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 colonize the aero digestive tract. Given this reality, prevention of the infection has always involved preventing bacteria colonization and the following aspiration of the contaminated secretions to the lower airways. (Babcock et al., 2004).
It is necessary that a reappraisal be carried out because of the limitations that the evidence base has. First, the current meta analyses are influenced heavily by three significant studies in patients undergoing cardiac surgery and they accounted for between forty to sixty percent of the patients analyzed before. The reliability of the studies lie in question because most of the patients' extubation is done within a day. VAP is the least likely outcome in such a situation. Second, not enough distinction has been made between double-blind and open-label investigations. This is key because VAP diagnosis is not always accurate and objective. It is hard estimating VAP rates because objectivity and specificity are always lacking. The study reappraised evidence base that support admitting oral care to mechanical ventilation patients with chlorohexidine. The study looked into what impact chlorohexidine had on oral care, VAP and ICU length of stay (Klompas et al., 2014).
Reducing the volume of oral microorganisms could help make significant strides in preventing VAP. Chlorohexidine might just hold the answer. It helps fight both aerobic bacteria and anaerobic bacteria. It can be active for long -- 6 hours after application. The question as to whether Chlohexidine is the best choice is still open to discussion (Zhang, Tang & Fu, 2014). Clinical workers are for sure free to make a decision based on the circumstances and their judgment of the needs of the patient.
VAP prevention will require thorough education of all concerned parties. It was found that 2 community hospitals and 2 teaching hospitals had dropped the infection rate by on average 46% after the staff had gone through professional development. VAP infections should be brought to near zero whatever the cost. It leads to higher medical care costs, lengthens hospital stay, raises patient morbidity and increases the workload of health workers. Education should therefore be a key priority (Pruitt & Jacobs, 2006). CDC states (Tablan et al., 2004) that preventing VAP needs the employment of a multifaceted approach. Oral care should be one of the approaches taken (Tablan et al., 2004).
Part 3: Selecting Sources of Literature
1. 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.
The study looks into what impact chlorohexidine oral care has on patient centered outcomes in those patients on mechanical ventilation. The paper indicates why there is need for re-evaluation of policies that encourage chlorohexidine routine oral care for patients undergoing non-cardiac surgery. It indicates that there isn't any significance difference between placebo and chlorohexidine use in cardiac surgery. There wasn't enough data on antibiotic prescriptions and length of stay in hospitals.
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 study reveals that having educational interventions help reduce VAP infections in an ICU. The decrease was statistically significant in a pediatric hospital and 2 of 3 adult hospital studies. There are clear gaps between what is spelled out in manuals and guidelines and what is actually being practiced; the paper goes on to say. The institution of an education module helped reduce the rates of infection in the 3 hospitals.
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.
Among the recommended changes to help in the prevention of bacterial pneumonia, especially VAP, is use of oro-tracheal tubes in place of nasotracheal tubes during mechanical ventilation. Studies show that almost 15% of hospital associated infections are pneumonia. Of all the infections, infections in the ICU and coronary care unit account for 27% and 24% respectively. The study states that chlorohexidine use in the prevention of healthcare-associated pneumonia in the other high risk patient groups hasn't been evaluated.
4. Zhang, T., Tang, S,. & Fu, L. (2014). The effectiveness of different concentrations...
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