Reducing Rates of Ventilator-Associated Pneumonia

Infections that occur in hospital settings as a result of hospital procedures can be fatal for patients who are already sick as well as hospitals that can be held liable for those infections. One of the most common infections that occur in hospital settings is Ventilator-Associated Pneumonia. This is due to the fact that the infection occurs in intubated patients, which is a common procedure that if often conducted in critical care or intensive care units. Patients in these units already have weakened immune systems. The infection can be contracted by a patient within a 48 hour period after intubation is done in the critical care unit. Patients can have recurrent infections as their immune systems become weakened even more by the infection. Hospitals with high rates of VAP may be seen as unsafe in treating their patients. The infection also increases hospital costs as the hospital must spend time, money and resources on treating a condition caused by the hospital staff. Nurses can play a vital role in reducing rates of VAP through the use of procedures that would safeguard their patients and themselves from the deadly infection.

Nurses can play a direct role in reducing rates of VAP due to their proximity to both the procedure and the equipment that is used to intubate a patient. Nurses can support doctors who administer the procedure. Nurses can also ensure that the equipment used to intubate a patient is sanitary. It would be in the best interest of the nurse to ensure that a patient does not contract VAP as they would then need to work harder to treat the new infection. The VAP infection also reduced the likelihood of the patient being released early, which increases hospital costs and resources that the nurse must devote to treating the patient. Nurses play a key role in reducing VAP and should want to eradicate the condition from their intensive care units. The research proposal will outline the research study that will be conducted to determine the procedures that are effective for nurses to utilize in reducing rates of VAP within intensive care settings in hospitals.

The research proposal will be used to determine which procedures are effective in reducing rates of VAP infection in intensive care units. This approach is beneficial as the current literature that exists on the subject has conflicting information on which method is the best in reducing infections. Some authors suggest preventive measures such as giving patients antibiotics before being intubated would reduce rates of infection. As Bouzo (2013) found “…patients in the intervention group were able to be ventilated longer that broad-spectrum antibiotics may offset or delay VAP infection by 4.5 days” (Bouza et al., 1550).While others suggest that the equipment used to intubate patients is outdated and leave patients more prone to infection. These authors also suggest that the use of antibiotics can be harmful as they can reduce the patient’s ability to fight off infections (Chastre, 2003). It has also been proposed that increased education and training is needed to improve the care provided to patients in intensive care units. The research proposal would determine which method is the most effective in reducing rates of VAP infection in intubated patients within intensive care units. 

The research proposal is designed to analyze which method is the most effective in reducing rates of VAP infection in the hospital. Based on the literature review there were three different recommendations posed for reducing these rates. The proposal will determine whether improving hospital procedures, improving the equipment used for intubation or just improving the training that is received by nurses will reduce rates of VAP and other infections within intensive care settings. 

The professional setting for the research proposal will be four nursing units within the intensive care setting. The four units would be similar in size of the unit, the types of patients treated, the resources they have and staff. One nursing unit would follow the recommendations to improve hospital policy surrounding intubation procedures. The second nursing unit would receive new equipment that has advanced technology to reduce rates of VAP. This equipment would include “subglottic drainage tubes, silver-coated endotracheal tubes, and ultra-thin sealing cuffs” (Efrati et al., 2010 166).  This equipment would be used as it has been determined that this new technology reduces rates of infection. The third unit would provide the nurses with ongoing training and education regarding VAP. The fourth nursing unit would continue practicing medicine as they had been with no intervention. The data regarding rates of VAP infection will be gathered to determine which method improved outcomes for the patients of the intensive care unit.

As a researcher, I will need to establish a clear role as an unbiased observer of the implementation of the methods. I would need to establish the guidelines that each unit is following as well as being clear about which recommendation they should be following. I would have to be knowledgeable about intubation procedures of patients. I would also have to be aware of the signs of VAP and what happens as a result of the onset of the infection. I would have to maintain my objective role as a researcher by not allowing any of my biases get in the way of the study.

As a researcher, I may already have an opinion on which method will be the most effective. However this opinion should not cloud my research. I may let my biases get the better of me if I began to assume that one unit was doing better than another without analyzing the data first. This assumption may impact the results as I may think that one unit did better than the other as a result of these assumptions. As a researcher I must also ensure that the nursing units are not aware of any biases. If a unit feels that the researcher thinks the method they are adopting is ineffective they may not be inclined to successfully implement the procedure in their day to day work. 

The study will utilize quantitative methods as the rates of VAP will only be analyzed to determine the success of one method over another. Due to the small size of the study, a non-probability sampling technique will be utilized. Purposive sampling will be utilized as the research study would need to be held in very specific settings such as the nursing units described above. These nursing units must also have high rates of VAP infection. The high rates of infection would indicate that the units are doing something wrong and the methods provided would show considerable difference after the implementation of the new methods or equipment within the units.

The participants of the setting would not necessarily be individuals. Rather the participants would be whole hospital units. These units would be intensive care units within hospitals. All of the staff and patients within those units would be considered participants of the research study. Due to the need to have as much similarity as possible, it would be important to select hospital intensive care units that are similar as possible to each other. These units should also have similar resources so that a lack of resources could not be considered a reason for the failure of the VAP reduction recommendations. The research proposal could be successful through following these steps and a recommendation could be made to the targeted audience of the study.

The targeted audience of the study would be individuals, such as hospital administrators, who are responsible for making decisions. The audience should also be those specific hospitals that struggle with high rates of VAP infections. As these hospitals review the results of the study, they can choose to implement changes within the intensive care units to reduce rates of infection. These changes would hopefully be implemented across the nation so hospitals and patients no longer have to face the consequences of VAP. With these changes, the study would have achieved its purpose.

My hypothesis is that improving the equipment used by hospitals to intubate patients will drastically reduce rates of VAP infection. The study will probably find that the changes that are implemented will have some effect on reducing rates of infection as the unit will become more focused on eradicating the condition from their unit. As other studies have found new equipment in intensive care units reduces rates of infection. This is because the equipment “reduces channel formation and fluid leakage from the subglottic area” (John et al., 2013 1). However, the rates will have significantly decreased within units that were able to use new and advanced medical equipment. 

Although these results will be beneficial in guiding the course of treatment for patients who need intubation, all of the guidelines may not be implemented. This is due to the fact that purchasing new equipment can be expensive for hospitals already constrained by budget limitations. While the audience of hospital administrators may recognize that the new equipment has reduced the infections, they may not have the ability to make the purchases required to reduce VAP. This is a predicament faced by hospital administrators in a variety of hospital units. While they recognize what changes are needed to improve their units, actually implementing these challenges can be difficult due to the administrative and financial barriers that exist for hospitals.  Although the guidelines may not fully be implemented the research proposal would provide new evidence to the current literature on VAP. The study could also provide new questions that would guide further research into the problem of infections contracted within hospital settings.

References

Bouza, E., Granda, M. J., Hortal, J., Barrio, J. M., Cercanado, E., & Munoz, P. (2013, September). Pre-emptive broad-spectrum treatment for ventilator-associated pneumonia in high-risk patients. National Center for Biotechnology Information. doi: 10.1007/s00134-013-2997-6

Chastre, J., Wolff, M., Fagon, J. Y., Chevret, S., Thomas, F., Wermert, D., Clementi, E., et al. (2003). Comparison of 8 vs. 15 days of antibiotic therapy for ventilator-associated pneumonia in adults: a randomized trial, JAMA, 290(19):2588-2598. 

Efrati, S., Deutsch, I., Antonelli, M., Hockey, P. M., Rozenblum, R., & Gurman, G. M. (2010). Ventilator-associated pneumonia: Current status and future recommendations. Journal of Clinical Monitoring and Computing, 24(2), 161-168. doi: 10.1007/s10877-010-9228-2

John, S., Karlnoski, R., Manger, D., Koll, J., Munoz, G., Thompson, P., ... Camporesi, E. M. (2013). Impact of a Low-Pressure Polyurethane Adult Endotracheal Tube on the Incidence of Ventilator-Associated Pneumonia: A before and after Concurrence Study. ISRN Critical Care, 2013, 1-6. doi: 812964