Conference Proceedings - School of Nursing & Midwifery - Trinity ...

School of Nursing & Midwifery, Trinity College Dublin: 8 th Annual Interdisciplinary Research Conference
Transforming Healthcare Through Research, Education & Technology: 7 th – 9 th November 2007
Conference Proceedings
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Evidenced-Based Nursing Practice Outcomes in Prevention of
Ventilator Associated Pneumonia
Cindy L. Hawkins, RN BSN
Clinical Nurse Specialist Graduate Student,
University of Alabama, Huntsville
Director of ICU, Marshall Medical Center North
8000 US Hwy 69
Guntersville, Alabama 35976
Tel: 1 256 753 8364
Fax: 1 256 753 8347
Email: cindy.hawkins@mmcenters.com
Background and context
Ventilator-associated pneumonia (VAP) is a nosocomial infection in
critically ill patients who receive mechanical ventilation. Nosocomial
pneumonia is the second most common hospital-acquired infection.
VAP occurs forty-eight hours or more after intubation – largely due
to the tube bypassing the lungs normal protection mechanisms.
With its high morbidity rate; increased length of stay; prolonged
mechanical ventilation; and increase in costs, interventions are
essential in impacting the care and outcomes of these patients. The
incidence rate of VAP can be as high as 65% and a mortality rate up
to 71%. The risk for death increases by 4.3 times compared to
patients in the intensive care unit (ICU) without pneumonia. In the
United States alone, VAP results in yearly expenditures of
approximately $1.5 million with an outstanding 1.75 million
additional hospital days per year. The Center for Disease Control
and Prevention states that the median rate per thousand ventilator
days was 14.7 in trauma ICU’s and the patient had a greater risk by
6 to 21 times in developing pneumonia than those patients not
ventilated. Therefore prevention of VAP must be regarded as one of
the most important issues in critical care, and it has already become
one of the core ICU performance measures proposed by the
Intensive Care Advisory Panel of the Joint Commission on
Accreditation of Healthcare Organizations.
The significance of preventing VAP is to improve patient care,
improve outcomes, and decrease incidence rates. The Institute for
Healthcare Improvement (IHI) has started a campaign to nationally
improve patient care and prevent avoidable deaths in ventilated
patients as a part of the 100,000 Lives Campaign.
Clinical practice guidelines which have been proven to decrease the
incidence of VAP include basic hand washing, oral care, daily
sedative interruption, assessment of readiness to extubate, semirecumbent
positioning, deep vein thrombosis and peptic ulcer
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