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Klompas M., Speck, K., Howell M.D., Greene, L.R., & Berenholtz, S.M. (2014). Reappraisal of routine oral care with chlorohexidine gluconate for patients receiving mechanical ventilation: systematic review and meta-analysis. JAMA internal medicine, 174 (5), 751-761.
This article deals with the routine oral care of patients using chlorhexidine gluconate as standard care when they receive mechanical ventilation during their hospital stay. Their aim is to assess the overall impact routine oral care has in conjunction with chlorhexidine in regards to patient-centered outcomes for patients receiving the aforementioned mechanical ventilation. They chose randomized clinical trials that compared a placebo to chlorhexidine and chose only sixteen studies out of the 171 citations they explored because the 3,630 patients observed in the selected studies met criteria.
The results showed chlorhexidine provide patients with a lesser occurrence of infection than with placebo, although pneumonia risk was around the same for both. Although chlorhexidine reduced the risk of nosocomial infection, it did not reduce the risk of ventilator-associated pneumonia. Although the review appeared thorough with only a few studies chosen out of the 171, it still lacked details that would help highlight the effectiveness of chlorhexidine in regards to reduction in nosocomial infection.
2. Babcock, H., Zack, J.E., Garrison, T., Trovillion, E., Jones, M., Fraser, V.J., & Kollef, M.H. (2004). An educational Intervention to reduce Ventilator-associated pneumonia in an integrated Health System Chest, 125 (6), 2224-2231.
The first thing observed and appreciated about this article is the objective of the study was mentioned early. The study objectives were to determine if educational initiatives could lessen the rates of ventilator-related pneumonia within regional healthcare systems. In order to perform the study, they observed two teaching and community hospitals within a health system that is integrated. The time frame for observation of patients admitted was three and a half years from January 1999 to June 2002.
They mention that educational programs allow for emphasis on proper practices for prevention of ventilator-related pneumonia. They used posters and fact sheets in order to reinforce the practices all throughout the respiratory care and ICU departments. The fault found in the study is they did not use enough supplemental literature to show why educational programs are beneficial. However, the 46% reduction in cases seen throughout the 3.5 years highlights the positive effect educational programs can have on infection prevention.
3. Tablan, O.C., Anderson, L.J.M Besser , R., Bridges., C., & Hajjeh, R. (2004). Guidelines for preventing healthcare associated pneumonia, 2003. MMWR, 53 (RR-3), 1-36.
This is a guide of sorts that helps explains key terms, abbreviations and backgrounds on various types of disease and infection. While this is a helpful guideline for understanding the names and conditions associated with such infections, it is outdated and does not rely on information from current literature. It also does not provide adequate study information highlighting and correct practices that could decrease the rate of health-care-associated infections. The summary at the beginning was useful in getting a general idea of what can be expected, but overall, it is outdated.
4. Zhang, T., Tang, S,. & Fu, L. (2014). The effectiveness of different concentrations of chlorohexidine for prevention of ventilator-associated pneumonia; a meta-analysis. Journal Nursing, 23 (11/12), 1461-1475. doi:10.1111/jocn.12312
The objectives and aims were stated in the beginning of the study. These are to assess the effectiveness of using chlorhexidine in a health care setting to prevent or lessen occurrence of ventilator-associated pneumonia as well as exploring the desired concentration of such a medicine (chlorhexidine) for the positive outcome. In essence, they wanted to see if oral care measures had a positive impact in infection reduction. The background portion felt repetitive and should have included investigation into other medicines used at varying concentrations and its success in treating infection. The design of the study was a meta-analysis.
They searched and gathered information on randomized controlled trials and selected eighteen trials. They found the majority of the selected trials proved 2% concentration of chlorhexidine can prevent ventilator-related pneumonia. They even devised a range for effectiveness of chlorhexidine, which was from 0-12%. The fact that they included the mortality rates in ICU directly related to ventilator-associated pneumonia was a great way to add importance to the use of chlorhexidine and shined a spotlight on oral care.
5. Munro, C.L., Grap,. Grap,. M.J., Jones, D.J., McClish, D.K., & Sessler, C.N. (2009). CHLOROHEXIDINE TOOTHBRUSHING, AND PREVENTING VENTILATOR-ASSOCIATED PNEUMONIA IN CRITICALLY ILL ADULTS. American Journal of Critical Care: An official Publication, American Association of Critical-Care Nurses, 18 (5), 428-438. http://doi.org/10.4037/ajcc2009792
This study observed roughly...
Chlorhexidine to Prevent Ventilator-Associated Pneumonia Ventilator-associated Pneumonia (VAP) is one of the most common infections acquired by patients who've utilized mechanical ventilation in health care facilities. This infection is a major concern because it leads to several deaths, extends hospital stay, and increases the costs of medical care services. The infections are commonly developed when pathogenic bacteria colonize the aero digestive tract. According to Babcock et al. (2004), the prevention of
PICOT In critically ill adults (p), how does the daily use of chlorohexidine (I) compared to sterile water reduce VAP (ventilator-associated pneumonia) (O) during hospitalized stay (T). Part 2 Identifying a Problem Of the infections acquired by patients who've used mechanical ventilation in hospitals, ventilator-associated pneumonia is the most common. It causes several deaths, prolongs hospital stay and adds to the cost of medical care. Ventilator-associated pneumonia is commonly developed when pathogenic bacteria
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pneumonia is a recurrent mechanical ventilation complication affecting almost 25% of ventilated patients. This type of pneumonia is referred to as ventilator-associated pneumonia (VAP) and it accounts for up to 90% of nosocomial infections among the 25% of ventilated patients, significantly increasing the cost, the duration of stay in the ICU, the duration of stay in the hospital and the length of stay under ventilation. The mortality rates for
Autonomic nervous system function and depth of sedation in adults receiving mechanical ventilation. The authors of the article were attempting to discover how the autonomic nervous system affected the depth of sedation which occurred when a patient was placed on mechanical ventilation. The reason for this concern was that patients have been known to have adverse effects due to changes in the autonomic functions during critical illness. The stated thesis of
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