Preventing & Controlling VAP: Oral Chlorine Use in MV Patients - Paper Example

Introduction

Ventilator-associated pneumonia (VAP) is one of the infections that arise in patients on mechanical ventilation. The routine care for the management of VAP includes the use of antiseptics to disinfect the respiratory equipment. The change proposal topic is the prevention and control of VAP. Additionally, the patient, intervention, comparison, outcome, and timeframe (PICOT) question chosen for the project is that among adult patients who are mechanically ventilated (P) is the use of oral chlorhexidine (I) compared to no oral chlorhexidine (C) help to prevent VAP (O) within four weeks (T)? As the project moves towards active planning and development stages, a literature review of quality papers that conduct studies on the prevention and control of VAP is needed. The paper aims to conduct a literature review of articles and a comparison of the research questions, sample populations, and limitations of the studies.

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A Comparison of Research Questions

By evaluating the various studies, most of them examine the same research question of whether interventions such as oral care antiseptics such as chlorhexidine help in the prevention and control of VAP. Nelson (2014) stated that best practice helps nurses to provide comprehensive care to patients. The research question in the study by Li et al. (2015) was whether oral care with antiseptics such as chlorhexidine reduces VAP prevalence in critically ill adults. Another study also investigated whether chlorhexidine mouthwash prophylaxis reduces VAP in patients in the ICU (Enwere et al., 2016). Another study had the same research question of whether chlorhexidine reduces VAP (Zuckerman, 2016). More so, Villar et al. (2016) examined whether chlorhexidine antiseptic minimizes the development of VAP. More so, another study examined whether patients who stay longer in the intensive care unit (ICU) develop VAP (Kozka et al., 2020). Additionally, another study investigated the question of whether a few days in the ventilator reduces VAP rates (Choudhari et al., 2018). Other studies examined whether VAP bundles’ incorporation reduce its development (Rodrigues et al., 2016; Álvarez-Lerma et al., 2018). The articles support my PICOT question.

A Comparison of Sample Populations

Examining the sample populations helps determine the strength of the evidence presented. Bridges (2015) indicated that research at the bedside could help in improving patients’ outcomes. Li et al. (2015) searched databases such as PubMed, Embase, and Web of Science to find research that fit their hypothesis. In the 17 studies they selected, the sample population did not exceed 50 participants (Li et al., 2015). In the research by Enwere et al. (2016), 158 patients between 18-89 years met the inclusion criteria. Additionally, Zuckerman (2016) conducted a comprehensive search of forty articles, which had a cumulative sample size of 928. Also, in the research by Villar et al. (2016), researchers included thirteen studies that had 1640 subjects who participated in the study. More so, in the study by Kozka et al. (2020), the sample populations included 1872 patients admitted in various settings of the hospital that required mechanical ventilation. Another study by Choudhari et al. (2018) had a sample size of 1221 patients admitted to the ICU of Loghman Hakim Hospital. A similar study by Rodrigues et al. (2016) included 26 patients admitted to the ICU of the public teaching hospital. Lastly, the study by Álvarez-Lerma et al. (2018) examined 171,237 patients admitted in 181 ICU centers in Spain.

A Comparison of the Limitations of the Study

All the studies had limitations. In the study by Li et al. (2015), for example, the limitation was that the reviews they selected had moderate sample sizes, which would affect the treatment effect in studies with larger sample sizes. Another inadequacy of the study concerns the heterogeneity in the studies, including different sample sizes, definitions of VAP, the concentrations of antiseptics, and frequency of administration (Li et al., 2015). Also, the study limitations Enwere et al. (2016) was the small sample size included in the analysis. Another limitation of the study was that reliance on electronic health records required gathering data from various systems. In the study by Villar et al. (2016), researchers did not include the study limitations. However, from reading the research, it is agreeable that the incorporation of various studies in their synthesis created heterogeneity because of the different sample sizes and results. In the study by Zuckerman (2016), the limitation was that health professional’s differences in caring for the patients affected the study results. In the research by Álvarez-Lerma et al. (2018), the limitation was bias regarding VAP diagnosis because of the many ICU facilities that participated in the study. Also, Rodrigues et al. (2016) mentioned that the study limitations included the lack of adherence to protocol and the lack of essential supplies such as chlorhexidine. The limitation of a separate research was the unavailability of data of patients in the ICU (Choudhari et al., 2018). Also, in the study by Kozka et al. (2020), the limitation was the larger sample size, which could affect statistics’ accuracy. Samonte and Vallente (2020) stated that evidence-based practice helps nurses apply quality results in clinical settings. Even though these studies had limitations, the results are generalizable in nursing practice.

Conclusion

Overall, the studies discussed in this literature review helped to establish more information on my PICOT question. From conducting the literature review, evidence suggests that the use of chlorhexidine and fewer stay in mechanical ventilation helps reduce VAP rates. Further research needs to be done on the risk factors of VAP to help nurses get the best evidence on how they can monitor patients on the development of VAP.

References

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