The Impact of oral care on VAP (ventilator associated pneumonia)

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ACKNOWLEDGEMENT

I would take this opportunity to thank my research supervisor, family and friends for their support and guidance without which this research would not have been possible.

DECLARATION

I [type your full first names and surname here], declare that the contents of this dissertation/thesis represent my own unaided work, and that the dissertation/thesis has not previously been submitted for the academic examination towards any qualification. Furthermore, it represents my own opinions and not necessarily those of the University.

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TABLE OF CONTENTS

ACKNOWLEDGEMENTII

DECLARATIONIII

CHAPTER 1: INTRODUCTION1

Background of the Study1

Purpose of the Study2

Problem Statement2

Rationale of the Study2

Aims and Objectives2

Research Questions3

CHAPTER 2: LITERATURE REVIEW4

Ventilator Associated Pneumonia (VAP)4

Morbidty, Mortality and Costs related to VAP4

Factors associated with risk for VAP5

Oral Care6

Oral Health and VAP7

Current recommendations for the prevention of VAP8

CHAPTER 3: METHODOLOGY9

Research Method9

Literature Search10

Research Approach10

Data Analysis11

Inclusion and Exclusion Criteria11

Limitations of Research12

REFERENCES13

CHAPTER 1: INTRODUCTION

Background of the Study

Ventilator associated pneumonia (VAP) has been reported as the cause of 60% of all deaths due to hospital-associated infections (HAl) (CDC & HICPAC, 2004). VAP is also reported to increase length of stay in the ICU up to 6.1 days and hospitalization up to 9 days. The cost associated with VAP due to the extended length of stay can reach $40,000 per patient (Cutler & Davis, 2005). The Centers for Disease Control and Prevention (CDC) first published recommendations for prevention of nosocomial pneumonia in 1981 and subsequently updated this recommendation in 2003 (Tablan, et aI., 2004). Mechanically ventilated adults normally have the cuff of the endotracheal tube inflated to secure the airway and to decrease the potential for secretions to leak around the cuff. Unintentional cuff deflation may occur facilitating leakage and introduction of secretions with bacteria into the lower respiratory tract and the lungs. The CDC recommendations include the reduction of oropharyngeal bacterial colonization by developing and implementing an oral care program that may include the use of an antiseptic agent (Tablan, et aI., 2004). This recommendation applies to patients in acute-care settings or residents of long-term facilities who are at high risk of developing healthcare associated pneumonia.

Purpose of the Study

The purpose of the study is to determine the oral care method procedusres and its impct on reducing the VAP (ventilator associated pneumonia).

Problem Statement

Cason, Tyner, Saunders and Broome (2007) concluded in their study that CDC recommendations for VAP prevention were not consistently nor uniformly followed. VAP is a complication of the intubated ICU patient and can lead to increased morbidity and mortality. Oral hygiene is an important part of VAP prevention. In order to determine if additional education or change in practice is needed to insure compliance with a comprehensive oral care program, it is necessary to determine whether or not current oral care practice follows the facility policy based on nursing documentation.

Rationale of the Study

Several studies have been done to assess oral care practices in health care. However, nursing documentation of oral care remains the final indicator for determining whether or not the process was performed and to what ...