Ventilator Associated Pneumonia (VAP) PICOT Systematic Review

Ventilator Associated Pneumonia (VAP) PICOT Systematic Review

Research problem

Patients under mechanical intubation in the ICU commonly experience problems in oral health which increase their risk to nosocomial infections. In the ICU, Ventilator-Associated Pneumonia (VAP) is the most prevalent hospital-acquired infection and it leads to additional medical costs, prolonged admissions and even death.

Purpose of the Study

To evaluate the impact that routine oral care using chlorhexidine gluconate has on Ventilator-Associated Pneumonia and patient health outcomes among patients in the ICU receiving mechanical ventilation.

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Procedure, Inclusion and Exclusion Criteria

            The inclusion criterion was as follows: studies that were randomized clinical trials and  compared the use of chlorhexidine and a placebo among adults who were on mechanical ventilation since July 2013.The process started by identifying randomized clinical trials which compared a placebo and chlorhexidine in adults were identified, evaluated for bias and extracted. Existing differences were resolved by consensus. Studies that were eligible were analyzed using a random effects meta-analysis.

Findings

Cardiac surgery patients who were randomized to chlorhexidine had few lower respiratory tract infections

Conclusion

Routine oral care using chlorhexidine can prevent infections of the lower respiratory tract in both cardiac and non-cardiac patients. For patients on mechanical ventilation, chlorhexidine is the gold standard of care that reduces the risk s of VAP with good patient-centered outcomes. Ventilator Associated Pneumonia (VAP) PICOT Systematic Review.

Implications to Nursing Practice

ICU patients under mechanical intubation should receive routine oral care using chlorhexidine to prevent VAP. Policies on the similar routines that encourage oral care using chlorhexidine should also be implemented in clinical settings,

PICOT Statement

            Among Intubated patients aged 40 years or older in  ICU settings (P) how does using oral 0.2% Chlorhexidine 8 hourly (I) compared to using normal saline (C) reduce the risk of Ventilator-Associated Pneumonia (O) during hospitalization(T)?

References

Klompas, M., Speck, K., Howell, M. D., Greene, L. R., & Berenholtz, S. M. (2014). Reappraisal of routine oral care with chlorhexidine gluconate for patients receiving mechanical ventilation: systematic review and meta-analysis. JAMA internal medicine, 174(5), 751-761. Ventilator Associated Pneumonia (VAP) PICOT Systematic Review.