Summarize your strategy for disseminating the results of the project to key stakeholders and tot the grater nursing community.
Order Description
Summarize your strategy for disseminating the results of the project to key stakeholders and tot the grater nursing community.
Developing an Evaluation Plan and Disseminating Evidence
Developing an Evaluation Plan and Disseminating Evidence
Instructions:
This checklist is designed to help students organize the weekly exercises/assignments to be completed as preparation for the final, capstone project proposal. This checklist will also serve as a communication tool between students and faculty. Comments, feedback, and grading for modules 1-4 will be documented using this checklist.
Topic
Task Completed Comments / Feedback Points
Developing an Evaluation Plan
• Described methods used to evaluate effectiveness of proposed solution. ____/ 4
• Described variables to be assessed when evaluating project outcomes.
____/ 4
• Developed tools necessary to educate project participants. _____ / 14
• Developed assessment tool(s) necessary to evaluate project outcomes. _____ /14
Written Format & Length Requirements for Developing an Evaluation Plan • Assignment formatted according to APA.
• Word Count: 800-1,000 _____/ 2
_____/ 2
Disseminating Evidence • Discussed strategy for disseminating results of project to key stakeholders. _____ / 18
• Discussed strategy for disseminating significance of project outcomes to greater nursing community.
_____ / 18
Written Format & Length Requirements for Disseminating Evidence • Assignment formatted according to APA.
• Word Count: Evidence
250-500 _____/ 2
_____/ 2
TOTAL POINTS
_____ / 80
The whole paper as of know:
My PICO project will be about hospital acquired phenomena.
P: Surgical patients or patient that are in the hospital for long periods of time may acquire hospital phenomena.
I: Turning patients every two hours, early ambulation and use of an incentive spirometer.
C: Antibiotic treatment, ambulation, cough and deep breathing.
O: Shorter hospital stays, less coast for patient, improving health.
T: This plan will start immediately, and check results in 3 weeks.
Can hospital acquired phenomena be avoided by educating staff. If patients are turned every two hours, ambulated when possible. Surgical patients are instructed to cough and deep breath and using an incentive spirometer. This could decrease hospital stay and increase health for the patient and lower coast.
Reference articles you can use:
Hospital acquired-pneumonia (HPA)
1. Chung, D. R., Song, J., Kim, S. H., Thamlikitkul, V., Huang, S., Wang, H., . . . Peck, K. R. (2011). High Prevalence of Multidrug-Resistant Non-fermenters in Hospital-acquired Pneumonia in Asia. Am J RespirCrit Care Med American Journal of Respiratory and Critical Care Medicine,184(12), 1409-1417.
According to Chung et Al. HAP and VAP are the most significant causes of death and have an increased antibacterial resistance. The statistical findings show that major bacteria responsible for HAP and VAP were Acinetobacter ssp, Pseudomonas aeruginosa, Staphylococcus aureus andKlebsiella pneumonia. 67.3% of Acinetobacter ssp and 27.2% of Pseudomonas aeruginosa are resistant to imipenem treatment. The mortality rate is 38.9%. The study suggests the use of discordant initial empirical antimicrobial therapy to decrease the mortality rate of pneumonia-related infections.
2. Freire, A. T., Melnyk, V., Kim, M. J., Datsenko, O., Dzyublik, O., Glumcher, F., . . . Gandjini, H. (2010). Comparison of tigecycline with imipenem/cilastatin for the treatment of hospital-acquired pneumonia. Diagnostic Microbiology and Infectious Disease,68(2), 140-151.
Tigecycline and imipenem are used for the treatment of HAP treatment. The study involved 945 patients where 67.9% responded to the cure of tigecycline and 78.2% of imipenem in clinically evaluable patients. 62.7% responded to the cure of tigecycline and 67.6% to that of imipenem in clinical modified intent-to-treat patients. The mortality rate of tegicycline is 14.1% while that of imipenem is 12.6%.Imipenem is more effective than tigecycline and thus, should be used more to cure people with HAP.
3. Hudcova, J., & Craven, D. E. (2013). Ventilator-associated pneumonia. Hospital-Acquired Pneumonia, 48-65.
HAP has various factors that enable its spread. Some of the risk factors such as malnutrition, general cleanliness are modifiable while others such as an acute, chronic disease are not preventable. Patients with critical risks of being infected with HAP such as those in mechanical ventilation, for instance, 9-40% patients on mechanical ventilation are at risk to be infected by HAP. The incidence of HAP among patients in the United States is 0.5-2% and has a mortality rate of 30-70%.The hospitals and other healthcare institutions should ensure they incorporate the general preventive measures such as washing hands to enable them to reduce the disease incidents.
4. Masterton, R. G., Galloway, A., French, G., Street, M., Armstrong, J., Brown, E., . . . Wilcox, M. (2008). Guidelines for the management of hospital-acquired pneumonia in the UK: Report of the Working Party on Hospital-Acquired Pneumonia of the British Society for Antimicrobial Chemotherapy. Journal of Antimicrobial Chemotherapy,62(1), 5-34.
According to Master HAP is a respiratory infection that develops after more than 48 hours of being admitted to the hospital. Ventilator-associated pneumonia is the most common HAP. HAP can be an early set caused by antibiotic-susceptible community type pathogen or late infection brought by antibiotic –resistant bacteria. HAP is a nosocomial disease and affects the illest patients and also those who have overstayed in the hospital. The article is not comprehensive since it does not give it does not give full evidence on the guidelines to be used. The study found that the percentage of intercellular organisms found that removal of less 2% infected cells gave a response of 80% to 82%. It is beneficial using the selective decontamination of the digestive tract method since it reduces mortality and morbidity rates of VAP. The gravity of HAP is not affected the number of ventilator machines are changed other it increases the cost.HAP affects 0.5% to 1% patients in the hospital thus being the most common healthcare-associated infections(HCAI). HAP associated with VAP has a mortality rate of 24% to 50% that is increased to 76% when caused by resistance to drug-resistant pathogens. VAP causes a morbidity rate of 25% for patients in the ICUs infections depending on the number of days spent in the mechanical ventilation. The study recommended the introduction of protocols for HAP empirical therapy in the affected clinical setting. The therapy improves outcomes economically and microbiologically without efficiency compromise. They also recommended a change of ventilator circuits before seven days to help control costs of maintenance.
5. Venditti, M. (2009). Outcomes of Patients Hospitalized With Community-Acquired, Health Care–Associated, and Hospital-Acquired Pneumonia. Annals of Internal Medicine Ann Intern Med,150(1), 19.
HAP is pneumonia in patients in recent hospitalization, who had hemodialysis, lives in the nursing home, receives intravenous chemotherapy or is in a long-term care facility. HAP is the new category of respiratory infection. The study included a small number of patients with HAP and included patients that were hospitalized with the HAP leaving the others out. The study included 362 patients with pneumonia; 61.6% had community-acquired pneumonia, 24.9% had HCAP, and only 13.5% had HAP. Patients with HCAP have a 3.0 sequential organ failure assessment scores compared to a 2.0 of community –acquired pneumonia patients and the majority are malnourished. Patients with HCAP have high fatality rates, 10.6% to 24.9%, compared to community-acquired pneumonia which varies between 2.7% to 10.5%. Longer hospital stays, depression of consciousness, and leucopenia increased the morbidity of HAP. The study recommended that physicians should keenly identify which type of pneumonia a patient has first. Patients with HAP are more vulnerable and thus should be given appropriate initial antibiotic therapy.
6. Rubinstein, E., Lalani, T., Corey, G. R., Kanafani, Z. A., Nannini, E. C., Rocha, M. G., . . . Stryjewski, M. E. (2011). Telavancin versus Vancomycin for Hospital-Acquired Pneumonia due to Gram-positive Pathogens. Clinical Infectious Diseases,52(1), 31-40.
According to Rubinstein et al. HAP major cause is methilicillin-resistant staphylococcus aureus (MSRA) that causes high rates of clinical failure. Vancomycin and linezolid are the only recommended treatments of HAP due to MRSA, and they do not give encouraging results. Therefore better antistaphylococcal agents for treatment are required. Telavancin does not fully guarantee the treatment of HAP infections. In all pool of all treated population involving 1503 patients, 58.9% were cured by the use of telavancin while 59.5% were cured by the use of vancomycin. 82.4% were cured using telavancin and 80.7% recovered in a pool of clinically treated patients. Telavancin cured more people with s.aureuscompared to those with methicilin-resistant Staphylococcus aureus. Vancomycin cured more people with gram-positive/gram-negative infections.Telavancin treatment has a mortality rate of 21.5% while vancomycin has a mortality rate of 16.6%.Telavancin is effective in treating patients with gram-positive pathogens and has an acceptable risk profile, thus, should be used to treat HAP patients.
7. Jones, R. (2010). Microbial Etiologies of Hospital-Acquired Bacterial Pneumonia and Ventilator-Associated Bacterial Pneumonia. Clinical Infectious Diseases CLIN INFECT DIS,51(S1).
According to Jones hospital-acquired bacterial pneumonia (HABP) and ventilator-associated bacterial pneumonia (VABP) are caused by a variety of bacteria that originate from the patient flora or the healthcare environment. The study found that Staphylococcus aureus, Pseudomonas aeruginosa, Klebsiella species, Enterobacter species, Acininetobacter, andEscherichilia coli cause 80% of the infections. Jones suggested the use of multidrug empirical treatment to help curb the resistance of pathogens to the medicine.
8. Kalsekar, I. (2010). Economic and Utilization Burden of Hospital-Acquired Pneumonia (HAP): A Systematic Review and Meta-analysis. CHEST Journal CHEST,138(4_MeetingAbstracts).
Kalsekar observed that HAP was the most common infection both in patients in ICUs and out. The study derived that VAP/HAP added the number of days spent in the ICU thus increasing the cost. VAP patients had a higher cost than the general HAP. The study proposed that clinical systems should reconsider the non-reimbursement event of VAP and provide evidence-based prevention measures.
9. Morris, A. C., Hay, A. W., Swann, D. G., Everingham, K., Mcculloch, C., Mcnulty, J., . . . Walsh, T. S. (2011). Reducing ventilator-associated pneumonia in intensive care: Impact of implementing a care bundle*. Critical Care Medicine,39(10), 2218-2224.
According to Morris et al. VAP is the most acquired infection in the ICUs and thus the need to implement the bundled care. The four element VAP associated bundle includes head-bed elevation, sedation holds, oral chlorhexidine gel and weaning protocol. The study found that the bundle had a compliance of 70% and reduction of VAP cases from 32 to 12 cases of VAP to 1000 patients. The study suggested that hospitals adopt VAP prevention bundle since it is cheaper and reduces the incidences of VAP.
10. Jansson, M., Kääriäinen, M., &Kyngäs, H. (2013). Effectiveness of educational program in preventing ventilator-associated pneumonia: A systematic review. Journal of Hospital Infection,84(3), 206-214.
According to Jansson et al. VAP is associated with outstanding morbidity and increased mortality rates and cost. Lack of awareness by the clinical nurse on how to prevent the disease perpetuates its existence. The study found that training and education of the clinical nurses helped to reduce VAP incidences significantly. This study, therefore, recommended training and education of the clinical workers.
11. Lung, M., &Codina, G. (2012). Molecular diagnosis in HAP/VAP. Current Opinion in Critical Care,18(5), 487-494.
According to Lung &Codina HAP/VAP, molecular diagnosis must give the accurate and rapidity of the pathogens to aid in antibiotic therapy. Nucleic acid-based amplification method is used for the diagnosis. The statistical data showed that the methods were 100% accurate in determining the specimen. The study suggested that the scientist should continue advancing the molecular based techniques since they rapidly help reduce the HAP diseases.
12. Koulenti, D., Blot, S., Dulhunty, J. M., Papazian, L., Martin-Loeches, I., Dimopoulos, G., . . . Rello, J. (2015). COPD patients with ventilator-associated pneumonia: Implications for management. Eur J ClinMicrobiol Infect Dis European Journal of Clinical Microbiology & Infectious Diseases,34(12), 2403-2411.
Koulenti et al. determined the relationship of chronic obstructive pulmonary disease (COPD) and VAP and found that ICU deaths of patients with COPD was increased by 17% when patients developed VAP, based on the fact there was increased days of mechanical ventilation. Bacteria Pseudomonas aeruginosa is present in patients with both VAP and COPD. The study suggested that antibiotic coverage is added to the empirical therapy.
13. Ramirez, J., Dartois, N., Gandjini, H., Yan, J. L., Korth-Bradley, J., &Mcgovern, P. C. (2013). Randomized Phase 2 Trial To Evaluate the Clinical Efficacy of Two High-Dosage Tigecycline Regimens versus Imipenem-Cilastatin for Treatment of Hospital-Acquired Pneumonia. Antimicrobial Agents and Chemotherapy,57(4), 1756-1762.
According to Rmirez et al. previous studies tigecycline had lower rates of curing HAP compared to imipenem and cilastatian. Their study discovered that when the doses of tigecycline were increased from 75mg to 100mg, the cure rate were higher than that of imipenem and cilastatin. There was no side effects with the new dosage of tigecycline. The study concluded that high doses of tigecyline be used in areas with high concentration of HAP.
14. Torres, A., Ferrer, M., &Badia, J. (2010). Treatment Guidelines and Outcomes of Hospital-Acquired and Ventilator-Associated Pneumonia. Clinical Infectious Diseases CLIN INFECT DIS,51(S1).
According to Torres et al. HAP is the leading nosocomial infection with high rates of mortality, morbidity, and the cost. The incidence of VAP is 10%-30% of patients who require mechanical ventilation. The study found that implementation of an antibiotic treatment protocol increased its adequacy from 46% to 81%. The mortality rate is decreased from 27% to 8%. The study failed to bring out the effects of the local protocol on the VAP patients. There should be a clinical practice of confirming and conforming to the treatment guidelines.
15. Niederman, M. (2010). Hospital-Acquired Pneumonia, Health Care–Associated Pneumonia, Ventilator-Associated Pneumonia, and Ventilator-Associated Tracheobronchitis: Definitions and Challenges in Trial Design. Clinical Infectious Diseases CLIN INFECT DIS,51(S1).
HAP is a parenchymal infection of the lung that occurs after 48 hours of hospitalization. The study derived that the overall mortality rate of VAP is 2.03. The study suggests that a patient should first meet the definition of clinical infection before being put on treatment.
Identify a theory that can be used to support your proposed solution:
I work in an adults’ hospital where hospital acquired pneumonia is prevalent. Despite the fact that we receive a large number of patients every day, we are understaffed and thus overworked. This in turn creates a fertile ground for the spread and thriving of the aforementioned pneumonia. As will be described in this essay, hospital acquired pneumonia presents a major challenge where I work, both to the members of the staff and the patients.
Hospital acquired pneumonia is also known as ventilator-associated pneumonia or nosocomial pneumonia. It refers to a lung infection that takes place in the course of a patient’s stay in hospital, precisely 48-72 hours after admission. It is different from infections that occur in the community, otherwise known as community-acquired pneumonia. Also, it is caused by bacteria and not a virus. Hospital acquired pneumonia normally occurs in those individuals who use a respirator to assist in their breathing. Health care providers can also spread the infection from their clothes or hands from one individual to another, the patients being the most vulnerable due to their weak immune system (NIH, 2015). At my workplace, we are understaffed and overworked, as I mentioned earlier. This means that the staff members have so much work to attend to within a short period of time. As result, most of them do not pay adequate attention to safety measures such as wearing gowns and hand-washing. This causes easy spread of the bacteria that cause the pneumonia amongst health workers and from healthcare workers to the patients. Moreover, the fact that a small number of staff has to attend to a high number of patients means that we often miss important signs that the patient could be suffering from hospital acquired pneumonia thus delaying intervention.
Owing to the above problem, the efficiency and the effectiveness with which we attend to patients is further hampered, more so considering that we are understaffed. To start with, patients who acquire hospital-acquired pneumonia are already sick and while we are trying to treat the current condition, we find that we also have to deal with the pneumonia. This adds onto the workload leaving some of the members of staff tired and demoralized, and thus unable to attend to their patients as required. As a result, some of the patients succumb to either their primary condition or the pneumonia, whereas timely infection could have prevented such a turn of events. On the part of the healthcare providers, some are unable to bear the situation and thus resort to resigning from their jobs. The rate of employee turnover is high and since it is often not easy to find a replacement, the problem is further worsened. Some health care workers also acquire the lung infection and are forced to be missing from their job for some time as they receive treatment. In summary, the problem is a cycle that begins with inadequate staffing, goes to spread of hospital acquired pneumonia, worsens the conditions of the patients, affects the morale and the health of the workers, and then goes back to even more spread of the infection.
The problem of hospital acquired pneumonia is an intense one at my workplace. Firstly, the type of germs located in a health facility is usually more dangerous and resistant to treatment compared to those found outside the facility in the community. On top of this, patients, owing to sickness, are usually unable to fight off the germs. This leaves them vulnerable to the illness to a point where it sometimes turns fatal. For those who survive, they go through a lot of suffering especially because their breathing problem is worsened, and they have to also deal with such symptoms as sharp chest pain, fever and chills, and nausea and vomiting (NIH, 2015). On the other hand, the problem affects the morale of the healthcare workers and in the case of the nurses; they are distracted from the core of their profession, which is to offer high quality of care to their patients. As aforementioned, some resign from their jobs and I have actually seen some go back to school and change profession out of having been frustrated by the condition of their work. The sight of patients under intense suffering is particularly unbearable for many nurses. When they are unable to do anything to salvage the situation, they get extremely frustrated.
Owing to the fact that the problem stems from being understaffed, the very first course of action is to employ additional staff so that the number will be consistent with the high number of patients they have to attend to. Secondly, the management needs to undertake an awareness program educating the staff members of the intense problem and the safety measures they can take so as not be the source of the spread of germs and thus the infection. They also need to be educated on the importance of keenly observing the patients for any signs of hospital acquired pneumonia and the course of action to take should any signs be noted.
In conclusion, hospital acquired pneumonia can turn fatal if appropriate intervention is not undertaken. Most importantly, the spread of the infection should be contained by ensuring that health care workers pay keen attention to all of the required safety measures. At my workplace, the problem is worsened by the fact that we are understaffed and overworked hence hampering our ability to properly attend to patients and pay attention to all safety measures. Dealing with the pneumonia should thus start by adequate staffing, after which the staff members should be educated on the need to take appropriate measures to contain the pneumonia problem.
Reference
National Institute of Health (NIH). (2015). Hospital Acquired Pneumonia. Retrieved on 10/2/2015 from: https://www.nlm.nih.gov/medlineplus/ency/article/000146.htm
The Analyze and appraised each article. This is for you to review. The teacher did not think this review was filled with enough information and did not seaport the question asked.
This part explains proposed solutions
Surgical patients or patients with longer periods of stay in hospitals often acquire hospital pneumonia. Hospital-acquired pneumonia is a lung infection, which often affects patients in the course of their stay in hospitals, precisely, more than 48 hours after their admission (Phm, Rotstein, Evans & Born, 2008). Some of the proposed solutions to this problem include educating the hospital staff on the problem as well as the safety measures they can take to reduce the spread of germs, and by extension reduce the spread of the infection. The staff may additionally be educated on the importance of keenly observing the patients for any signs of hospital-acquired pneumonia, as well as the course of action to take when the presenting signs are noted. The psychodynamic theory, which is considered to be very useful in the nursing and health care systems, supports these solutions, and theoretical basis for the proposed project.
The psychodynamic theory is typically not regarded as a learning theory, but some of its concepts hold significant implications for both learning and changing implications. The psychodynamic perspectives emphasize the importance of conscious and unconscious forces that guide behavior that influence an individual’s experiences. The stresses involved in the hospital setting such as the staff nurses dealing with the strains of working in hospitals as well as the stresses of being understaffed and overworked makes the knowledge of defense mechanisms very useful to the nurses. This theory of institutional change emerged from the existing literature on the practical approaches to nursing situations as well as the evidence-based practice.
The Psychodynamic theory is borrowed from the behavioral science, and its ideas and concepts greatly affect the understanding of many diseases and the nature of the treatments involved (Braungart&Braungart, 2008). A nurse can use the psychodynamic theory to understand the nature of the individual personality development, as well as to establish the cause and remedy of particular diseases, including hospital-acquired pneumonia. Besides, the nurse can use the theory to identify the patient needs as well as respond to the behavior in a more appropriate manner. Understanding of the basic concepts of the psychodynamic theory, such as the id, ego, and superego helps a nurse to recognize patient denial in cases of major events like loss of life, or a particular disease.
Educating the health care workers on the epidemiology of the infection, as well as the infection-control procedures, draws greatly from the theory, specifically, in understanding the processes of the infection as well as the nature of the solution presented, identifying the patient needs more appropriately with the help of the theory and identifying non-compliance issues and discussing the issue with the patient. The interpersonal relationships in nursing, such as the patient-nurse relationship, awareness of the feelings and the use of experiential learning approach to enhance the staff education heavily relies on the theory.
The psychodynamic theory will be used to guide the nurse education, by focusing on the interpersonal relationships as the basis of instructions for the nursing education (Braungart&Braungart, 2008). The theory emphasizes the importance of interpersonal relationships in acquiring the desired nursing education objectives, and the role can sometimes be a difficult one for the staff nurses struggling with the stresses of the work environment. Therefore, the staff nurses will be educated on the issues that impede effective interpersonal relationships in the workplace. A reflective educator’s role will be adopted, which makes sense of the nurse’s personality as well as motivation by listening to them and posing questions that stimulate insight, conscious awareness, and ego strength as they deal with the issue.
In conclusion, the psychodynamic theory has been found to be increasingly useful in the nursing and health care system. The theory has a great impact on the nurse’s understanding of many processes of diseases as well as the nature of the treatment solutions provided. The theory emphasizes on the importance of the interpersonal relationships and the importance of incorporating them in intervention approaches proposed. As such, the theory will be incorporated into the proposed solutions in several ways, that include the incorporation of a reflective educator using appropriate approaches to stimulate insight, conscious awareness, and ego strength.
References
Phm, B. M. B., Rotstein, C., Evans, G., & Born, A. (2008). Clinical practice guidelines for hospital-acquired pneumonia and ventilator-associated pneumonia in adults. Can J Infect Dis Med Microbiol, 19(1), 19.
Braungart, M., &Braungart, R. (2008). Applying learning theories to healthcare practice. In S. B. Bastable (Ed.), Nurse as educator. Sudbury, MA: Jones & Bartlett Publishers International.
This is a review of the reach article that you can you: The teacher thought the review did not express the point of my topic. Hospital Acquired phenomena.
Review of Literature
Hospital-acquired pneumonia (HAP), also known as ventilator-associated pneumonia or nosocomial pneumonia, refers to a lung infection that occurs in the course of a patient’s stay in a hospital, precisely, more than 48 hours after the patient’s admission. HAP is caused by many different germs, and more often, it tends to be serious than the other lung infections since the it affects patients that already very sick and cannot fight off the germs, and the types of the germs in the hospitals are often more dangerous and even more resistant to treatment compared to the ones in the outside community.
HAP is a growing problem in our health care facilities, which are contributing to the skyrocketing cost patient care, as well as the increase in the patient-care time, length of stay in hospitals (LOS) and patient morbidity (Jansson, Kääriäinen&Kyngäs, 2013), and the lack of awareness by the hospital staff on how to prevent the disease makes the situation even worse. Nurse factors are said to contribute significantly towards its spread as the health care workers pass on the germs from their hands or clothes to other people. Therefore, it is hypothesized that educational initiatives can lead to significant reductions in the rates of HAP. This paper reviews the literature related to HAP, prevention strategies and how the existing literature supports the given hypothesis.
In the research article by Chung et al. (2011), HAP and VAP are regarded as the most significant causes of morbidity in Asian nations, and their increased antibacterial resistance is noted. The paper focuses on the distribution of the HAP and VAP, as well as their antimicrobial resistance patterns for cases in selected Asian countries. The study findings reported in this article show that the major bacteria responsible for HAP and VAP were Acinetobacter ssp, Pseudomonas aeruginosa, Staphylococcus aureus andKlebsiella pneumonia. Moreover, 67.3% of Acinetobacter ssp and 27.2% of Pseudomonas aeruginosa are resistant to imipenem treatment. This study suggests that the best practices for reducing HAP were not implemented consistently, resulting in a mortality rate of 38.9%. The study advocates for the use of discordant initial empirical antimicrobial therapy to manage the mortality rates due to infections related to pneumonia.
Some of the guidelines aimed at reducing the mortality rates resulting from HAP and improve the health outcomes of the patients embrace the prevention, diagnosis, and prompt, appropriate, and broad spectrum initial antibiotic therapy. Previous studies on the treatment of HAP reveals the efficacy of tigecycline as a treatment for HAP. The study by Freire et al. (2010) compares the efficacy of tigecycline with that of imipenem, and its findings portray imipenem as a better treatment for HAP. The study involved a primary study of 945 where the clinical response was tested in clinical modified intent-to-treat (c-mITT) and clinically evaluable (CE) populations, and the cure rates for the populations were 67.9% for tigecycline and 78.2% for imipenem in CE patients, and 62.7% for tigecycline and 67.6% for imipenem in c-mITT patients. Further, the findings indicate that the mortality rates for tegicycline and imipenem were 14.1% and 12.6% respectively. Ramirez et al. (2013) also show that tigecycline has lower cure rates for HAP compared to both imipenem and cilastatian. However, the study establishes that when the doses of tigecycline are increased from 75mg to 100mg, the cure rate was higher than that of imipenem and cilastatin. This shows the inadequacies of the existing treatments such as tigecycline, thus the need for educational programs to enhance the efficiency of the intervention techniques.
As earlier mentioned, the spread of HAP is influenced by various factors, which include general cleanliness and malnutrition. Other factors that influence its spread include acute and chronic diseases. According to Hudcova and Craven (2013), the incidences of HAP among the patients in the U.S. ranges from 0.5% to 2%, with mortality rates ranging from 30% – 70%. This is alarming. There is a need for the hospitals and other health care organizations the incorporation of the general preventive measures such as staff education on the measures of reducing the disease incidences.
The guidelines for the prevention of the diseases have been further discussed in an article by Masterton et al. (2008). The article offers a systematic review of a range of issues affecting the influencing the prevention, diagnosis and treatment of HAP, giving a particular focus to the role of staff education programs. The primary studies reviewed in this article reveal that indeed, they are effective in reducing the incidences of HAP and VAP. According to Masterton et al. (2008), the introduction of protocols and education programmes have been successful in controlling staff-to-staff as well as staff-to-patient outbreaks. In fact, the authors of the article recommend hospital education programmes as part of the measures for the overall infection control strategy for HAP.
Venditti (2009) introduces another aspect of HAP, stating that it is the new category of respiratory infection. In his study, Venditti compares the epidemiology and outcome of community-acquired pneumonia and HAP, where by 362 patients with pneumonia are included; 61.6% had community-acquired pneumonia, 24.9% had health care–associated pneumonia (HCAP), and only 13.5% had HAP. The findings reveal that patients with HCAP had higher mean sequential organ failure scores (3.0) than those with community-acquired pneumonia (2.0). Patients with HCAP also had longer hospital LOS and higher fatalities than community-acquired pneumonia. This emphasizes the fact that patients with HAP are more vulnerable, hence the need for enhanced staff education programmes as a control strategy.
Just like the other studies mentioned above, Rubinstein et al. (2011) emphasize the magnitude of the HAP problem, stating that it is the leading cause of mortality that is attributable to critical infections. The study further reveals that the findings of the previous studies on pneumonia trials are not encouraging, and as such, there is a need for additional antistaphylococcal agents, which formed the basis for its comparison of telavancin and vancomycin as treatment measures for HAP.
Jones (2010) argues that both HAP and VAP can be caused by a variety of bacteria originating from the patient’s flora or the health care environment. In his article, Jones reviews several microbiology literature as well as the results from the SENTRY Antimicrobial Surveillance Program (1997-2008) to establish the most likely pathogens to cause HAP and VAP. The systematic review reveals slight changes in the pathogens for geographic regions, with the Latin America having increased incidences of non-fermentative gram-negative bacilli, and the levels of drug resistance of the pathogens increased by 1% per year (Jones, 2010). Due to the prevailing drug resistance as well as the bacterial causes, makes the existing drugs less effective. Whereas Jones recommends a multi-drug empirical treatment regimens, promotion of staff education programmes will be effective preventive measures for effectively dealing with the issue.
Kalsekar (2010), also, notes the higher costs associated with the treatment of both HAP and VAP. Kalsekar examined the existing literature and performed a meta-analysis of the economic impact of HAP and VAP. The article reveals that HAP and VAP pose a considerable attributable cost, and length of stay both in ICU and in a hospital. Further, the author recommends further development and implementation of systems that are aimed at increasing the use of evidence-based measures of prevention, such as hospital staff education to bring the infection under control.
In the recent years, researchers have focused their attention on holistic interventions for HAP (Walsh, 2011). Walsh argues that since HAP and VAP are caused by a wide range of bacteria, originating from the patient flora or even the health care environment, and also considering the resistance of the disease to the existing treatments, a ‘bundle of care’ should be implemented to achieve significant reductions in HAP and VAP. In a study conducted by Walsh, the bundle of care consisting of thee four element VAP, which included head-bed elevation, sedation holds, oral chlorhexidine gel and weaning protocol, had a compliance of 70% and reduction of VAP cases from 32 to 12 cases of VAP to 1000 patients. However, a bundle of care cannot be effectively implemented without proper staff education to improve the nurse awareness on how to prevent the disease (Jansson, Kääriäinen&Kyngäs, 2013).
A systematic review conducted by Jansson, Kääriäinen and Kyngäs (2013) on the effectiveness of educational programmes focused on learning and clinical outcomes, establishes that the increasing education on the ICU personnel leads to significant improvement in the level of knowledge, as well as their adherence to the guidelines, which further serves to support the hypothesis of this project. Most of the studies reviewed in the article portray a decrease in the VAP incidences, LOS, mortality and even cost. This is also demonstrated in the by Torres, Ferrer and Badia (2010).
Niederman (2010) also recognizes the significance of HAP in the healthcare facilities, and emphasizes the importance of controlling for the standards of care in the clinical studies involving HAP, HCAP and VAP, which may include the timing of initial therapy, duration of therapy, recent antibiotic use, local microbiology patterns, and the use of a de-escalation therapy strategy (Niederman, 2010). The standard of care is a variable that is greatly influenced by the level of integration of educational programmes within the health institution, as an increase in the educational programmes results in improved care.
Torres and colleagues explore the guidelines of the American Thoracic Society and the Infectious Disease Society of America for the management of HAP HCAP and VAP, which include the recommendations for risk stratification, initial and definitive antibiotic treatment as well as prevention. Their findings suggest that the implementation of the guidelines result in significantly improved outcome parameters for the patient. Education is said to include the HAP, VAP definitions, incidences, pathogens, care as well as the preventive measures that are emphasized in the article.
Koulentiet al. (2015) determined the relationship between chronic obstructive pulmonary disease (COPD) and VAP, establishing that the development of VAP for patients with COPD increased their mortality rates by 17%. This was mainly due to the increase in the days of mechanical ventilation by 12. According to Koulentiet al. (2015), the patients with COPD, who developed VAP were more likely to experience worse outcomes. However, Lung and Codina (2012) argues that the advances made in the field of molecular sciences over the recent years provide high sensitivity and specificity in the identification of the multiple and single pathogens, as well as the antimicrobial resistance determinants of the causing bacteria.
In conclusion, HAP is a serious problem facing our health care facilities today that is contributing significantly to the increasing costs of patient care, the length of stay in the hospital stay, as well as patient morbidity rates. The lack of awareness by the health care facility staff worsens the situation. This literature review identifies the approaches that have been employed in the disease diagnosis, treatment and prevention. Further, risk stratification, initial and definitive antibiotic treatment are also explored, and the review establishes that educational programmes for the health care facility staff are important in promoting the health outcomes for HAP patients.
References
Chung, D. R., Song, J., Kim, S. H., Thamlikitkul, V., Huang, S., Wang, H., . . . Peck, K. R. (2011). High Prevalence of Multidrug-Resistant Non-fermenters in Hospital-acquired Pneumonia in Asia. Am J RespirCrit Care Med American Journal of Respiratory and Critical Care Medicine,184(12), 1409-1417.
Freire, A. T., Melnyk, V., Kim, M. J., Datsenko, O., Dzyublik, O., Glumcher, F., . . . Gandjini, H. (2010). Comparison of tigecycline with imipenem/cilastatin for the treatment of hospital-acquired pneumonia. Diagnostic Microbiology and Infectious Disease,68(2), 140-151.
Hudcova, J., & Craven, D. E. (2013). Ventilator-associated pneumonia. Hospital-Acquired Pneumonia, 48-65.
Masterton, R. G., Galloway, A., French, G., Street, M., Armstrong, J., Brown, E., . . . Wilcox, M. (2008). Guidelines for the management of hospital-acquired pneumonia in the UK: Report of the Working Party on Hospital-Acquired Pneumonia of the British Society for Antimicrobial Chemotherapy. Journal of Antimicrobial Chemotherapy,62(1), 5-34.
Venditti, M. (2009). Outcomes of Patients Hospitalized With Community-Acquired, Health Care–Associated, and Hospital-Acquired Pneumonia. Annals of Internal Medicine Ann Intern Med,150(1), 19.
Rubinstein, E., Lalani, T., Corey, G. R., Kanafani, Z. A., Nannini, E. C., Rocha, M. G., . . . Stryjewski, M. E. (2011). Telavancin versus Vancomycin for Hospital-Acquired Pneumonia due to Gram-positive Pathogens. Clinical Infectious Diseases,52(1), 31-40.
Jones, R. (2010). Microbial Etiologies of Hospital-Acquired Bacterial Pneumonia and Ventilator-Associated Bacterial Pneumonia. Clinical Infectious Diseases CLIN INFECT DIS,51(S1).
Kalsekar, I. (2010). Economic and Utilization Burden of Hospital-Acquired Pneumonia (HAP): A Systematic Review and Meta-analysis. CHEST Journal CHEST,138(4_MeetingAbstracts).
Morris, A. C., Hay, A. W., Swann, D. G., Everingham, K., Mcculloch, C., Mcnulty, J., . . . Walsh, T. S. (2011). Reducing ventilator-associated pneumonia in intensive care: Impact of implementing a care bundle*. Critical Care Medicine,39(10), 2218-2224.
Jansson, M., Kääriäinen, M., &Kyngäs, H. (2013). Effectiveness of educational program in preventing ventilator-associated pneumonia: A systematic review. Journal of Hospital Infection,84(3), 206-214.
Lung, M., &Codina, G. (2012). Molecular diagnosis in HAP/VAP. Current Opinion in Critical Care,18(5), 487-494.
Koulenti, D., Blot, S., Dulhunty, J. M., Papazian, L., Martin-Loeches, I., Dimopoulos, G., . . . Rello, J. (2015). COPD patients with ventilator-associated pneumonia: Implications for management. Eur J ClinMicrobiol Infect Dis European Journal of Clinical Microbiology & Infectious Diseases,34(12), 2403-2411.
Ramirez, J., Dartois, N., Gandjini, H., Yan, J. L., Korth-Bradley, J., &Mcgovern, P. C. (2013). Randomized Phase 2 Trial To Evaluate the Clinical Efficacy of Two High-Dosage Tigecycline Regimens versus Imipenem-Cilastatin for Treatment of Hospital-Acquired Pneumonia. Antimicrobial Agents and Chemotherapy,57(4), 1756-1762.
Torres, A., Ferrer, M., &Badia, J. (2010). Treatment Guidelines and Outcomes of Hospital-Acquired and Ventilator-Associated Pneumonia. Clinical Infectious Diseases CLIN INFECT DIS,51(S1).
Niederman, M. (2010). Hospital-Acquired Pneumonia, Health Care–Associated Pneumonia, Ventilator-Associated Pneumonia, and Ventilator-Associated Tracheobronchitis: Definitions and Challenges in Trial Design. Clinical Infectious Diseases CLIN INFECT DIS,51(S1).
An implementation plan:
Hospital Acquired Pneumonia
Method of Obtaining Approval
The medical industry carries with it high levels of sensitivity in all aspects. Complete care and caution is therefore required while dealing with its important task of providing a population’s well-being. The Institutional Review Board therefore ensures the review of all researches and projects in an effort to ensure the safety of all participants of it and the entire organization as a whole. It specializes in the emotional, mental, physical and possible invasive risks of the participants. Every project that involves the participation of human beings therefore requires approval from the board (Thompson, 2004).
The definition of a research according to the board is any investigation whose development is directed towards contribution to general knowledge. If the knowledge brings about new information or decisions, it must go through the approval of the board before any steps are taken. The board conducts pilot studies, observations, surveys, interviews, case studies and analysis of the existing data. This happens before the consideration of the research project as well as legal implementation. After the above process, a proposal is written including all measures used for review and a copy is submitted to the Institutional Review Board.
In case the project requires a huge financial budget to be implemented, the organization needs to fully support and back it up. In addition, the hospital staffs who play a big role in ensuring the success of the implementation and running of the required project should completely understand the impact intended. It is important they understand how it will impact on their efficiency and the health of the entire population; especially in reducing the cases of hospital acquired pneumonia.
Description of the problem
The inadequate number of nurses and other medical personnel in the hospital has been linked to the increased rates of hospital acquired pneumonia. The hospital receives a very large number of patients on a daily basis. Despite this, the hospital has been understaffed for as long as I can remember and this leads to overworking of the available staff. It has therefore resulted to provision of fertile grounds for the spread and thrive of hospital acquired pneumonia. The form of pneumonia describes a form of lung infection which occurs as the patient continues to stay in hospital. In this case of study, when patients stay in hospital for over 48 hours, they begin developing symptoms of the bacterial infection.
In common cases, the pneumonia is seen to mostly affect the patients who use a respirator to enable their breathing. Health providers are also studied to spread this infection from one patient to the other as they make their rounds. The means of bacterial transfer is through clothing, or hands; and the weak immune systems of their patients make easier the spread of the infection (American Association for Respiratory Care, 2000).
The amount of work the hospital staff has to do within a short period of time makes it harder to pay attention to safety measures such as hand washing as well as use of gloves. It therefore contributes heavily to the spread of the bacteria from one patient to another. In addition, dealing with large number of patients within a short period of time makes it almost impossible to recognize signs of a patient suffering from the bacteria infection. Failure to recognize the signs therefore translates to increased rates in the spread of the pneumonia.
Detailed Explanation on the Proposed Solution
The policy involves turning patients after every two hours as well as beginning early ambulation as soon as they can for those patients that underwent operation. The two methods have been studied to reduce the cases of infection by this type of pneumonia. However, the problem of inadequate staffing does not allow enough space or time for nurses to ensure that patients are turned at the respective time as well as taken for early ambulation. A solution where the hospital employs more staff would be a good start.
When a single nurse is assigned to different patients with different illnesses, all in a small span of time, it becomes almost impossible for them to concentrate on the well being of each at a time. They therefore tend to generalize and do not handle the patients individually or satisfactorily. They also tend to assume some responsibilities and if taking patients who have had surgery for walks and turning the bedridden ones is among the assumed, cases of hospital acquired pneumonia increase.
Also, increase in the number of nurses enables them to divide themselves among different sections of the hospital as well as take special precaution. Having a job that involves contact with lesser patients creates more time for the staff to attend to one patient by one taking note of special and safety measures. It creates time to give services like ambulation and turning the patients every two hours as required. It also creates time to wear gloves and maintain cleanliness of hands thus reduces chances of spreading infections to various patients. Patients are prone to infections due to their weakened immune system; unlike healthy persons (American Association for Respiratory Care, 2000).
Rationale for Selecting the Solution
The reason for choosing the two methods of preventing pneumonia is that they have been proven to increase immunity and this in return prevents pneumonia infection. The movement mobilizes the secretions of the lungs and a result reduces infections of the respiratory tract. Increase in the nurses’ population in the hospital would therefore enhance the movements since there would be more nurses to concentrate on the patients. If the nurses are less, they would be very busy with other responsibilities and would therefore not get enough time to take the patients out for the walk or even turn those who are confined to their bed (American Association for Respiratory Care, 2000). However much they try, the exhaust they get at the end of the day will automatically reduce their efficiency
In addition, when there is too much to do, people tend to dislike their jobs and this reduces the efficiency and care in which they carry out the required responsibilities. On the other hand, increase in staff reduces the amount of work one has to do thus increasing work efficiency. Increase in work efficiency will automatically bring down the levels of hospital acquired pneumonia, bringing long term benefits for the hospital.
Evidence from Review of Literature
According to Kennerly and Yap (2010), immobility causes mucus accumulation in the zones around one’s lungs. Pooled secretions consequently act as a nidus for proliferation of bacterial culmination in the infections affecting the respiratory system. Turning the patients regularly as well as ensuring they take frequent walks as soon as they can therefore reduce chances of these infections. They do this by mobilizing the lung secretions and as a result lead to reduced risk of tract infections.
Turning and repositioning of the patients appropriately also enhances gas exchange and this works just like the frequent movements in enabling a short stay of the patient in the hospital as a result of improved outcome. According to a American Journal of Critical Care 19, a published study shows that an increase in the number of times a patient is turned reduces the chances for catching pneumonia. Even the patients who are critically ill positively respond to this form of mobility. Stroke patients also respond to the exercise.
Describing the Implementation Logistics
The implementation of the projects should be set to occur in six phases. The first phase should include acquiring approval from the Institution Review Board, as well as all departmental heads. The guidelines of the board require that any investigation or research that is created to develop knowledge must acquire their approval.
The second phase deals with designing and planning of the project. All research and strategies of the project’s development are developed in this phase. In addition, the financial aspect together with budgeting and gathering of resources occur in this stage too. Budgeting is important since it ensures that resources are used effectively throughout the entire process (Thompson, 2004).
After this phase, complete research and analysis based on the project’s viability is carried out. Possible challenges that may occur during the project are identified and solutions are sort. A research on viability of available resources is also carried out, and it includes resources like health practitioners and equipment. This ensures a smooth implementation process during the application of it.
The fourth phase includes education of the staff which is a crucial aspect of the project implementation and success. The training can be carried out through seminars within the hospital environs to enable easy accessibility. The training may take a minimum of two months or less depending on the flexibility of their schedules.
The fifth phase is the implementation of the project which occurs at least half a year after the project’s approval. It will oversee the launch of the project as well as the initial stages of the project’s implementation.
Finally, the sixth and last phase includes an analysis of the project, its achievements so far, it’s financial sustainability as well as its viability. The phase should occur at least a year after the project is launched. After the analysis, recommendations are made on whether to continue with the project or to bring it to an end. Decisions made are based on the analysis of the projects experience during its time of existence.
Resources needed for the Implementation
Implementation of the project requires a number of resources. For instance, finances are needed to employ more nurses to reduce the issue of inadequacy. More nurses will make smooth the running the project by making it easy to take care of the patients individually or in small groups. Education materials will also be required since it is vital and part of the process to educate the staff about the various aspects of the project. They may include handouts, pamphlets, PowerPoint presentations and posters. Researchers will also be part of the resources since they will be required to analyze the project. Finally, lawyers may be included to provide legal advice on the legality of the project (Thompson, 2004).
References
Kennerly M. S. and Tracey L. Yap L. Tracy. (2010). The Role of Manual Patient Turning in Preventing Hospital Acquired Conditions.
American Association for Respiratory Care. (2000). Hospital acquired pneumonia. Dallas, TX: AAFRC.
Thompson, D. A. (2004). Clinical and economic outcomes of intra-abdominal surgery patients who develop hospital acquired pneumonia.
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