Date of Award

8-3-2015

Degree Type

Evidence-Based Project Report

Degree Name

Doctor of Nursing Practice (DNP)

Department

Nursing

First Advisor

Thomas Blodgett

Abstract

Ventilator-associated pneumonia (VAP) is a common but preventable health-care associated infection that affects up to 20% of mechanically ventilated adult patients, resulting in estimated mortality rates ranging from 13% to 55% (Chahoud, Semaan, Almoosa, 2015; Melsen et al., 2013). In an effort to reduce morbidity, mortality and related costs, the Centers for Disease Control and Prevention (CDC) and the National Healthcare Safety Network (NHSN), proposed ventilator-associated pneumonia prevention as a national patient safety goal. In 2014, amid growing concerns that the subjectivity of existing definitions had led to inconsistent reporting, thereby impeding efforts to reduce VAP, the CDC refocused surveillance efforts on, the more broadly defined, ventilator associated events (VAE), which include VAP as well as a set of related conditions. Hospitals have been inconsistent in their adoption of evidence-based practice (EBP) to reduce the incidence of VAE. The purpose of this EBP project was to design, implement, and evaluate the use of a comprehensive oral health intervention to: (a) reduce the cumulative VAE rate at four facilities and (b) determine whether project adherence over a four month period had an impact on VAE incidence rate reduction. The Epidemiological Triangle of Infectious Disease and Everett Rogers’ Diffusion of Innovation framework guided this multisite pretest-posttest study. The study introduced oral care and biofilm elimination education for nurses, and an oral health assessment tool. Aggregated VAE data was collected from each facility’s infection preventionist. The analysis involved pooled mean comparisons of data in the pre-intervention and post-intervention periods. The data showed a decrease in pooled VAE incidence rates of 1.8 per 1,000 ventilator-days, but this difference was not statistically significant, Χ2 (1, N = 4,846) = .37, p = .54. There was also a moderate correlation between documentation compliance and reduction of VAE rate (r = .4). However, this correlation was not statistically significant (p = .6). These findings provide preliminary evidence that routine oral assessment and timely intervention in MV patients are useful components of comprehensive oral care practices to prevent VAE.

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