¶ … Chlorhexidine Gluconate Use in Ventilator Assisted Patients Prevent Ventilator Associated Pneumonia
Chlorahexidine Gluconate
Ventilator associated pneumonia is a common and fatal complicated issue for patients in ventilator care within the intensive care unit. Ventilated and incubated patients are a challenging threat for registered nurses to deliver high quality of care. It has been observed that incubation impedes the natural defense of the body against respiratory infections. The placement of an endotracheal tube enforces negative effect on the cough reflexes, which aims to protect the airway from invasive pathogens. The endotracheal tube prevents mucocoliary clearance of secretions and depresses epiglottic reflexes (Rello, Lode, Cornaglia, & Masterton, 2010; Labeau, Vyver, Brusselaers, Vogelaers, & Blot, 2009). It causes the virulent bacteria to enter and it leaks around the inflated cuff of the endotracheal tube. Consequently, the lungs of patient infiltrate due to which pneumonia is caused. The ventilator associated pneumonia possibly occurs early or late during the course of intubation along with a mechanical ventilation of a patient (Evans, et al., 2011; Tantipong, Morkchareonpong, Jaiyindee, & Thamlikitkul, 2008; Abad, McKinley, & Safdar, 2008). The ventilator associated pneumonia is generally referred to nosocomial bacterial pneumonia, which develops in patients on ventilation. It is known to occur between 48 and 72 hours after tracheal intubation resulting from aspiration that has complicated the intubation procedure. If ventilator associated pneumonia occurs after this period, it is then known as late-onset pneumonia. The early onset pneumonia occurs due to the antibiotic sensitive bacteria, whereas, late onset pneumonia associated with ventilator patients is caused by antibiotic resistant pathogens. This disease consists of supportive care along with the administration of antibiotics and the mortality attributable to it is greater than ten percent (Pileggi, Bianco, Flotta, Nobile, & Pavia, 2011; Ozcaka, et al., 2012).
PICO Question.
The PICO question regarding the paper is "Does the use of chlorhexidine gluconate use in ventilator assisted patients prevent ventilator associated pneumonia?"
Search Strategy
The search strategy for this research paper is the use of keywords including chlorhexidine + ventilator associated pneumonia, intensive care unit + ventilator associated pneumonia, infection control + ventilator associated pneumonia, and mechanical ventilation + chlorhexidine gluconate. These keywords are used on Google, Medline, ProQuest, and EbscoHost.
Ventilator Associated Pneumonia
According to the studies of Evans, et al. (2011), Lorente, Blot, and Rello (2007), and Shi, et al. (2010), nosocomial infections are responsible for approximately forty to ninety deaths costing more than $20 billion in the United States. It is found in the studies of Abad, McKinley, and Safdar (2008), and Evans, et al. (2011) that ventilator associated pneumonia is the most common nosocomial infection among the patients in the intensive care unit. Maselli and Restrepo (2011), Tantipong, Morkchareonpong, Jaiyindee, and Thamlikitkul (2008), and Lorente, Blot, and Rello (2007) conducted the study in a hospital in Tehran and the results provide the evidence of pneumonia to be the most common infection among the patients of Tehran.The reports of its neighboring countries also presented that pneumonia is found to be most prevalent infection in the intensive care unit as Lebanon reported approximately 45% and India reported approximately 80%. It can be said that ventilator associated pneumonia occurs in at least 20% patients receiving mechanical ventilation and it is responsible for the occurrence of nosocomial infections in patients on ventilators (Pileggi, Bianco, Flotta, Nobile, & Pavia, 2011; Chan, Ruest, Meade, & Cook, 2007; Elward, Warren, & Fraser, 2002).
The colonization of respiratory-gastrointestinal system and aspiration of contaminated secretions are observed to be introduced as most important processes playing their role in the development of the ventilator associated pneumonia. Panchabhai and Dangayach (2009) provide that the negative species can be replaced in throat within two days after hospitalization but it has been observed that the patients in ventilation are exposed to the contact with bacteria in the environment of ICUs. Safdar, Crnich, and Maki (2005), on the contrary, have provided the significant role of tracheal tube in colonization of bronchial tracheal tree while making the patients prone to aspiration has caused the need for endotracheal tube is inevitable in different patients. Tantipong, Morkchareonpong, Jaiyindee, and Thamlikitkul (2008) have proposed that use of non-absorbable antibiotic for selective cleaning of the gastrointestinal tract is a way of reducing the incidence of nosocomial infection. It has been found that this method increases the chances of developing of resistant species. The chlorhexidine glucomate is known to be the bisbiguanide disinfectant and it is effective on different...
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