PICO Project in a Hospital

PICO Project in a Hospital

The whole paper as of know:
My PICO project will be about hospital acquired phenomena.

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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 Respir Crit 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 and Klebsiella 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.aureus compared 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, and Escherichilia 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 Clin Microbiol 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.