In recent decades, healthcare-associated infections are some of the most common and avoidable diseases that affect patients during their stay in hospital. Ventilator-Associated Pneumonia (VAP) is among the preventable ailments frequently experienced by long-stay patients. In the past, VAP numbers have been used to measure the quality of healthcare services. However, the frequency of hospital-associated illnesses puts patients with weak immunity and danger due to impaired physiology and organ dysfunction during their hospital stay. Numerous studies focused on the effect and prevention mechanism for VAP in the adult population, with few studies examining the children in the pediatric care unit.
This paper examines current research on ventilator-associated pneumonia in pediatric intensive care units (PICU). In this paper, a thorough review of available literature from various research designs, including non-experimental quality improvements and observation research methods, will be provided. The paper analyzes examples of practical uses of evidence-based protocols in preventing VAP projects in the past and presents an overview of the outcome.
PICO Clinical Question and Evidence-Based Projects
In this project, an evidence-based approach to investigating the effectiveness of the VAP prevention bundle is formulated to provide a guideline for a comprehensive review of current interventions related to children admitted to the pediatric intensive care unit. PICO (Patient interest, Intervention, Comparison, and Outcome) provides a guideline for evidence-based approaches to adhere to research goals (Torres et al., 2018). The PICO question for this research review project is: Does the implementation of ventilator-associated pneumonia care practices decrease the infection rates of VAP patients in pediatric intensive care units?
Literature Review
Jam et al. (2018) conducted a study investigating the effectiveness of the current VAP interventions in one of the country’s Midwestern institutions. In the survey, Jam et al. (2018) included the pediatric intensive care unit and respiratory therapy sections to change ventilator practices while improving staff understanding of the VAP intervention practices. Jam et al. (2018) insisted on waiting until the ventilator was filthy before breaking the circuit to change it. During the study, nursing staff in these departments observed clear circuit-breaking protocols and waited for the ventilators to achieve their targets before being removed from patients. Jam et al.’s (2018) study was conducted over three years. The results showed an apparent reduction in ventilator days from five less than a day for every mechanical ventilator day.
In another study, Coppadoro et al. (2019) improvised a quality improvement procedure to observe the effectiveness of VAP practices in preventing bacterial contamination in PICU patients. Coppadoro et al. (2019) included gastric ulcer prophylaxis to promote pH level regulation in the study. In the survey, Coppadoro et al. (2019) attempted to reduce the effectiveness of ventilator-associated pneumonia by observing the effect of pH increase on patients. According to Coppadoro et al. (2019), the rise in pH to other VAP interventions could help protect pediatric patients with extended hospital stay from contracting VAP and other infections from the pH-regulated intervention. At the end of the twelve-month study, Coppadoro et al. (2019) observed no ventilator-associated pneumonia rates during the implementation period in their improved bundle.
Another study investigating the effectiveness of VAP intervention practices was conducted by Kharel et al. (2021) in a pediatric teaching and referral hospital to determine the financial impact of ventilator-associated-pneumonia treatment methods used. The study correlated the use of VAP intervention measures and ventilator days with a patient’s length of stay in the hospital. Researchers observed that the study reduced the prevention mechanism by over two points per 1000 ventilator days. This reduction resulted in more than two million dollars in operating costs for the departments. According to Kharel et al. (2021), operating expenses were attributed to reducing patients’ length of stay by half during the two years.
In another study, Binnichan et al. (2021) highlighted a study conducted on the effectiveness of weaning patients off ventilators by using vacation holidays where the researcher used sedatives to intubate patients into a sedated state. In the study, researchers implemented a strategy to observe the speed of sedation to wean a patient off a ventilator concerning their chance of contracting VAP. In the study, researchers insisted on using hand and equipment hygiene to prevent the transfer of bacterial infections when the patients were in a sedation state. The study was conducted over five years, where VAP interventions were coupled with sedation holidays. After the investigation, results indicated a reduction from 3.9 to1.5 for every 1000 ventilator days.
Review and Critical Appraisal of Evidence in Literature Review
In the available evidence from the literature review, various components of ventilator-associated pneumonia intervention practices occurred. Ventilator care, hand hygiene, and patient head and bed elevation appeared to have been some of the most effective techniques in preventing and reducing the effects of VAP in PICU.
Ventilator Care. Cleaning and draining the ventilator substrate by changing the circuits when necessary ensured the success of the current VAP interventions. In the nursing and respiratory therapy departments, caregivers ensured that the ventilator moisture was emptied and cleaned during position changes before the patient was plugged into the ventilator. According to Binnichan et al. (2021), a daily routine check of the circuit and ventilator maintenance was recommended for patients during their stay. Ventilator care and accurate monitoring is the most significant component of this VAP intervention. According to Torres et al. (2018), this method ensures that patients experience a reduction in air system congestion, preventing them from contracting VAP during their length of stay.
Binnichan et al. (2021) observed that nurses experienced challenges determining the appropriate time to drain ventilator fluid in handling ventilator maintenance. Additionally, the patient’s position changes did not coincide with the scheduled ventilator concentrate changes. This challenge reduced the effectiveness of the intervention. However, personnel training significantly increased success rates. On the other hand, the method required additional time until the nurse had adjusted to cleaning and removing the substrate from the ventilators. This delay reduced the effectiveness of the VAP intervention significantly.
Hand Hygiene. Observing hand hygiene is one the most effective means of reducing and preventing hospital-related infections, including ventilator-associated pneumonia (Coppadoro et al., 2019). According to research, an acute awareness of personal hand hygiene before interacting with patience is a critical component of this intervention criteria for reducing VAP in pediatric intensive care units. According to research observation, ensuring that patient equipment sanitation reduces patients’ exposure to VAP. Adherence to strict hand-washing practices and surface cleaning coincided with reduced cases of infection in patients admitted to PICU.
In the study, frequent forgetfulness to practice hand-washing reduces the intervention’s success rate. Additionally, patient equipment was prone to infection even when they have been cleaned and maintained as they came into contact with more than two people. According to the study, the success of this intervention depended on hand hygiene during moments of interaction between physicians and patients. However, due to the delicateness of the method, numerous factors contributed to the technique’s success.
In the above literature review and evidence appraisal, numerous research methodologies increased the chances of reducing VAP incidences in hospitals and preventing transference of similar infection during a patient’s length of stay in the hospital. According to Torres et al. (2018), various combinations of matching sets of VAP intervention increased the chances of success in reducing infection rates, while others remained ineffective throughout the implementation phase. Therefore, deciding on the appropriate package to implement and maintain a consistent approach toward patient care increases the chances of long-term success (Torres et al., 2018).
Evaluating and Implementing Evidence
By considering the homogeneity of the current invention practices from the reviewed journals, strict adherence to hand hygiene and ventilation care produced reliable evidence in pediatric intensive care units. In these articles, the success of these intervention packages depended on whether the interventions were implemented together rather than in a single unit, according to the journals reviewed in this paper.
Depending on these requirements, these methods can be implemented in practice. However, the success of these methods depends on combining regulatory techniques, management, and process auditing throughout the implementation phase. A pediatric intensive care unit VAP implementation kit would be required to ensure adherence to necessary protocols. Additionally, continuous maintenance and auditing during the implementation phase would be critical to sustaining long-term reduced or zero ventilator-associated pneumonia cases in children.
Conclusion
Ventilator-associated pneumonia is among the most common ailments that affect children and infants in pediatric intensive care units worldwide. Currently, various interventions exist to handle hospital-based infections. Research suggests that combining multiple methods can increase the chances of success in reducing the possibility of contracting VAP for children in hospitals. However, most of the available research and practices are still experimental, with most recent studies offering mixed results. In this paper, some of the methods and implementable methods highlighted have indicated higher levels of success in reducing VAP in PICU from a long-term perspective.
References
Binnichan, J. K. (2021). Ventilator-Associated Pneumonia Bundle Care.
Coppadoro, A., Bellani, G., & Foti, G. (2019). Non-pharmacological interventions to prevent ventilator-associated pneumonia: a literature review. Respiratory Care, 64(12), 1586-1595.
IfHI, I. H. I. (2006). How-to guide: Prevent Ventilator-Associated Pneumonia. IHI, editor. EUA.
Jam, R., Mesquida, J., Hernández, Ó. Sandalinas, I., Turégano, C., Carrillo, E., & Delgado‐Hito, P. (2018). Nursing workload and compliance with non‐pharmacological measures to prevent ventilator‐associated pneumonia: a multicenter study. Nursing in Critical Care, 23(6), 291-298.
Kemnic, D., Schaffer, K., & Yoshida, J. Reduction of Ventilator-Associated Pneumonia with Chlorhexidine Gluconate Oral Care versus Standard Oral Care.
Kharel, S., Bist, A., & Mishra, S. K. (2021). Ventilator-associated pneumonia among ICU patients in WHO Southeast Asian region: A systematic review. PloS One, 16(3), e0247832.
Torres, A., Niederman, M. S., Chastre, J., Ewig, S., Fernandez-Vandellos, P., Hanberger, H., & Wunderink, R. (2018). Summary of the international clinical guidelines for managing hospital-acquired and ventilator-acquired pneumonia. ERJ Open Research, 4(2).
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