Significance to Nursing

It is not only necessary but also important to create a plan for standardized protocol for oral care for every hospital; and the conclusions of the researches may help in this process. These findings could also show the benefits for nurses in other areas such as pediatrics and many other medical fields.

Summary

The findings from the research show that there exists a connection between VAP and oral care. This simply means that the oropharynx from critically ill patients is colonized or related to the  potential respiratory pathogens. The purpose of the research was to find out how hospital factors and nurse's background, educational level, and approaches influence the quality of oral care in the ICUs.

Research Elements

The research elements of the study carried out was on a random national survey of 102 institutions/506 surveys. The study entailed a two-step analytical approach that was used to carry out the research. In the view of this, the hypotheses which was  based on background, factors, and attitudes were tested during the study.

Results

The findings from the study show that factors such as nurse's education, adequate time, and prioritizing, positive attitude towards quality of provided care have an impact on the health care given. This means that critical care experience, oral care education, and having sufficient time had indirect effects.

Significance in Nursing

Improving oral care in intensive care unit is a very important task. These tasks can only be effective if a lot of work and commitment is encouraged. In this case, it is important to reinforce proper oral care through education and de-sensitizing of nurses. This will help to change the negative perception of unpleasantness of cleaning oral cavities. It is also crucial for nurses to corporate and work together with hospital managers. All these will help in order to get acceptable time to attend to oral care.

Summary

This study discovered that ventilator-associated pneumonia is a preventable disease that is a result of mechanical ventilation. This means that patients receiving mechanical ventilation in ICUs are subjected to a high risk of developing VAP due to many conditions of hospitalization.  This study points on a assumption that in order to prevent and decrease the incidents of VAP, oral care which includes timed toothbrusing, combined with VAP bundle should be developed.

Research Elements

The research elements from a random selected controlled study of a 24 bed, was a part of an accomplished 8 hour teeth brushing intervention during the study The purpose for the Oral care policies was to improve the Project. However, this has not only added to the tooth brushing process but is also opposed to the usage of Toothettes in order to remove plaque.

Results

The results of the findings after seven days of teeth brushing by the patients showed that the VAP rate fell to zero percent. In this way, the VAP rate amongst the Control group was dropped after 6 months and all mechanical ventilated patients teeth were brushed every 8 hours, with zero VAP rate until the end of study. 345 patients showed 0.62% of VAP rate during 1850 days. However, the study also experienced several of limitations. However, there were certain limitations that were experienced during the study.  These study limitations included: inadequate documentation by nurses and limited respiratory therapists.

Significance to Nursing

This research is very important because of its reliable results in relation preventing VAP. The study highlights the necessity of tooth-brushing while receiving mechanical ventilation. And this (tooth-brushing) is a direct duty of nurses.

Summary

The research findings from the study showed that the VAP is a common and serious disease which, if ignored, could lead to mortality. To decrease VAP incidence, the improvements should focus on the preventing measures such as oral care in order to control and manage the consequences. This can be achieved by purposive educational programs. The study was carried out to evaluate this effectiveness.

Research Elements

The research entailed a two-hour observation which was performed on 100 ventilated patients without VAP and their interacting clinical staff. The implementation included a compliance checklist, a demographic patient survey, and the Acute Physiology and Chronic Health Evaluation tool.  Unit-specific educational interventions were made and implemented on each participating unit.

Results

The research findings from this study found that the VAP and the ventilator days did not improve substantially. There were no abundant improvements; and there was a small difference in pre-intervention and post-intervention periods. On the one hand, it was noted that during the pre-intervention and post-intervention observations only some practices experienced an improvement. On the other hand, some practices worsened contrary to the expectations. The largest improvement was in hand washing. Limitations were found in project flaws.

Significance to Nursing

In this case, it is evident that in-depth research and study are needed in order to determine nursing significance and introduce improvements in the nursing environment.

Summary

Mechanical (toothbrushing), pharmacological (chlorhexidine), and combination (toothbrushing plus chlorhexidine) oral care is expected to influence on the development of VAP in critically ill patients on mechanical ventilation. Owing to high mortality and morbidity because of VAP, this research looked at the effects of above oral care.

Method

A randomized controlled 2x2 factorial experimental study was conducted on patients from 3 ICUs and enrolled within 24 hours of intubation.  547 patients were randomly assigned to 1of 4 treatments: 0.12% solution chlorhexidine oral swab twice daily, toothbrushing three times daily, a combination of both, or usual oral care (control). The VAP rate was determined by using Clinical Pulmonary Infection Score (CPIS).

Results

The research findings showed that the usage of Chorhexidine had helped to largely reduce incidences of pneumonia. The findings showed that tooth brushing did not show changes or any improvement.  However, it is necessary to carry out an advanced study with thought of enlarging focus group size and using a different tooth brushing protocol.

Nursing Significance

The results from the findings determine the importance of implementation of oral care protocol with chlorhexidine oral swabbing. This at a very high rate and can reduce VAP. In its turn, this implementation will significantly decrease the morbidity and mortality among patients on mechanical ventilation.

Summary

Patient safety should always be the first priority in any health center. One of the conditions that threaten the patient safety and thus should not be ignored is VAP. Patients can easily get ventilator-associated pneumonia which is caused by ventilation from mechanical factors. The Nurses association recommends steps for decreasing the occurrence of VAP called the "ventilator bundle". The use of ventilator bundle to prevent VAP requires critical care nurses to have special knowledge. The purpose of the study was to examine nurses' knowledge level.

Research Elements

A 10-item pre- and post-test was given to 61 nurses. Between testing, a 30-min presentation providing information on guidelines, microorganisms, hand washing, hand adornments, positioning, feeding, factors, definition, and diagnosis was provided. These same nurses were observed with a combined 99 patients noting care and changes of care before and after education.

Results

The conclusion of the research clearly shows that educational sessions brought its results and nurses managed much better on 8 of the 10 items tested. Ventilator bundle guidelines and hand washing remained a high constant. But the most encouraging improvement came to light in treatment-related and host-related risk factors for VAP, going from <30% to >70%.

Nursing Significance

The significance of these results is that education is not only important but necessary in identifying and preventing VAP. Educational programs and lectures should be provided to health care professionals and medical staff.

Summary

The study carried out showed that oral hygiene is one of the key factors that help to decrease ventilator-associated pneumonia. Similarly, oral care is also counted as a basic factor. However, it is potentially nonessential,. The evidence from randomized controlled trials that inform best practice is limited. Peer-reviewed literature was researched for best evidence in providing oral care to ICU patients receiving mechanical ventilation as well as documentations made.

Research Element

The research elements reports on relevant publications were searched on the Internet The search was also carried out on published articles, generating 55 articles total (11 control trials, 20 observational studies, & 24 descriptive reports) dating from 1985-2006. The outcomes from the measurements considered were in reference to the oral health. These outcomes were plaque, oral assessment, microbial counts, and validation of tools used.  There were also articles contained unsubstantial information, healthy patients, or setting outside of ICU type environments. They were excluded. Variations in measurements did limit research foundation.

Results

To reduce organisms’ colonization and infections chlorhexidine can be used although its association with VAP is uncertain. It is important to note that, because of host infections, the use of tap water for oral rinsing is also uncertain. Sodium bicarbonate, hydrogen peroxide, Listerine, sterile water, and normal saline appeared to be neither effective nor ineffective. But as a preventive measure they are encouraged t use. The most effective tool studied in this context is the toothbrush.

Nursing Significance

The study showed that it important for nurses to prioritize toothbrush as one of the most effective tools used for oral care in attempt to prevent VAP. All other methods and tools can be used, and are stimulated, as additional.

Summary

Death that occurs among the patients, prolonged hospitalization can be cause by Ventilator-Associated Pneumonia. For this reason, patient well-being, good treatment and pneumonia prevention are of greatest importance. In this way, there can be explanation to the causes and prevention of VAP among the patients.

Research Elements

Research findings have shown that the human body is designed to fight off infection through hair nostrils, epithelium cells, increased mucus, cilia, and white blood cells, coughing, and sneezing. However, mechanical ventilation is related to basic defense mechanisms which can easily be blocked or hindered by many different factors.. This artificial support material becomes also a source and breeding ground for illnesses leading to VAP.

Results

Implementation of the Ventilator Bundle will decrease risks. In addition, frequent oral care, with two times daily teeth brushing, finds a 69% reduction in respiratory tract infections.

Nursing Significance

It is important to note that the nursing staff also needs to become familiar with the requirements of the ventilator bundle. They also need to be aware of the benefits as well as take the time to provide adequate oral care.

Summary

The study discovered that the patients receiving mechanical ventilation are exposed to many risks and threats and ventilator-associated pneumonia is one of the most dangerous. It is therefore essential to compare actual practices of critical care nurses’ oral care to the recommended guidelines, a study was carried out.

Research Elements

The research elements in this case included a 347 members of the nurses association were selected randomly to gather data on oral care practices using a cross sectional which is descriptive and designed with a 31-item online-survey. All the nurses worked in adult ICU.

Results

There were disparities between reported practices and policies in data collected from 347 surveys. It must be mentioned that the number of members randomly selected was between  353 to  2000 in the survey process between November 1, 2006 to January 5, 2007. This means that the Oral care protocols were not used properly. Limitations were in the low survey response.

Nursing Significance

Oral care policies used in hospitals are often ignored or performed in incongruous way. It is necessary to provide proper recommendations and protocols to maintain oral care on a high level that will help intubated patients to avoid pneumonia. And the results are aimed at care policies to concur the recommendations

Summary

According to the Allegheny General Hospital in Pittsburgh, who have directed their forces to resolve the problem, ventilator-associated pneumonia which is frequent among patients on mechanical ventilator. As many other establishments across the country they want to decrease the level of problems caused by low oral care policies which often entail VAP

Study Elements

It is therefore important to securing the patient resuscitation bag in one location, maintaining the patient's head-of-bed-elevation to more than 30 degrees, Yankauer suction tip care, and use of chlorexidine mouth rinse were chosen through a multidisciplinary approach as best interventions to prevent the organizations rates of VAP. After approval of these 4 interventions a survey was conducted to determine compliance, establish a baseline, and develop a plan. This plan should be developed after each month, data is analyzed and changes are implemented.

Results

The results from VAP incidence has significantly reduced by 43% in a 6 month period. The incidences of VAP were. Additional VAP prevention interventions such as sedation, weaning protocol, and education of staff were established and encouraged in order to ensure enhancement in reduction of VAP.

Significance

Ventilator-associated pneumonia can have even larger influence on patient than financial burden on the institution. However, in order to achieve this, efforts must be made to prevent the incidence of VAP. This will not only have a positive impact on the patient but on the institution as well.