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Preventing Ventilator Associated Pneumonia with an Antiseptic

Preventing Ventilator Associated Pneumonia with an Antiseptic

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Ventilator Associated Pneumonia (VAP) is an illness that patients in intensive care units (ICU) have a high risk of getting. VAP remains the leading cause of hospital- acquired infections in the worlds ICUs. 10% to 30% of the all mechanically ventilated patients in the worlds ICUs will acquire VAP (Li et al., 2015). VAP increases already compromised patient’s chances of mortality and the period of hospital stay. In addition VAP is extremely costly for patients, and the World’s Health Systems. “A patient that gets infected with VAP has a mortality rate from 40% to 80% and has a length of hospital stay that increases two fold. Hospital expenses for a patient treated for VAP increase an additional $29,000 to $40,000 (Fields, 2008)”.

Oral Health Care (OHC) for the ventilated patients was hypothesized as an intervention by healthcare experts that stop VAP. The most successful OHC intervention as compared to placebo and usual oral care has been the use of an antiseptic as oral care intervention. Given that VAP affects such a high percentage of the world’s ventilated ICU patients, interventions that will stop patients from being susceptible to VAP are highly crucial. Oral care with an antiseptic is the most successful intervention that medical teams have in their arsenal to stop VAP. The purpose of this research paper is to provide knowledge to the medical community on the ability of oral care with antiseptics to stop VAP. In ventilated ICU patients (P), does the use of oral care with an antiseptic (I) as compared placebo and usual care (C) help reduce the risk forgettingVAP(O) during a 3 year time period (T)?

Articles that were included in this research paper compared oral care with an antiseptic to oral care with a placebo or normal standards and it pointed out whether or not oral interventions had the best ability to prevent VAP over a time period of 3 years.

Articles that were included in this analysis were meta-analysis, random-controlled trials, and systemic reviews which were conducted in that last 10 years. These research articles were printed in the English language. In addition these studies were published in a peer-reviewed journal. Articles that were excluded from this analysis focused on just bundles, cross sectional studies and studies that used other intervention other than oral care.

Search terms for finding best evidence for this research analysis included VAP, ICU, antiseptic, patients, prevention with oral care, pneumonia, nosocomial infections, placebo and usual standards of care. Mesh terms for finding best evidence to be included in this analysis included Ventilated-associated pneumonia, healthcare-associated infections, infection control, oral care ventilated patients, intensive care units, qualityimprovements guidelines. The research databases that were selected to search for best evidence included ProQuest Health and the Cochrane Databases. There were 59 hits in Pro-Quest health and medicine, and 9 in the Cochrane databases. 20 articles were identified for review from the comprehensive search. 5 articles met the inclusion for this review. When limiting results to randomized control trials, systematic reviews, multi-center studies, meta-analyses that were conducted using human subjects and printed in English within the last 10 years 5 research articles were found. SearchingPro-Quest health and medicine for research articles published within the last 5 years2 research articles were found. Expanding my search for articles to include articles produced within the last 10 years, 2 additional research articles were found. Searching the Cochrane Databases 1 research article which was published in the last 5 years was found. When I looked into the Cochrane Database research producedin the last 10 years there were no results found.

The research articles that were analyzed in this research review were 3 meta-analysis and 2 randomized control trials. There was some overlapping of randomized control trials that were analyzed in the meta-analysis research reports. In the randomized control trials analyzed by (Li et al., 2015) 7 randomized control trials overlapped. In the randomized control trials analyzed by (Shi et al., 2011) 6 randomized control trials overlapped. In the randomized control trials analyzed by (Shi et al., 2013) 6 randomized control trials overlapped.

The purpose of the three meta-analyses and 1 of the randomized control trials by (Koeman et al., 2005) included in this review is to analyze OHC with antiseptics chlorhexidine or povidone-iodine compared to placebo or usual care and examine if their use is associated with a reduction in VAP. The purpose of the randomized control trial by (Fields, 2008) is to examine if the inclusion of an OHC bundle was successful compared to usual practice at preventing VAP. All research articles chosen for this research paper are meta-analysis of randomized control trials or are randomized control trails, which are considered level-1 evidence. The population for all 5-research studies included ventilated patients in the ICU. Research shows that there were thirty-five RCTs in which 5374 participants were included. A case study revealed that there were 17 randomized control trials with a population of 4,249 participants and another one with 14 randomized control trials and had 2481 patients participating in the research study. The randomized control trial entailed two different population sizes of patients. One had a population size of 385 patients while the other one had a population size of 2,000 patients. All 5-research studies had both an intervention and a control group.

In the RCT performed by (Koeman et al., 2005) it was found that “topical oral decontamination with chlorhexidine or povidone-iodine significantly reduces the incidence of VAP”. The RCT performed showed that the oral care bundle had a 0 rate of VAP until the end of the study. In the 2 meta-analysis performed, it was found that “oral care with an antiseptic significantly reduced the incidence of VAP” In the meta-analysis, explanation were made on how effective and important OHC is for ventilated patients in intensive care. OHC that includes chlorhexidine is associated with a 40% reduction in the odds of developing ventilator-associated pneumonia in critically ill adults”.

References

• Fields, L. B. (2008, October). Oral Care Intervention to Reduce the Incidence of Ventilator-Associated Pneumonia in the Neurologic Intensive Care Unit. Journal of Neuroscience Nursing 40(5). Retrieved from www.proquest.com

• Koeman, M., Van der Ven, A. J., Hak, E., Joore, H. C., Kassjager, K., De Smet, A. G., ... De Bel, E. E. (2006, March 31). Oral Decontamination with Chlorhexidine Reduces the Incidence of Ventilator-associated Pneumonia. American Journal of Respiratory Critical Care Medicine, 173(5), 1348-1355. Retrieved from www.proquest.com http://dx.doi.org/10.1164/rccm.200505-820OC

• Labeau, S. O., Van de Vyver, K., Brusselaers, N., Vogelaers, D., & Blot, S. I. (2011). Prevention of ventilator-associated pneumonia with oral antiseptics: a systematic review and meta-analysis. Lancet of Infectious Disease, 11, 845-854. Retrieved from www.proquest.com http://dx.doi.org/10.1016/S14733099(11)70127-X

• Li, L., Ai, Z., Zheng, X., &Jie, L. (2015, February 15, 2015). Can routine oral care with antiseptics prevent ventilator-associated pneumonia in patients receiving mechanical ventilation? An update meta-analysis from 17 randomized controlled trial

s. International Journal of Clinicalclinical and experimentalMedicine, 8(2), 1645-1657. Retrieved from www.proquest.com

• Shi, Z., Xie, H., Wang, P., Zhang, Q., Wu, Y., Chang, E., ... Furness, S. (2013). Oral hygiene care for critically ill patients to prevent ventilator-associated pneumonia (Review). Cochrane review, Issue 8, 1-127. Retrieved from www.Cochranereview.com http://dx.doi.org/DOI: 10.1002/14651858.CD008367


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