Proposed Change for Preventing VAP Infections Capstone Project

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Chlorhexidine to Prevent Ventilator-Associated Pneumonia

Ventilator-associated Pneumonia (VAP) is one of the most common infections acquired by patients who've utilized mechanical ventilation in health care facilities. This infection is a major concern because it leads to several deaths, extends hospital stay, and increases the costs of medical care services. The infections are commonly developed when pathogenic bacteria colonize the aero digestive tract. According to Babcock et al. (2004), the prevention of these infections has usually entailed preventing bacteria colonization and the subsequent aspiration of the contaminated secretions to the lower airways. Given the increased incidents of ventilator-association pneumonia, this paper proposes the use of chlorhexidine in preventing it. Chlorhexidine has proven effective in prevention of VAP as shown in baseline data. The implementation of this proposed procedure in patient care will entail various logistics based on approval from organizational leadership.

Methods for Obtaining Necessary Approval and Support

One of the most important elements in the implementation of this proposed procedure in patient care with regards to preventing VAP infections is obtaining necessary approval and securing support from organization's leadership and fellow staff. The first method to be utilized in this process is conducting a leadership team meeting in which the proposed change will be introduced and explained with regards to its rationale, positive impacts, and implementation process. This explanation and implementation process will be discussed on the premise of the current health care environment and practices within the organization. The second process will involve conducting a staff meeting to discuss existing best practices in preventing ventilator-associated pneumonia. The proposed change will be discussed with fellow staff based on the review of the proposal in the leadership meeting. An explanation of the roles and duties of fellow staff in implementing this proposal will be provided.

Current Problem Requiring Change

As previously mentioned, ventilator-associated pneumonia is the most common infection acquired by patients who've utilized mechanical ventilation in health care facilities. Mechanical ventilation is utilized among critically ill patients who may be sedated or unconscious while receiving treatment in intensive care units. The use of these machines for such patients is geared towards helping them breathe. The machines, which act as ventilators, may contribute to acquisition of ventilator-associated pneumonia if utilized for over 48 hours. The infection is commonly developed when pathogenic bacteria take over the aero digestive tract. This infection is a potentially severe complication for the already critically ill patients. Actually, ventilator-associated pneumonia is linked to increased morbidity and mortality (Munro et al., 2009, p.428). Some of the major effects of this infection include deaths, prolonged hospital stay, and increased costs of medical care. As a result of its severity, identifying a suitable procedure or method of preventing these infections is increasingly important. This need is exacerbated by the fact that existing interventions primarily focus on preventing bacteria colonization and the subsequent aspiration of the contaminated secretions to the lower airways. However, these interventions have been seemingly ineffective in dealing with the problem in an effective manner.

Explanation of Proposed Solution

The proposed solution for this problem is a procedure or practice change that entails the use of chlorhexidine to prevent ventilator-associated pneumonia. Generally, keeping the mouth and teeth clean, avoiding the development of plaque on the teeth, and preventing secretions in the mouth is considered beneficial in lessening the risk of acquiring ventilator-associated pneumonia. These processes are part of initiatives to ensure and enhance oral hygiene, which is a crucial aspect or factor in lessening the risk of these infections. Klompas et al. (2014) state that regular oral hygiene through the use of chlorhexidine gluconate is part of normal care for patients under mechanical ventilation across various health care facilities and hospitals. Chlorhexidine is currently used as the standard of care in approximately 70% of intensive care units across North America and Europe because of its effect in preventing ventilator-associated pneumonia and its negative outcomes. According to findings of the surveys of the increased use of this standard of care, chlorhexidine lessens the rate of these infections by approximately 40%.

Chlorhexidine is basically described as a cationic chlorophenyl bis-biguanide antiseptic agent (Snyders, Khondowe & Bell, 2011, p.49). It helps in preventing the risk of ventilator-associated pneumonia through acting as an antiseptic solution for decontaminating oropharynx. Moreover, it suppresses the ability of potential pathogens to colonize the dental plaque through mechanical plaque removal. Chlorhexidine also has the capability to bind to oral tissues with successive slow release of antiseptic elements, which in turn contribute to prolonged period of antibacterial action.

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Rationale for the Proposed Solution

The use of chlorhexidine has proven effective in preventing ventilator-associated pneumonia by reducing the risk of acquiring the infections by nearly 40%. Hoshijima et al. (2013) argues that previous meta-analyses showed that oral chlorhexidine is effective in preventing these infections. As compared to sterile water and toothbrushing, chlorhexidine has been found effective in lessening early ventilator-associated infection in patients without pneumonia according to baseline data (Munro et al., p.428). These researchers report that chlorhexidine oral swabbing generated positive outcomes or results with regards to reducing early acquisition of these infections among patients in clinical, surgical or trauma, and neuroscience intensive care units.

This procedure change has been recommended because of the numerous evidence in existing literature that chlorhexidine helps in prevention of ventilaltor-associated pneumonia. Based on evidence-based practice, chlorhexidine lessens the risk of these infections during hospitalized stay as compared to sterile water. Sterile water is a conventional care measure that has not been effective in lessening these infections. On the contrary, oral hygiene care through the use of chlorhexidine is beneficial in lessening the incidence of these infections among patients in intensive care unit.

Evidence from Literature Review

Evidence from Review of Literature in Topic 2 supports the use of chlorhexidine in preventing VAP as compared to sterile water. The evidence shows that chlorhexidine is part of effective oral hygiene care for patients subjected to mechanical ventilation while hospitalized in intensive care units. It achieves this goal by reducing the risk of contacting the infections by nearly 40% regardless of whether it's used as a gel or mouthrinse. The effectiveness of chlorhexidine in this process is attributable to its ability to keep the mouth and teeth clean, prevent the development of plaque on the teeth, and lessen the risk of secretions. While the impact of chlorhexidine in preventing VAP among non-cardiac patients is unknown, it has proven to be beneficial among cardiac surgery patients with regards to mortality, mechanical ventilation period, and other results (Keyt, Faverio, Restrepo, 2014, p.818).

Implementation Logistics

The implementation of this proposed change will entail integrating it into the current organizational culture, structure, and workflow. In this case, the project team will propose a change in organization's policy and current practices with regards to patient care in intensive care units. To this extent, a new policy for effective oral care for patients under mechanical ventilation through the use of chlorhexidine will be established in the hospital. This policy will be utilized as the premise for guiding actions by the hospital staff towards the use of this proposed change in lessening the risk of VAP. Once the policy has been established, the leadership team will create buy-ins for this procedure change through conducting staff education and providing necessary resources for the project. The organization's staff will implement the solution based on their respective roles and responsibilities while providing feedback on its effectiveness, which will be utilized for making necessary changes for further improvement.

Resources Required for Implementation

In order to ensure smooth implementation, necessary resources will be provided so that leaders, supervisors, and nurses can carry out their various roles effectively. The resources needed for implementation of proposed solution include financial resources, educational materials, and assessment tools. In this case, the educational materials are handouts, PowerPoint presentations, pamphlets, and posters for educating staff and other relevant stakeholders about the change. On the other hand, financial resources will be utilized in staff education, collecting and analyzing data, and buying necessary materials whereas assessment tools include questionnaires, technology, and surveys. Pre- and post-implementation tests and surveys will be conducted to evaluate the effectiveness of the proposed change relative to desired objectives.

In conclusion, ventilator-associated pneumonia is a major healthcare issue that commonly affects patients using mechanical ventilation in hospitals. This issue is characterized by severe outcomes including causing several deaths, prolonging hospital stays, and increasing healthcare costs. Therefore, identifying and utilizing a suitable solution to prevent these infections is crucial towards enhancing the health and well-being of critically ill patients. Based on evidence-based practice, the use of chlorhexidine is more beneficial in preventing VAP among critically ill patients as compared to sterile water. Consequently, this study proposes and demonstrates an implementation plan for the use of chlorhexidine in VAP among these patients......

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