NR 449 Week 5 RUA Analyzing Published Research Solved
Healthcare-Associated Infections
There have been heightened calls for better patient care, safe patient care, and reasonable healthcare costs in recent years. Even though there have been efforts to achieve such goals, various events still exist in health care that threatens patient safety and lead to poor patient care, hence a need to address them. One of such is healthcare-associated infection (HCAIs). Healthcare-associated infections have been shown to result in various adverse impacts such as longer hospital stays and health care spending. Healthcare-associated infection is connected to pathogens like viruses, bacteria, and fungi (da Silva et al., 2018). An infection can occur at any healthcare facility like; assisted living, orthopedic centers, urgent care, hospitals, and even dialysis centers. HCAIs are important causes of morbidity and mortality in the United States and are associated with a substantial increase in health care costs each year (Healthy People 2020, 2021).
In general, HCAIs are the leading cause of sickness and death, with critical medical, financial, and emotional repercussions to both the patient and the healthcare facility. One way of addressing the problem is through quality improvement and evidence-based practice projects. Central to quality improvement and evidence-based practice project initiatives is an analysis of published literature and research guidelines to get the best evidence that supports the effort. Therefore, the purpose of this assignment is to interpret two articles relevant to the topic of healthcare-associated infections.
Description of the Matrix Table Data
From the matrix table, it is evident that the two studies were both focused on ways of addressing healthcare-associated infections and preventing them, specifically, CAUTI. While Zurmehly (2018) article had education and incidences of CAUTI, the article by Bui et al. (2020) used total antimicrobial defined daily dose and chlorhexidine bathing. While both studies used quantitative design, the first article was a quasi-experimental design; the second article was a randomized controlled trial. Both studies had 95% levels of confidence. In addition, any result with a p-value bigger than 0.05 was considered non-significant. Both nurses and patients formed part of research subjects in the case of Zurmehly (2018) article. On the other hand, the research subjects in the other article were patients only. One of the instruments used is the Braden Scale. Its reliability ranges from 0.83 to 0.99. The research findings provide evidence to support the clinical problem. From the findings, healthcare-associated infections are still common in the healthcare setting, which highlights the need for better intervention. Implementation of nurse protocols that focus on reduction of the same is therefore key in reducing the rates of infection.
Conclusion
Healthcare-associated infection is one of the leading causes of death and high healthcare spending in the world today. Therefore, there is always a need to come up with better strategies to control the same. In particular, this write-up has focused on catheter-associated urinary tract infections which are also common in clinical settings. While various strategies have been applied in trying to address and control the same. The implementation of an educational nursing protocol was found to be effective in lowering the rates of CAUTI significantly. However, bathing using chlorhexidine was not such effective as was predicted. The question remains, can these protocols be placed as the standards of practice, especially the ones shown in research papers, to be effective?
References
Bui, L. N., Swan, J. T., Perez, K. K., Johnson, M. L., Chen, H., Colavecchia, A. C., … & Graviss, E. A. (2020). Impact of Chlorhexidine Bathing on Antimicrobial Utilization in Surgical Intensive Care Unit. Journal of Surgical Research, 250, 161-171. https://doi.org/10.1016/j.jss.2019.12.049.
da Silva, A. A., Marques, A. F., di Biase, C. B., Zingg, W., Dramowski, A., & Sharland, M. (2018). Interventions to prevent urinary catheter-associated infections in children and neonates: a systematic review. Journal of pediatric urology, 14(6), 556-e1. https://doi.org/10.1016/j.jpurol.2018.07.011.
Healthy People 2020. (2021, November 28). Healthcare-associated infections. Healthcare-Associated Infections | Healthy People 2020. https://www.healthypeople.gov/2020/topics-objectives/topic/healthcare-associated-infections
Zurmehly, J. (2018). Implementing a nurse-driven protocol to reduce catheter-associated urinary tract infections in a long-term acute care hospital. The Journal of Continuing Education in Nursing, 49(8), 372-377. https://doi.org/10.3928/00220124-20180718-08
Please I will request the person who wrote the previous RUA under the same topic last week to write this one too.
Also, use the same article on the previous paper, except Monpora et al article, due to the fact that only Primary source have to be use.
lastly, There is a Matrix table to be filled, I will post it under the manage order together with the Rubrics. Thanks.
Decreasing the Impact of Risk Factors for Ventilator-Associated Complications in Covid19 Patients
Covid19 is a respiratory infection that increases the need for ventilator support for most of the patients. The severe involvement of the respiratory system translates into the need for the respiratory support to promote adequate body tissue perfusion. Covid19 patients put on ventilator support are highly at a risk of developing ventilator-associated complications. Ventilator associated complications have a negative effect on the health and health outcomes of the patients. Therefore, healthcare providers have a critical role to play in adopting responsive interventions to minimize the risk of ventilator-associated complications in Covid19 patients.
Description of the Problem
The focus of the group work is to propose evidence-based practice approach intervention that can be used to prevent and low the risk of ventilator-associated complications among covid19 patients. According to evidence, more than 80% of the patients affected by Covid19 may require ventilator support (Maes et al., 2021). The provision of respiratory support via mechanical ventilation increases the risk of ventilator-associated complications such as pneumonia, pulmonary edema and pulmonary embolism. An occurrence of ventilator-associated complications weakens the prognosis of care for most of the Covid19 patients on ventilator support (Póvoa et al., 2020). As a result, it is important that healthcare providers adopt evidence-based practice interventions to minimize and prevent the risk of ventilator-associated complications.
Significance of the Problem
As noted above, the risk of ventilator-associated complications is significantly enhanced in patients on
mechanical ventilation. The enhanced risk is attributed to the colonization of infective microorganisms in around the ventilator and trauma that the ventilator has to the respiratory system (Mahmudin et al., 2020). The occurrence of ventilator-associated complications worsens the outcomes of treatment in Covid19 patients. There is an increased risk of mortality alongside extended stay in the intensive care unit. The cost of care also rises significantly since most of the insurers do not provide financial support for Covid19-related care. The risk of worse outcomes with ventilator support is seen in patients with comorbid conditions such as diabetes, hypertension and cancer. The immune system of the patients with Covid19 is significantly affected due to immunopathogenesis associated with the disease (Blot et al., 2020). Cumulatively, the above factors worsen the health outcomes in Covid19 patients due to ventilator-associated complications.
Also Read: NR 449 Skills Module Nutrition Feeding Eating Solved
Purpose of the Paper
The purpose of this paper is to propose the use of a prevention bundle by the healthcare providers to prevent the risk of covid19 patients developing ventilator-associated complications.
Evidence Matrix Table
|
Article |
References |
Purpose
Hypothesis Study Question(s) |
Variables
Independent(I) Dependent(D) |
Study Design | Sample
Size & Selection |
Data Collection
Methods |
Major Finding(s) |
| 1
(SAMPLE ARTICLE) |
Smith, Lewis (2013),
What should I eat? A focus for those living with diabetes. Journal of Nursing Education, 1 (4) 111-112. |
How do educational support groups effect dietary modifications in patients with diabetes? | D-Dietary modifications
I-Education |
Quantitative | N- 18
Convenience sample-selected from local support group in Pittsburgh, PA |
Focus Groups | Support and education improved compliance with dietary modifications. |
| 1 | Mahmudin et al., (2020) | What is the correlation between the use of ventilator associated pneumonia prevention bundle and the incidence rate of ventilator-associated pneumonia at Dr. Soetomo General Hospital. | Dependent-Incidence rate of ventilator associated pneumonia
I-implementation of ventilator associated pneumonia prevention bundle |
Cross-sectional method with surveillance data | 189 intubated paitents in the ICU. Stratified random sampling was used. | Observation and use of checklist for the core areas of the prevention bundle. | The use of ventilator associated pneumonia prevention bundle was effective in reducing the incidence rate of ventilator-associated complications. |
| 2 | Blot et al., (2020) | How does the clinical and biological characteristics, immune response and outcomes compare between Covi19 patients and non-Covid19 patients with severe pneumonia? | D-Outcomes, clinical and biological characteristics
I-disease state i.e. Covid19 or non-Covid19 patients |
Prospective exploratory substudy | 36 immunocompetent non-Covid19 and 27 Covid19 patients with severe pneumonia. Participants were selected purposively at the University Hospital of Dijon-Bourgogne, France. | Heparin and Ethylenediamine tetraacetic acid blood samples were collected from the patients within 48 hours of admission. Lymphocyte phenotyping was performed using AQUISOS flow cytometer. Cytokine level was measured using Human XL Cytokine Magnetic Luminex assay. | Covid19 patients have unique cytokine response, high plasma GM-CSF and CXL10, which predict the long period of mechanical ventilation in these patients. |
| 3 | Carter et al., (2020) | What is the role of the nurse in the management of Covid19 patients requiring invasive ventilation to improve outcomes and prevent complications? | Not stated | Literature review | None | Review of literature | Nurse play a critical role in implementing multi-disciplinary approaches in the management of Covid19 patients who require invasive ventilation. |
| 4 | Maes et al., (2021) | What is the incidence of ventilator-associated pneumonia and bacterial lung microbiome composition of ventilated Covid19 and non-Covid-19 patients? | D-incidence of lung microbiome composition and ventilator associated pneumonia
I-disease states either covid19 or non-covid19. |
Retrospective observational study | 94 patients with covid19 and 144 patients without covid19. The participants were purposively sampled from covid19 and non-covid19 patients in ICU settings in Addenbrooke’s Hospital Cambridge, UK | Sample collection for specific analyses | Covid19 increases the risk of ventilator-associated pneumonia that is not linked to prolonged duration of ventilation. |
| 5 | Póvoa et al. (2020) | What is the risk of ventilator-associated pneumonia in in Covid19 inpatients? | Not stated | Literature review | Not stated | Literature review | Prevention and early treatment of ventilator associated pneumonia can influence the success of treatment and treatment outcomes |
Description of Findings
Covid19 infection increases the need for ventilator support, which predisposes patients to ventilator-associated complications. The most prevalent ventilator-associated complication in covid19 patients is ventilator-associated pneumonia. According to a prospective exploratory substudy research conducted by Blot et al., (2020), covid19 patients on ventilator support are highly at a risk of developing ventilator-associated pneumonia due to the immunosuppression by the disease. The data obtained from 27 covid19 patients with severe pneumonia showed that the patients had an elevated level of cytokines, high plasma GM-CSF and CXL10. The elevation of these biomarkers has an adverse effect on the immune status, hence, the prolonged ventilator support for covid19 patients. The results reported by Blot et al., (2020) cannot however be relied upon wholly due to the use of a small sample size, which affects the generalizability of the findings. A retrospective observational study conducted by Maes et al., (2021) showed that covid19 increases the risk of prolonged ventilator support and ventilator-associated pneumonia in the affected patients. However, the authors argued that the increased risk of ventilator-associated pneumonia was not attributed to prolonged duration of intubation. This argument agree with that by Blot et al., (2020) where ventilator associated complications such as pneumonia are attributed to other physiological processes and not prolonged intubation in covid19 patients. The fact that Maes et al., (2021) used a larger sample size increased the confidence of their assertions about the pathophysiological mechanism of covid19 and its associated complications. Carter et al., (2020) review of literature performed by Carter et al., (2020) showed that nurses have a critical role in the prevention and management of ventilator-associated complications in covid19 patients. The authors asserted that nurses have the role to implement best practices as well as work in multi-disciplinary teams in identifying effective interventions to minimize and prevent ventilator-associated complications. A similar review of literature performed by Póvoa et al. (2020) showed that through the preventive and management roles played by the nurses, the success and outcomes of treatment of ventilator-associated complications are significantly enhanced. However, the assertions made by Póvoa et al. (2020) and Carter et al., (2020) have low reliability and validity since they were literature reviews. Mahmudin et al., (2020) agrees with Póvoa et al. (2020) and Carter et al., (2020) that nurses play the critical role in the prevention and management of ventilator-associated complications. Mahmudin et al., (2020) proposes that the use of ventilator-associated pneumonia preventive bundle is one of the effective ways of preventing and managing ventilator-associated complications among covid19 patients. The data obtained from 189 intubated patients in the ICU showed that the use of ventilator-associated pneumonia prevention bundle led to a significant reduction in the incidence, risk and complications associated with ventilator support.
The analysis of the above evidence shows that healthcare providers, including nurses have a critical role to play in the prevention of ventilator-associated complications in covid19 patients. Healthcare providers explore the effective and best practices that are effective for use in their clinical settings. They also have to work in multi-disciplinary teams to ensure that enhanced outcomes of care are achieved in caring covid19 patients on ventilator support. Therefore, the following two questions can be developed to guide further the work of our group:
- What are the critical determinants of successful implementation of prevention bundles for use in the prevention of ventilator-associated complications in covid19 patients?
- What evidence exists on the effectiveness of prevention bundles in minimizing ventilator-associated complications in patients on ventilator support?
Conclusion
Overall, the risk of ventilator-associated complications in covid19 patients is high. Ventilator-associated complications have an adverse effect on the outcomes of treatment in covid19 patients. Nurses and other healthcare providers have critical roles to play in the prevention and management of ventilator-associated complications. They explore the use and effectiveness of interventions such as prevention bundles in improving the treatment outcomes in covid19 patients. Therefore, the focus of practice in healthcare should be on prevention and optimum management of ventilator associated complications in covid19 patients to improve the treatment outcomes and survival rate among the affected patients.
References
Blot, M., Bour, J.-B., Quenot, J. P., Bourredjem, A., Nguyen, M., Guy, J., Monier, S., Georges, M., Large, A., Dargent, A., Guilhem, A., Mouries-Martin, S., Barben, J., Bouhemad, B., Charles, P.-E., Chavanet, P., Binquet, C., Piroth, L., & for the LYMPHONIE study group. (2020). The dysregulated innate immune response in severe COVID-19 pneumonia that could drive poorer outcome. Journal of Translational Medicine, 18(1), 457. https://doi.org/10.1186/s12967-020-02646-9
Carter, C., Osborn, M., Agagah, G., Aedy, H., & Notter, J. (2020). COVID-19 disease: Invasive ventilation. Clinics in Integrated Care, 1, 100004. https://doi.org/10.1016/j.intcar.2020.100004
Maes, M., Higginson, E., Pereira-Dias, J., Curran, M. D., Parmar, S., Khokhar, F., Cuchet-Lourenço, D., Lux, J., Sharma-Hajela, S., Ravenhill, B., Hamed, I., Heales, L., Mahroof, R., Solderholm, A., Forrest, S., Sridhar, S., Brown, N. M., Baker, S., Navapurkar, V., … Conway Morris, A. (2021). Ventilator-associated pneumonia in critically ill patients with COVID-19. Critical Care, 25(1), 25. https://doi.org/10.1186/s13054-021-03460-5
Mahmudin, A. A., Chalidyanto, D., Martanto, T. W., & Semedi, B. W. (2020). Reducing incidence rate of ventilator-associated pneumonia (VAP) using prevention bundle in the ICU. EurAsian Journal of BioSciences, 14(2), 3193–3199.
Póvoa, H. C. C., Chianca, G. C., & Iorio, N. L. P. P. (2020). COVID-19: An alert to ventilator-associated bacterial pneumonia. Infectious Diseases and Therapy, 9, 417–420.