C361 - MLM1 – Performance Assessment 1 Impact of the Problem on the Patient

Ventilator-associated pneumonia (VAP) is one of the most threatening hospital-acquired pneumonia infections in the intensive care unit. The condition occurs 48 hours following intubation in patients subjected to invasive mechanical ventilation.  VAP results in significant impacts on the patient and the organization. For the patient, VAP results in prolonged hospital stays, increased complications, reduced life quality, increased antibiotic use, healthcare costs, morbidity and mortality rates in the intensive care unit (ICU)( Aysegul, Oznur, & Asiye r, 2020). However, healthcare providers can prevent VAP through effective oral care.

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Impact of the Problem on the Organization

The impact of the problem on the organization includes the increased length of hospital stay, decreased return on investments, decreasing availability of beds, and increased use of resources, including staff, lab, and radiology. Additionally, VAP prevalence can undermine an organization’s reputation, further undermining its financial health.

Identify the PICO components

P – Ventilated adult patients in the ICU

I – Implement best practice for oral hygiene

C – Current Practice

O – Decreased rates of VAP

Evidence-Based Practice Question

Can oral care prevent Ventilator Associated pneumonia?

 Research Article: Effect of 0.12% Chlorhexidine Use for Oral Care on Ventilator-Associated Respiratory Infections: A Randomized Controlled Trial 

Background Introduction

According to Kes et al.(2021),  changes in the microorganism and oropharyngeal flora occur within 24hrs  following  an individual’s admission to the intensive care unit.  The authors note that the intubation’s mechanical process breaks natural barriers and boosts bacterial colonization in the lower respiratory tract.  The lower respiratory tract gets infected by microorganisms from the oropharynx, endotracheal tube leakage or biofilm from this tube.  As a result, mechanically ventilated patients are at risk of VAP.  Nonetheless, Kes et al.(2021) note that  Chlorhexidine(CHX) is widely utilized in oral care because it effectively reduces microbial accumulation . The most widely utilized CHX concentrations are 2%, 0.2%, and 0.12%. However, CHX application varies across clinical settings, with some applying once a day while others applying four times a day in individuals receiving mechanical ventilation.  

However, insufficient evidence exists regarding the superiority of the various CHX concentrations in VAP prevention. Therefore, further research is necessary to determine the most effective CHX concentration level in preventing VAP in mechanically ventilated patients. Although some meta-analysis researches have concluded that 0.12% CHX concentrations are effective in VAP prevention, these studies had some level of bias, thus undermining the reliability of the study findings. Thus, the article contributes to the study area by providing details about VAT (Ventilator-associated tranche bronchitis) development in oral care utilizing 0.12 CHX.

Methodology

“Prospective, single-blinded, randomized controlled trial performed in 2 intensive care units at a hospital. The sample comprised 57 mechanically ventilated adults randomly allocated to the 0.12% CHX and the placebo groups. Barnason’s oral assessment guide was used to evaluate the oral health of both groups before oral care during the first 24 hrs of tracheal intubation (Day 0) and on Day 2 and Day 3. Oropharyngeal secretion, endotracheal tube aspirate, and nonbronchoscopic bronchoalveolar lavage samples were collected on Day 0 and Day 3”.

Level of Evidence 

Level 1

Data Analysis

“All statistical analyses were conducted using SPSS Version 25.0 (IBM, Armonk, NY). The skewness and kurtosis were used for testing normality. All statistical tests were one-tailed, and statistical significance was considered as p < .05. Differences between groups were assessed using Fisher’s exact test or the chi-square test for nominal data. Numerical variables were evaluated using the Mann– Whitney U test or Student’s t test. A two-way repeated- measures analysis of variance was used to compare the BOAG values based on the groups and time, whereas Duncan’s test was used in multiple comparisons.  Bonferroni correction was utili