Ventilator-Associated Pneumonia in Nursing Practice

Introduction

Ventilator-associated pneumonia remains one of the leading causes of death among critically ill patients in intensive care units. Nursing interventions have been long identified as an efficient strategy for managing this condition. However, it is important to note that general guidelines are currently lacking – the COVID-19 pandemic has shown that today’s interventions need further tailoring to ensure better results. Specific strategies need to be implemented in order to increase the survivability rates and lessen the risks of complications among the patients on mechanical ventilation.

Literature Review

There is a significant body of literature on the topic of ventilator-associated pneumonia and its prevention. Several studies were chosen to research how specific and tailored nursing interventions compete against general guidelines of risk assessment and prevention in managing VAP among critically ill patients on mechanical ventilation. Lack of knowledge about evidence-based VAP prevention strategies and, therefore, low adherence to them among nurses is claimed to be one of the most acute issues currently.

The first two studies that were chosen for this research review the overall knowledge of ventilator-associated pneumonia and the role of nurses in preventing and managing it. Kumar and Raghavendran (2021) discuss the causes and risk factors of VAP and how they can be addressed in by the healthcare professionals in the ICU unit. Kumar and Raghavendran (2021) state that “various VAP prevention strategies need to be followed mainly by respiratory therapy staff, but as the members of a multi-disciplinary care team, nurses should also be aware of these” (p. 40). The second study by Osti et al. (2017) describes specifically the role of nurses in managing VAP in the clinical setting. Osti et al. (2017) assess how the actions of nurses influence patient outcomes, affect the possibilities of VAP occurrence, and determine the potential course of treatment. While not too specific, these studies offer a necessary review and basic knowledge of VAP and general prevention guidelines and can be used as a comparison with other studies that feature more tailored approaches.

There is an issue with compliance with the guidelines that result in poor health outcomes for the patients. The study conducted by Aloush (2017) evaluates how reduced compliance of nurses with tailored guidelines affects patient outcomes. Aloush (2017) states that “low nurse-patient ratio and large intensive care unit beds capacity was found to affect nurses’ compliance and patients’ outcomes” (p. 147). The results show that in an ICU setting with a 1:1 nurse-patient ratio, nurses were more willing to adhere to the VAP prevention guidelines, influencing VAP outcomes positively. This is a rather important finding for the research: the shortage of healthcare personnel in ICU units causes nurses significant stress, which in turn affects their work negatively. Nurses working in more comfortable conditions were able to adhere to specific VAP prevention guidelines, thus improving patient outcomes. Aloush’s (2017) study provides important conclusions on the obstacles that prevent nurses from using tailored interventions. Thus, the barriers that obstruct nurses from implementing proper ventilator use practices have been studied extensively.

Training of ICU nurses in preventing VAP affects the rates of the condition incidence. Oner Cengiz and Kanan (2019) observed several groups of nurses during pre-and post-VAP-education sessions and assessed the mean knowledge scores and rates of VAP occurring through quantitative and qualitative analysis. According to Oner Cengiz and Kanan (2019), “increasing ICU nurses’ knowledge of VAP and implementation of evidence-based applications in the care environment are the effective way to prevent VAP” (p. 38). This study proves that tailored training and specific guidelines are crucial for pneumonia prevention, as they provide the nurses with both the necessary knowledge and confidence in their actions.

Since ventilator use practices and non-compliance have been well-research, there are specific methods developed to help nurses use this tool properly. Álvarez-Lerma et al.’s (2018) research offer a review of a specific VAP prevention program, “Pneumonia Zero,” applied in Spanish ICU. This program uses a multimodal approach to preventing VAP in critically ill patients based on implementing a wide variety of evidence-based guidelines (Álvarez-Lerma et al., 2018). The study (2018) discusses the effectiveness of the “Pneumonia Zero” program, supplying its findings with relevant statistics on pre-and post-intervention rates of VAP occurrence. According to the authors (2018), “implementation of a bundle of measures to prevent VAP in Spanish ICUs was associated with a highly significant – 55.8% – reduction of VAP” (p. 184). This study might prove to be the most relevant for the research, as it shows real-life evidence of the effectiveness of specific intervention measures in preventing VAP.

Finally, there are multiple advantages of implementing a multi-criteria risk evaluation model for assessing the possibility of VAP occurrence. Drnovšek et al. (2020) state that “the evaluation model is intended to assist a holistic evaluation of the risk of developing ventilator-associated pneumonia by considering patient-related risk factors and the use of preventive measures” (p. 1021). Using DEXi software solution, Drnovšek et al. (2020) developed a decision-making support system that can assist nurses in clinical settings. The results of the implementation of this system were provided by real healthcare practitioners and nurses who applied the proposed risk evaluation model in their work in the ICU. Findings support the author’s initial claim, evidencing that a tailored risk assessment strategy can provide significant assistance in preventing VAP, which makes this study especially relevant for the research.

Conclusion

Ventilator-associated pneumonia is a serious condition that can severely affect the patient’s chances for complete recovery or even become a cause of death. It is important to recognize how different prevention measures influence the possibility of VAP occurrence and how nursing interventions factor in it. Literature suggests that, while general guidelines are helpful for managing the incidence of VAP, specific and well-tailored approaches provide much better results in the clinical setting. Nurses remain at the forefront of interacting with ICU patients, and thus, it might be beneficial to invest in specialized training to reduce the potential of VAP occurrence and overall patient outcomes.

References

Aloush, S. M. (2017). Nurses’ implementation of ventilator-associated pneumonia prevention guidelines: An observational study in Jordan. Nursing in Critical Care, 23(3), 147–151. Web.

Álvarez-Lerma, F., Palomar-Martínez, M., Sánchez-García, M., Martínez-Alonso, M., Álvarez-Rodríguez, J., Lorente, L., Arias-Rivera, S., García, R., Gordo, F., Añón, J. M., Jam-Gatell, R., Vázquez-Calatayud, M., & Agra, Y. (2018). Prevention of ventilator-associated pneumonia. Critical Care Medicine, 46(2), 181–188. Web.

Drnovšek, R., Milavec Kapun, M., & Rajkovič, U. (2020). Multi-criteria risk evaluation model for developing ventilator-associated pneumonia. Central European Journal of Operations Research, 29(3), 1021–1036. Web.

Kumar, A., & Raghavendran, M. (2021). Ventilator-Associated Pneumonia. RGUHS Journal of Nursing Sciences, 11(2), 38–41. Web.

Oner Cengiz, H., & Kanan, N. (2019). The effectiveness of training given to nurses for reducing ventilator-associated pneumonia in intensive care patients. Developments in Health Sciences, 2(2), 36–45. Web.

Osti, C., Wosti, D., Pandey, B., & Zhao, Q. (2017). Ventilator-Associated Pneumonia and Role of Nurses in Its Prevention. JNMA; Journal of the Nepal Medical Association, 56(208), 461–468.