Ventilator-associated pneumonia (VAP) is among the most common nosocomial infections during a patient’s hospital stay. Its frequency and the severity of the related adverse effects are significantly higher in critically ill patients due to their impaired immune response, physiology and multiple organ dysfunction. VAP is among the indicators of quality care. However, despite recent prevention strategies that have been implemented to ensure reduced incidence, VAP is still a menace to the critically ill, with an approximate mortality rates of 50% (Papazian, Klompas & Luyt, 2020). This article analyzes minimizing ventilator exposure as a quality improvement initiative in reducing VAP in critically ill adults.
Purpose of the quality improvement initiative on Ventilator-Associated Pneumonia
Minimizing exposure to mechanical ventilation is among the most important evidence-based practice for preventing VAP. There are two approaches through which it can be achieved. first, through promoting the use of noninvasive ventilation methods. This includes the use of bi-level positive airway pressure (BPAP) or continuous positive airway pressure (CPAP). The discomfort associated with face masks in these methods can be counteracted with helmets. Lower intubation rates are associated with helmets compared to facemasks. Second, through using ventilator weaning protocols to minimize the duration of mechanical ventilation when it is inevitable. According to Boltey, Yakusheva, and Costa (2017), Nurse-led and respiratory therapist-led ventilator-weaning protocols such as daily disruption of sedation in conjunction with spontaneous breathing exercises are effective in quick and successful removal from mechanical ventilation. These approaches will ensure reduced incidence of VAP among the critically ill adults, thereby reducing their length-of-stay in hospital, and improving patient satisfaction rates.
The target population
The target population for this quality improvement initiative is the critically ill adults in the intensive care unit. High rates of mortality (50%), associated with VAP among this population have been reported recently (Papazian et al., 2020). This is due to the inability of their immune response to fight off nosocomial infections such as VAP, which is common among patients using assisted ventilation. Additionally, their impaired physiological processes and multiple organ dysfunction are key contributing factors to their increased susceptibility to acquiring VAP.
Benefits of the Quality improvement initiative
There are immense benefits associated with minimizing ventilation exposure. First, the cost incurred during treatment will be significantly reduced. The huge economic burden due to VAP not only affects the hospital but the patients too. Patients pay high hospital bills, especially if they have no insurance. Second, implementing this initiative will ensure the reduced length of stay in hospital for patients which is related to high patient satisfaction rates. These rates are useful during hospital reimbursement by the federal government. Lastly, these initiatives will ensure timely delivery of better health outcomes, which is essential in a critically ill patient’s journey to achieving full recovery.
Interprofessional collaboration required to implement the initiative
Effective collaboration among various professionals in the ICU is integral in the prevention and management of VAP. A team of ICU nurses, physicians, and respiratory therapists is key in managing this infection. Nurses play a critical role in the care of patients being weaned off from ventilation. They use ABC (Airway, Breathing, Circulation) to assess and monitor signs of weaning failure. In collaboration with the respiratory therapists, ICU nurses implement weaning protocols to reduce patients’ exposure to mechanical ventilation. As a result, the likelihood of contracting VAP is significantly reduced. Physicians are also responsible for ensuring timely weaning of mechanical ventilation and treatment in case of VAP to ensure reduced length of stay in the hospital.
The economic burden associated with VAP directly affects the nation and the individuals who are responsible for paying hospital bills. According to Papazian et al. (2020), the current cost of VAP stands at between $36,286 and $44,220. While both US and European treatment guidelines recommend 7 days as the maximum duration of treatment, a longer duration is required for patients with severely compromised immune response and organ dysfunction. Effective prevention strategies such as minimizing the duration of exposure to mechanical ventilation are key in cutting the cost of treatment. Also, compared to invasive ventilation, noninvasive ventilation is cheaper and poses fewer health risks (Hall et al., 2021). Some risks associated with invasive ventilation include nosocomial infections, hemodynamic instability due to sedation, and the risk of delirium (Hall et al., 2021). Thus, it is inarguable that the minimum time spent on mechanical ventilation is a reflection of the cost incurred.
The effectiveness of these prevention strategies would be evaluated after three months. A baseline data of the number of VAP, the weaning protocols used, the standard duration of exposure before weaning, and the healthcare workers involved in the care of a patient would be obtained. After three months of implementing timely weaning protocols, minimizing exposure to ventilation, and collaborating with relevant healthcare providers, an evaluation will be done by obtaining the current number of VAP infections. This number would determine whether the prevention strategies were effective or not.
Boltey, E., Yakusheva, O., & Costa, D. K. (2017). 5 Nursing strategies to prevent ventilator-associated pneumonia. American nurse today, 12(6), 42. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5706660/
Hall, J., Turner, A. M., Dretzke, J., Moore, D., & Jowett, S. (2021). Cost-effectiveness of domiciliary non-invasive ventilation in patients with chronic obstructive pulmonary disease. Thorax. Retrieved from https://thorax.bmj.com/content/early/2021/11/25/thoraxjnl-2021-217463
Papazian, L., Klompas, M., & Luyt, C. E. (2020). Ventilator-associated pneumonia in adults: a narrative review. Intensive care medicine, 46(5), 888-906. Retrieved from https://link.springer.com/article/10.1007/s00134-020-05980-0
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