Reducing Incidence of Ventilator-Associated Pneumonia

¶ … suffered from its quasi-experimental approach, as several participants left the study since they left the facility or otherwise were not permitted to participate -- for example, those patients who recovered sufficiently to conduct their own oral care no longer engaged in the experimental protocol and condition. The results were positive and significant, however, the severity of the patients' conditions and the small sample size challenged the researchers, as discussed below.

The title of the article, Oral Intensity: Reducing Non-Ventilator-Associated Hospital-Acquired Pneumonia In Care-Dependent, Neurologically Impaired Patients, is absolutely clear, unambiguous, and accurate. The abstract offers a clear overview of the study, particularly as it is divided into sections that enable readers to quickly learn about the methodology, results, discussion, and implications of the study. The purpose of the research study is clearly defined: The purpose of the study is to determine if an enhanced oral care protocol would decrease the incidence of non-ventilator-associated, hospital-acquired pneumonia in a neurosurgical population outside of the critical care environment.

The literature review is logically organized that first addresses the nature of the hospital-acquired pneumonia condition, then discusses the critical care literature, the neuroscience literature, the oral hygiene literature, and oral care intervention literature. The literature offers a balanced critical analysis of the literature, although there were a number of references to "one study," which did not substantially strengthen the basis for the research. The majority of the literature is of recent origin, with several references to seminal studies, and mainly from primary sources of an empirical nature.

A theoretical framework has been articulated and it appears to have a sound basis and be adequately described. The two major guidelines (the Association of Medical Microbiology and Infectious Disease Canada -- AMMI -- and the Canadian Thoracic Society's joint document Clinical Practice Guidelines for Hospital-Acquired Pneumonia and Ventilator-Associated Pneumonia in Adults) recommend prevention oral care protocols for all in-patients whether or not they are ventilated. The theoretical framework and hypothesis of the Robertson & Carter (2013) research are derived from the definition, diagnosis, and prevention studies in these guidelines.

The aims, objectives, research question, and hypothesis of the research have been identified and are clearly identified. What's more, they reflect the information presented in the literature.

The target population was clearly identified, and both prospective and retrospective members of the sample consisted of neurosurgical patients subject to the inclusion criteria consistent with the research question. The members of the sample were all age 19 years or older, non-intubated, care-dependent, and had a primary diagnosis of neurological injury or insult. A sample size of 35 patients per group was identified by estimating the percentage of patients on the neurosurgical unit who would experience an NV-HAP event during their hospitalization, and a 60% potential effect size, with alpha-level at 0.05 and beta-level at 0.80. A notable, but not significant due to the small sample size, finding was that 28% of the participants with tracheostomies developed HAP compared to 13.8% of those participants without a tracheostomy (p=0.134, 2 sided Fishers Exact test). Moreover, all occurrences of HAP in the EOC group (n=2) were in subjects with a tracheostomy, but only 38% of the HAP cases in the SOC group (n=5) were in subjects who did have tracheostomies.

The findings were associated with the key lines of research delineated in the literature review.

All the terms, theories, and concepts mentioned in the study are clearly defined -- as they are used -- in the study. The research design is clearly defined as quasi-experimental. The two data gathering instruments were appropriate for the research and are described as: 1) Collecting data constants, and 2) weekly data. The variables collected were evidence-informed and standard data for determining the medical condition of the patients as well as demographic information.