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Blair Donalson

on 2 May 2013

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Transcript of EBP VAP

Summary of Literature & Research Implications for Nursing Practice Evidence Based Project As practicing nurses, we should maintain the standard of care for oral care.
Continue to suction oral secretions, brush teeth, gums, and tongue, and moisturize the oral mucosa and lips.
Obtain an order for chlorhexidine gluconate if necessary per hospital protocol. Blair Donalson
Elizabeth Hederer
Kaylin Mellem
Kelly O’Donnell Practice Problem Ventilator-associated pneumonia (VAP) is the number 1 cause of healthcare-associated infections in intensive care unit patients. It's a major cause of patient mortality, and it increases healthcare costs. A majority of ICU patients are on mechanical ventilation, therefore are at risk for VAP. This high risk may be due to the lack consistency in infection control. A reduced incidence of VAP in the ICU setting may be accomplished by implementing chlorhexidine gluconate oral rinse for decontamination. PICOT Question What is the effectiveness of chlorhexidine gluconate oral rinse on reducing VAP among mechanically ventilated patients compared to the use of saline swab in an ICU setting ? P: ICU mechanically ventilated patients, ages 25-55 in, an urban hospital setting.

I: Implementing use of chlorhexidine gluconate oral rinse 3 times a day for decontamination for the prevention of ventilator-associated pneumonia(VAP) in mechanically ventilated patients aged 25-55 in an urban hospital Intensive Care Unit (ICU).

C: Saline swab or routine vent care.

O: Decrease in positive cultures (C&S), decrease rate of VAP and increased comfort indicated by patient posture in patients aged 25-55 in an urban hospital Intensive Care Unit (ICU) who are mechanically ventilated.

T: Duration of endotracheal intubation. Clinical Practice Guideline AACN (2010) proposes expected practice that include brushing teeth, gums and tongue at least twice a day using a soft adult toothbrush, providing oral moisturizing to the oral mucosa and lips every 2-4 hours, using an oral chlorhexidine gluconate (0.12%) rinse twice a day during the perioperative period for adult patients who undergo cardiac surgery (based on CDC guidelines). However... routine use of oral chlorhexidine gluconate (0.12%) in other populations not recommended at this time. Themes of Research Recommendations for Practice Based on the evidence, chlorhexidine gluconate solutions should be incorporated into oral care protocols in patients at risk for developing ventilator-associated pneumonia. Research demonstrated that the use of chlorhexidine gluconate decreased rates of ventilator-associated pneumonia (VAP) even in patients at highest risk (Halm & Armola, 2009).

Compared with normal saline solution, chlorhexidine solution had fewer cases of VAP (Boeser et al. 2011).

Chlorhexidine oral rinse is included in the standard protocol for cardiac surgery patients (Martin, 2010). References So What Does This All Mean? Ventilator Associated Pneumonia Boeser, K., Ingalls, L., Retzer, K., Tescher, A., Tismer, S., Weinert, C., & Wiersgallas, S. (2011). Prevention of ventilator-associated pneumonia. Health care protocol. Institute for Clinical System Improvement.

Cuccio, L., Cerello, E., Paradis, H., Padula, C., Rivet, C., Steeves, S., & Lynch, J. (2012). An evidence-based oral care protocol to decrease ventilator-associate pneumonia. Dimensions of Critical Care Nursing 31(5), 301-308. doi: 10.1097/DCC.0b013e3182619b6f

Halm, M., & Armola, R. (2009). Effect of oral care on bacterial colonization and ventilator-associated pneumonia. American Journal Of Critical Care, 18(3), 275-278. doi:10.4037/ajcc2009842

Martin, B. (2010). AACN practice alert: oral care for patients at risk for ventilator-associated pneumonia. American Association of Critical Care Nurses.

Pineda, L., Saliba, R., El Solh, A., (2006). Effect of oral decontamination with chlorhexidine on the incidence of nosocomial pneumonia: a meta-analysis. Crit Care, 10(1): R35. PICOT Conclusion Critical care nurses should provide the standard of care to their patients. Ventilated patients require more resources, time, and attention from their nurses. Chlorhexidine gluconate solutions should be part of their daily oral care to prevent VAP.
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