Question

2 Paragraphs Identify & explain 2 nursing actions for VAP that can prevent it to occur. Must have citations and references-see instructions

Answer 1

Ans) The ventilator bundle recognized by IHI and the Joint Commission consists of a group of evidence-based practices that, when implemented together, dramatically reduce VAP incidence in mechanically ventilated patients. The bundle includes these interventions: head-of-bed elevation above 30 degrees.

- Core strategies for preventing VAP focus on interrupting the three most common mechanisms by which it develops: the aspiration of secretions, the colonization of the aerodigestive tract, and the use of contaminated equipment.

- The CDC recommends using non-invasive, positive-pressure ventilation (delivered continuously via a face or nose mask) instead of intubation wherever possible and minimizing the duration of ventilation. Proactive surveillance of ventilated patients is needed, particularly by nursing and respiratory therapy staff.

Core recommendations for VAP prevention are autonomous nursing interventions, which you can practice every day in the ICU.

- Practicing good hand hygiene is essential – clean your hands with soap and water or an alcohol-based rub before touching the patient or the ventilator.

- Maintaining the patient’s oral hygiene can help to prevent bacterial colonization of the endotracheal tube. Regular care with an antiseptic solution is recommended, although specific practices are not defined.
Unless there are contraindications, maintain the patient in a semirecumbent position, with the head of the bed elevated at an angle of 30 to 45 degrees, to help prevent aspiration.

- Nurses should be aware of, as members of a multi-disciplinary care team:

• A key concern is that secretions accumulate above the cuff on the endotracheal tube – and since the tube prevents the glottis from closing, these secretions can be aspirated or can leak into the lungs. Suctioning them is difficult because they can’t be reached by typical oral suctioning methods, so the CDC recommends a device known as a CASS tube which provides constant suction of oral secretions. Research indicates the device greatly lowers the chance of VAP.
• CDC guidelines also recommend using orotracheal rather than nasotracheal intubation, unless contraindicated. Nasal tubes can cause sinus infections, which can result in pathogens reaching the lower respiratory tract.