VAP Protocol in ICU

Reflective Thoughts Related to the Study

Relevance to the nursing practice:

Because VAP is the leading cause of death among critically ill ventilated patients, it is important that ICU nurses are educated on VAP and VCB in order to reduce the incidence of VAP.

Personal thoughts about the research:

I found this research significant in quantifying the importance of educating nurses, especially ICU nurses, on VAP and VCB in order to reduce the incidence of VAP and providing improved quality of care to their intubated patients.

Title of the Study

Results and Evaluation

Impact of education on ventilator-associated pneumonia in the intensive care unit

Incidence of VAP among patients admitted to the ICU during the study period

Pathmawathi Subramanian, Kee Leong Choy, Suresh Venu Gobal, Marzida Mansor, Kwan Hoong Ng

Demographic Characteristics of nurses enrolled in the study (n = 71)

Background

Variable No. (%)

Preintervention Postintervention

Patients admitted to ICU 136 130

Intubated and ventilated 101 (74.26) 110 (84.61)

patients

Episodes of VAP 22 7

Total ventilation days 564 463

Incidence of VAP 39.01 15.11

(per 1,000 ventilator days)*

*VAP incidence (per 1,000 ventilator days) = (episodes of VAP/total ventilation

days) × 1,000.

Singapore Medical Journal. May 2013

Characteristic No. (%)

Gender

Male 4 (5.6)

Female 67 (94.4)

Age* (yrs) 26.10 ± 4.99

Range (yrs)

21–31 63 (88.7)

32–41 8 (11.3)

Education level

Diploma 63 (88.7)

Post-basic diploma 8 (11.3)

Work experience in critical care (yrs)

< 1 15 (21.1)

1–5 34 (47.9)

6–10 14 (19.7)

> 10 8 (11.3)

*Data is presented as mean ± standard deviation.

• Study was conducted in a Malaysian ICU that lacked any structured VCB guidelines
• 71 ICU nurses were the subjects

What is the important question?

Comparison of nurses' pre- and posttest knowledge (n=71) and compliance (n=66)

Evaluation

"...nurse-led educational intervention on VAP and VCB successfully enhanced ICU nurses' knowledge of and compliance with VCB guidelines, effecting a reduction in the postintervention incidence of VAP."

Variable Pre- and posttest scores

Mean ± SD 95% CI t(df) p-value*

Knowledge −3.28 ± 7.64 −34.63 to −31.01 −36.19 (70) < 0.001

Compliance −3.61 ± 13.69 −39.43 to −32.69 −21.41 (65) < 0.001

"What effects would the implementation of a nurse-led education program on VCB have on the enhancement of knowledge and compliance among nurses in the ICU?"

*p <0.05 is considered statistically significant

Purpose of Study

Compliance Test Scores

• Pretest: 60.00 ± 11.09
• Posttest: 96.06 ± 8.75

Knowledge Test Scores

• Pretest: 63.17 ± 9.34
• Posttest: 95.99 ± 4.68

Subramanian, 2013, pg. 284

"Aimed to determine the effects of nurse-led VCB education on the incidence of VAP among ventilated patients in a critical care setting."

Subramanian, 2013, pg. 281

Let's talk about VAP and VCB!

VAP Protocol in ICU

Ventilator-Associated Pneumonia (VAP)

• Nosocomial airway infection of the lung tissue that occurs 48-72 hours post-intubation and initiation of mechanical ventilation
• Leading cause of death among critically ill patients

Mallory Price

PREVENTION IS IMPORTANT!

Methodology Used

Ventilator Care Bundle (VCB)

5 important components of VCB include:

• elevate HOB 30-45 degrees
• daily sedation hold
• peptic ulcer disease prophylaxis (panoprazole or ranitidine)
• DVT prophylaxis (heparin or Lovenox and SCDs)
• daily oral care with suction toothbrush and chlorhexidine gluconate 0.05%

Quasi-experimental study using a pretest-posttest design with convenience sampling.

Population Breakdown

Three Phases of Data Collection

Instruments Used

Pretest and Posttest Evaluation

Clinical Pulmonary Infection Score (CPIS), Gram Staining, and Culture

• Patient Population: mechanical ventilated-assisted patients in ICU
• Study Population: 71 ICU nurses in a Malaysian hospital

• Phase I: Pretest evaluation and preintervention observation
• Phase II: Educational Intervention
• Phase III: Posttest evaluation and postintervention observation

2 Parts:

• 5 questions on the demographic characteristics of the enrolled nurse
• 20 multiple-choice questions regarding knowledge of VAP and prevention via VCB practices

Scoring:

• 1 point for each correct answer
• >80% = good knowledge

CPIS checklist

• used to determine the development of VAP
• 6 clinical and lab variables
• tracheal secretions
• chest radiography
• body temperature
• leukocyte count
• arterial oxygenation ratio
• microbiology

Gram Staining and Culture

Scoring

• CPIS checklist
• scored between 0 and 12
• >6 = excellent predictive value of VAP
• Gram Staining and Culture
• if positive, 2 points were added

Observation

Statistical Analysis

• Statistical Package of the Social Sciences for Windows version 16
• Sample t-test used to compare the mean scores of pre- and posttest evaluations on knowledge and compliance
• p-value <0.05 is considered statistically significant

5 important elements:

• HOB elevation
• daily sedation hold
• PUD prophylaxis
• DV prophylaxis
• Daily oral care

Scoring:

• 1 mark per intervention applied
• Compliance determined by a score of 5/5
• Based on the all-or-none principle

Reference

Subramanian, P., Choy, K., Gobal, S., Mansor, M.,

& Ng, K. (2013, May). Impact of education on

ventilated-associated pneumonia in the

intensive care unit. Singapore Medical Journal, 54(5), 281. Retrieved April 23, 2014, from PubMed