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Infection prevention at a hospital setting
Infection prevention at a hospital setting
Hospital acquired infection case study
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Hospital-acquired infections (HAI) are preventable and pose a threat to hospitals and patients; increasing the cost, nominally and physically, for both. Pneumonia makes up approximately 15% of all HAI and is the leading cause of nosocomial deaths. Pneumonia is most frequently caused by bacterial microorganisms reaching the lungs by way of aspiration, inhalation or the hematogenous spread of a primary infection. There are two categories of Hospital-Acquired Pneumonia (HAP); Health-Care Associated Pneumonia (HCAP) and Ventilator-associated pneumonia (VAP).
VAP develops in a patient after 48 hours or more of endotracheal intubation. According to a study by Relio et al. (as citied in Fields, L.B., 2008, Journal of Neuroscience Nursing, 40(5), 291-8) VAP adds an additional cost of $29,000-$40,000 per patient and increases the morality rate by 40-80%. Mechanically ventilated patients are at an increased risk in developing VAP due to factors such as circumvention of body’s own natural defense mechanisms in the upper respiratory tract (the filtering and protective properties of nasal mucosa and cilia), dry open mouth, and aspiration of oral secretions, altered consciousness, immobility, and possible immunosuppression. Furthermore, the accumulation of plaque in the oral cavity creates a biofilm that allows the patient’s mouth to become colonized with bacteria.
Many interventions are already in place to improve patient outcomes while on a ventilator. For example, elevating the head of the bed to 30 degrees, preventing venous thrombus via sequential compression devices or anticoagulant drugs, initiating early mobilization and practicing good hand hygiene were among the interventions listed by Fields, L.B., 2008. However, oral care was n...
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...he data collected by the above mentioned studies it is time to shift our thinking of oral care as simply a comfort measure to an effective intervention to lower costs, for both the patients and the hospital, and prevent the development of pneumonia.
References
Fields, L. B. (2008). Oral care intervention to reduce incidence of ventilator-associated pneumonia in the neurologic intensive care unit. Journal of Neuroscience Nursing,
40(5), 291-8. Retrieved from http://search.proquest.com/docview/219184601?accountid=14400 Jones, D. J., Munro, C. L., & Grap, M. J. (2011). Natural history of dental plaque accumulation in mechanically ventilated adults: A descriptive correlational study. Intensive &
Critical Care Nursing, 27(6), 299-304. doi:http://dx.doi.org/10.1016/j.iccn.2011.08.005
Ventilator Associated Pneumonia (VAP) is a very common hospital acquired infection, especially in pediatric intensive care units, ranking as the second most common (Foglia, Meier, & Elward, 2007). It is defined as pneumonia that develops 48 hours or more after mechanical ventilation begins. A VAP is diagnosed when new or increase infiltrate shows on chest radiograph and two or more of the following, a fever of >38.3C, leukocytosis of >12x10 9 /mL, and purulent tracheobronchial secretions (Koenig & Truwit, 2006). VAP occurs when the lower respiratory tract that is sterile is introduced microorganisms are introduced to the lower respiratory tract and parenchyma of the lung by aspiration of secretions, migration of aerodigestive tract, or by contaminated equipment or medications (Amanullah & Posner, 2013). VAP occurs in approximately 22.7% of patients who are receiving mechanical ventilation in PICUs (Tablan, Anderson, Besser, Bridges, & Hajjeh, 2004). The outcomes of VAP are not beneficial for the patient or healthcare organization. VAP adds to increase healthcare cost per episode of between $30,000 and $40,000 (Foglia et al., 2007) (Craven & Hjalmarson, 2010). This infection is also associated with increase length of stay, morbidity and high crude mortality rates of 20-50% (Foglia et al., 2007)(Craven & Hjalmarson, 2010). Currently, the PICU has implemented all of the parts of the VARI bundle except the daily discussion of readiness to extubate. The VARI bundle currently includes, head of the bed greater then or equal to 30 degrees, use oral antiseptic (chlorhexidine) each morning, mouth care every 2 hours, etc. In the PICU at children’s, the rates for VAP have decreased since the implementation of safety ro...
Ventilator-associated pneumonia (VAP) remains to be a common and potentially serious complication of ventilator care often confronted within an intensive care unit (ICU). Ventilated and intubated patients present ICU physicians, nurses, and respiratory therapists with the unique challenge to integrate evidence-informed practices surrounding the delivery of high quality care that will decrease its occurrence and frequency. Mechanical intubation negates effective cough reflexes and hampers mucociliary clearance of secretions, which cause leakage and microaspiration of virulent bacteria into the lungs. VAP is the most frequent cause of nosocomial infections and occurs within 48 hours of intubation. VAP is a major health care burden with its increased morbidity, mortality, longer ventilator days and hospital stay, and escalating health care cost.
My disease is Streptococcal pneumonia or pneumonia is caused by the pathogen Streptococcus pneumoniae. Streptococcus pneumoniae is present in human’s normal flora, which normally doesn’t cause any problems or diseases. Sometimes though when the numbers get too low it can cause diseases or upper respiratory tract problems or infections (Todar, 2008-2012). Pneumonia caused by this pathogen has four stages. The first one is where the lungs fill with fluid. The second stage causes neutrophils and red blood cells to come to the area which are attracted by the pathogen. The third stage has the neutrophils stuffed into the alveoli in the lungs causing little bacteria to be left over. The fourth stage of this disease the remaining residue in the lungs are take out by the macrophages. Aside from these steps pneumonia follows, if the disease should persist further, it can get into the blood causing a systemic reaction resulting in the whole body being affected (Ballough). Some signs and symptoms of this disease are, “fever, malaise, cough, pleuritic chest pain, purulent or blood-tinged sputum” (Henry, 2013). Streptococcal pneumonia is spread through person-to-person contact through aerosol droplets affecting the respiratory tract causing it to get into the human body (Henry, 2013).
Airway Pressure Released Ventilation was first introduced in the late 1980s, by Dr. Christine Stock and Dr. John Browns. APRV is a time triggered, pressure limited, and time cycled ventilation that provides two levels of continues positive airway pressure (CPAP). It allows the patient to breathe spontaneously without pressure support, throughout the periods of inspiratory and expiratory phases and characterized by higher mean airway pressure. This modality of mechanical ventilation was originally used as a rescue therapy to manage critically ill patients who have difficulty in oxygenation.1 APRV reduces the risk of lung injury and provides better ventilation-perfusion matching, patient synchrony and cardiac preload than other modes that do
HENDERSON, Y (1998) A practical approach to breathing control in primary care. Nursing Standard (JULY) 22 (44) p41
Healthcare-associates Infections (HAIs) are infections that patients acquire during the course of receiving healthcare treatment for other conditions and can be devastating or even deadly ("CDC - HAIs the Burden - HAI", 2013). An HAI was defined as a localized or systemic condition that (1) results from an adverse reaction to the pres¬ence of an infectious agent(s) or its toxin(s), (2) that occurs during a hospital admission, (3) for which there is no evidence the infection was present or incubating at admission, and (4) meets body site-specific criteria (Klevens et al., 2007, p.2).
Hess Dean R., M. N. (2012). Respiratory Care: Principles and Practice 12th Edition. Sudbury, MA: Jones and Bartlett Learning.
Oral hygiene is critically important when it comes to the overall health of an individual. Not only is the mouth and teeth inside used for speaking, chewing, and swallowing, but insufficient oral hygiene can lead to an influx of bacteria in the mouth, which increases the risk of malnutrition, stroke, diabetes, heart disease, and respiratory infections like influenza or pneumonia (Compton & Kline, 2015, p.12). With this is mind, the importance of performing oral hygiene on dependent people in old age is apparent. Unfortunately, there are countless barriers that hinder achieving this goal in residential care, such as a lack of appropriate assessment tools for oral
Over time as individuals age and are faced with access to care issues they may begin to neglect their oral health. As time passes between dental hygiene cleanings or dentist visits the presence of oral disease may begin to increase.
Respiratory assessment is a significant aspect of nursing practice. According to the National Institute for Health and Care Excellence, respiratory rate is the best indicator of an ill patient and it is the first observation that will demonstrate a problem or deterioration in condition (Philip, Richardson, & Cohen, 2013). When a respiratory assessment performed effectively on a patient, it can result in upholding patient’s comfort and independence in progress of symptom management. Studies have acknowledged that in spite of the importance of the respiratory rate (RR) it is documented rarely than the other vital signs in the hospital settings (Parkes, 2011). This essay will highlight the importance of respiratory assessment and discuss why nurses
Ventilator-associated Pneumonia (VAP) is pneumonia that develops 48 hours or longer after mechanical ventilation is given be means of an endotracheal tube or tracheostomy. VAP results from the invasion of the lower respiratory tract and lung parenchyma by microorganisms. VAP may account for up to 60 percent of deaths from healthcare-associated infections in the United States. VAP an also increase the patient’s stay in the ICU by four to six days.
Hospital acquired infections are spread by numerous routes including contact, intravenous routes, air, water, oral routes, and through surgery. The most common types of infections in hospitals include urinary tract infections (32%), surgical site infections (22%), pneumonia (15%), and bloodstream infections (14%). ( book). The most common microorganisms associated with the types of infections are Esherichila coli, Enterococcus species, Staphylococcus auerus, Coagulase-negative staphylococci, or Pseudomonas aeruginosa.(secondary) Urinary tract infections occur when one or more of microorganisms enter the urinary system and affect the bladder and/or the kidneys. These infections are often associated improper catheterization technique. Surgical site infections occur after surgery in the part of the body where the surgery took place. These infections may involve the top of the skin, the tissue under the skin, organs, or blood vessels. Surgical site infections sometimes take days or months after surgery to develop. The infections can be cause by improper hand washing, dressing change technique, or improper surgery procedure. Pneumonia can also become a hospital acquired infection. Ventilator-associated pneumonia is a type of lung in...
Dental plaque is broadly classified as supragingival or subgingival based on its position on the tooth surface toward the gingival margin. Supragingival plaque is found at or above the gingival margin. Therefore, it can be further differentiated into coronal plaque, whi...
Knowing the origins of career is key to understanding the importance of why it began. According to the American Dental Association (ADA), dentistry's ancient origins began in 500 B.C. with the belief of "tooth worms as the cause of teeth decay." Later down the road in 1700 – 1550 B.C., an Egyptian text reveals toothache remedies. Oral cavity issues were provident in very early time of the human race. As a result, oral cavity issues continued therefore so did research which inspired Hippocrates and Aristotle
While taking care of my patient on the cardiothoracic intensive care unit, I assisted another nurse who was helping her seventy-one year old patient ambulate to promote circulation and decrease the patient’s chance of developing pneumonia. It also helps the patient to build strength and confidence after such a major surgery like this patient underwent. This patient had come in with non-ischemic cardiomyopathy and had a history of cocaine and alcohol abuse, atrial fibrillation, mitral regurgitation, and hypertension. She had a left ventricular assistive device placed, and ten days after the device had been placed, she was diagnosed with H1N1, had a tracheostomy performed, and was placed on the ventilator. Since she had to wear a mask when outside of her room and had a tracheostomy, it was really difficult to understand the patient’s needs, and this was very concerning to me.