...…………………………..……………………………7 Power analysis …………………………………..…………….……………………………8 Instrumentation ...............................................................................................................…...8 Data collection ……………………………………..………….……………………………8 Statistics and data analysis …………………………………………………………….…...9 Expected results …………………………………………………………………………………..9 References cited………………………………………………………………………………….10 Appendix A………………………………………………………………………………………13 Appendix B………………………………………………………………………………………14 Appendix C………………………………………………………………………………………15 Appendix D………………………………………………………………………………………16 Ventilator associated pneumonia and chlorhexidine use in the traumatic brain injured patient Ventilator associated pneumonia (VAP), is defined as, a nosocomial pneumonia that develops more than 48 hours following endotrachial intubation and mechanical ventilation, and is a common and serious intensive care unit (ICU) complication. VAP causes noteworthy morbidity, mortality, amplified hospital costs, and increased utilization of healthcare resources, prolonged time for ventilator support, as well as lengthened ICU and hospital stay (Caruso, 2009). Antibiotics (ATBs) have traditionally been used to treat VAP, but the occurrence of resistance...
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...Journal of Intensive Care Medicine http://jic.sagepub.com/ The Impact of a Simple, Low-cost Oral Care Protocol on Ventilator-associated Pneumonia Rates in a Surgical Intensive Care Unit Carrie S. Sona, Jeanne E. Zack, Marilyn E. Schallom, Maryellen McSweeney, Kathleen McMullen, James Thomas, Craig M. Coopersmith, Walter A. Boyle, Timothy G. Buchman, John E. Mazuski and Douglas J. E. Schuerer J Intensive Care Med 2009 24: 54 originally published online 17 November 2008 DOI: 10.1177/0885066608326972 The online version of this article can be found at: http://jic.sagepub.com/content/24/1/54 Published by: http://www.sagepublications.com Additional services and information for Journal of Intensive Care Medicine can be found at: Email Alerts: http://jic.sagepub.com/cgi/alerts Subscriptions: http://jic.sagepub.com/subscriptions Reprints: http://www.sagepub.com/journalsReprints.nav Permissions: http://www.sagepub.com/journalsPermissions.nav Citations: http://jic.sagepub.com/content/24/1/54.refs.html >> Version of Record - Jan 14, 2009 OnlineFirst Version of Record - Nov 17, 2008 What is This? Downloaded from jic.sagepub.com at UNIV OF THE INCARNATE WORD on April 15, 2013 Original Research The Impact of a Simple, Low-cost Oral Care Protocol on Ventilator-associated Pneumonia Rates in a Surgical Intensive Care Unit Journal of Intensive Care Medicine Volume 24 Number 1 January/February 2009 54-62 # 2009 SAGE Publications 10.1177/0885066608326972 http://jicm.sagepub...
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...Prevention of Ventilator-Associated Pneumonia Prevention of Ventilator-Associated Pneumonia Ventilator-Associated Pneumonia (VAP) is the most common nosocomial infection in Critical Care units. VAP is linked with high mortality rates, increased hospital stays, longer mechanical ventilation and increased costs to hospitals and patients (Rosa, Hernandez, Carillo, Fernandez, & Valles, 2012). Patients who have an endotracheal tube (ETT) with mechanical ventilation are more likely to develop VAP. These patients have a poor cough reflex due to a decreased level of consciousness and diminished movement of the respiratory tract mucocila, leading to the inability to clear secretions. These contaminated secretions will then sit on top of the ETT cuff and eventually leak down and invade the lungs. Also aiding as a reservoir for microbes is a biofilm that can form on the ETT and enter the lungs causing infection (Mietto, Pinciroli, Patel, & Berra, 2013). Nurses are responsible for applying pharmacological and non-pharmacological measures to help prevent VAP which poses a very difficult challenge. Nurses must research and incorporate the use of evidence-based practice into their daily care of patients on mechanical ventilation (Sedwick, Lance-Smith, & Nardi, 2012). This paper will look closely at the evidence-based research and protocols implemented which best prevent ventilator-associated pneumonia. To help prevent further complications and improve outcomes in patients...
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...A number of studies have shown that establishing infection control guidelines based on scientific evidence results in considerable savings. The SENIC study demonstrated that good infection control programs result in real savings and improved health care for the patients. Clinical care protocols and suitable antibiotic use reduce infection, thus reducing the length of stay in hospitals, the single most costly part of medical care. Infection control programs reduce morbidity and mortality. Infection control teams are particularly helpful for preventing outbreaks caused by multidrug-resistant organisms such as methicillin-resistant Staphylococcus aureus (MRSA) or gram-negative bacilli. A significant contribution has been made in high-risk areas, such as intensive care units (ICUs), where infection rates have been reduced by good...
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...I. Introduction This is a case of a 74 year old woman who was diagnosed with Community Acquired Pneumonia. Pneumonia is an inflammation or infection of the lungs most commonly caused by a bacteria or virus. Pneumonia can also be caused by inhaling vomit or other foreign substances. In all cases, the lungs' air sacs fill with pus , mucous, and other liquids and cannot function properly. This means oxygen cannot reach the blood and the cells of the body. Most pneumonias are caused by bacterial infections.The most common infectious cause of pneumonia in the United States is the bacteria Streptococcus pneumoniae. Bacterial pneumonia can attack anyone. The most common cause of bacterial pneumonia in adults is a bacteria called Streptococcus pneumoniae or Pneumococcus. Pneumococcal pneumonia occurs only in the lobar form. An increasing number of viruses are being identified as the cause of respiratory infection. Half of all pneumonias are believed to be of viral origin. Most viral pneumonias are patchy and the body usually fights them off without help from medications or other treatments. Pneumococcus can affect more than the lungs. The bacteria can also cause serious infections of the covering of the brain (meningitis), the bloodstream, and other parts of the body. Community-acquired pneumonia develops in people with limited or no contact with medical institutions or settings. The most commonly identified pathogens areStreptococcus pneumoniae, Haemophilus influenzae, and...
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...infection control and hospital epidemiology march 2014, vol. 35, no. 3 original article Ventilator-Associated Pneumonia: Overdiagnosis and Treatment Are Common in Medical and Surgical Intensive Care Units Veronique Nussenblatt, MD, MHS;1 Edina Avdic, PharmD, MBA;2 Sean Berenholtz, MD, MHS;3,4 Elizabeth Daugherty, MD, MPH;5 Eric Hadhazy, MS;1 Pamela A. Lipsett, MD, MHPE;3,4 Lisa L. Maragakis, MD, MPH;1 Trish M. Perl, MD, MSc;1 Kathleen Speck, MPH;3 Sandra M. Swoboda, RN, MS;3 Wendy Ziai, MD;3,6 Sara E. Cosgrove, MD, MS1 objective. Diagnosing ventilator-associated pneumonia (VAP) is difficult, and misdiagnosis can lead to unnecessary and prolonged antibiotic treatment. We sought to quantify and characterize unjustified antimicrobial use for VAP and identify risk factors for continuation of antibiotics in patients without VAP after 3 days. methods. Patients suspected of having VAP were identified in 6 adult intensive care units (ICUs) over 1 year. A multidisciplinary adjudication committee determined whether the ICU team’s VAP diagnosis and therapy were justified, using clinical, microbiologic, and radiographic data at diagnosis and on day 3. Outcomes included the proportion of VAP events misdiagnosed as and treated for VAP on days 1 and 3 and risk factors for the continuation of antibiotics in patients without VAP after day 3. results. Two hundred thirty-one events were identified as possible VAP by the ICUs. On day 1, 135 (58.4%) of them were determined to not have VAP...
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...Literature Review: Enlarged Tracheoesophageal Puncture after Total Laryngectomy: A Systematic Review and Meta-Analysis Name Affiliation Date ABSTRACT Objectives: Enlargement of the tracheoesophageal puncture (TEP) is a challenging complication after laryngectomy with TEP. We sought to estimate the rate of enlarged puncture, associated pneumonia rates, potential risk factors, and conservative treatments excluding complete surgical TEP closure. Methods: A systematic review was conducted (1978–2008). A summary risk estimate was calculated using a random-effects meta-analysis model. Results: Twenty-seven peer-reviewed manuscripts were included. The rate of enlarged puncture and/or leakage around the prosthesis was reported in 23 articles (range, 1% to 29%; summary risk estimate, 7.2%; 95% confidence interval [CI], 4.8% to 9.6%). Temporary removal of the prosthesis and TEP- site injections were the most commonly reported conservative treatments. Prosthetic diameter (p =.076) and timing of TEP (p = .297) were analyzed as risk factors; however, radiotherapy variables were inconsistently reported. Conclusions: The overall risk of enlarged puncture seems relatively low, but it remains a rehabilitative challenge. Future research should clearly establish risk factors for enlarged puncture and optimal conservative management. Keywords: tracheoesophageal puncture, total laryngectomy, enlarged tracheoesophageal puncture, complications, leakage Enlarged Tracheoesophageal Puncture after Total...
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...AFT Task 4: Periodic Performance Review Accreditation Audit Case Introduction The accreditation process is designed to assist healthcare establishment to identify and enhance the patient’s safety and the quality of service delivery. This paper presents a review of the readiness Nightingale Community Hospital for accreditation audit. The paper comprises of a periodic performance review of the establishment. The review has focus of several priority areas. These areas include; assessment and care; quality improvement; patient safety, and staffing effectiveness. Trend within the hospital indicates the Nightingale has made significant progress towards fulfilling the standards of the Joint Review Commission. However, the trends in staffing effectiveness are limiting the organization’s compliance. Periodic Performance Review (PPR) The PPR is based on data collected in the Joint Commission Survey. The survey utilized the priority focus methodology to evaluate the compliance of Nightingale Community Hospital. The priority focus process is a methodology that makes use of data to establish priority areas for reviewing compliance. This process has utilized of both external and internal data to evaluate the compliance of Nightingale Community Hospital. This methodology identified several priority areas. These include; assessment and care services; quality improvement activities, and patient safety. This paper evaluates Nightingale’s compliance in these three priority areas. Compliance...
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...Diseases THEIR TRANSMISSION AND CONTROL This project is designed to inform or further the reader’s knowledge about the different diseases and how they are transmitted and can be controlled. Therefore, it is divided into three (3) major sections. These sections includes: water borne diseases, food borne diseases and air borne diseases. These subtopics will go into further details as to make it simpler for your understanding. TABLE OF CONTENTS INTRODUCTION WATER BOURNE DISEASES FOOD BOURNE DISEASES AIR BOURNE DISEASES ACKNOWLEDGEMENT First I would like to thank the Lord who is the head of my life who has given me the strength, courage, and inspiration in completing this assessment. I would also like to thank my teacher who has helped me in every step of the way. I would also like to thank my friends and family, specifically my parents who has provided the necessary resources needed to complete this assessment and also in giving me the ongoing encouragement and assistance. Once again I say thank you. WATER BOURNE DISEASES HOOKWORM Hookworm is an intestinal parasite of humans. The larvae and adult worms live in the small intestine can cause intestinal disease. The two main species of hookworm infecting humans are Anclostoma duodenale and Necator americanus. Hookworm eggs are passed in the faeces of an infected person. If an infected person defecates outside (near bushes, in a garden, or field) or if the faeces from an infected person are used as fertilizer...
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...The disease was also reported among humans, especially those working in collective farms. Stachybotryotoxicosis was found to mostly affect individuals who handled hay infested with black mold or those who had been exposed to dust and debris from materials that were already contaminated. Further outbreaks among farm workers prompted more investigation into the disorder, with most studies reporting that there was a strong connection between Stachybotryotoxicosis and the presence of black...
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...INTRODUCTION Electronic cigarette (e-cigarette) use, or vaping, in the worldwide is increasing. Less than a decade ago, the e-cigarette was an obscure product marketed as a safe, tobacco-free alternative to conventional cigarettes by a single company in China. Seven years ago, the electronic nicotine delivery device entered the US market. Today, health officials, policy makers, and researchers are all scrambling to keep up with a rapidly expanding, wildly controversial, and largely unregulated $3 billion global industry that has, at last count, 466 brands, 7,764 flavors (bubblegum, cherry crush, bacon, java jolt, menthol), and slick, youth-oriented Big Tobacco marketing designed to create the perception that e-cigarettes are not only safe, but cool. Non-nicotine, but an abundant amount of toxic chemicals produced by the combustion of tobacco are the cause of well-known health problems. E-cigarette vapor contains no or only minimal quantities of potentially harmful substances. Hence it can be assumed that vaping in adults is much less harmful than smoking of cigarettes. Furthermore, no data exist that e-cigarettes will encourage youngsters to become cigarette smokers. E-cigarette vaping has the potential to reduce the daily number of cigarettes smoked or facilitates cessation of smoking in heavily nicotine-dependent smokers, who keep on smoking despite a structured smoking cessation program. Health professionals should be aware of this type of nicotine substitution, since the...
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...Capstone Project Abstract Background Hand washing and hand hygiene are consider to be the number one, cheap essential measure of preventing and controlling spread of hospital acquired infections (HAIs). Hand washing and hygiene can significantly reduce the burden of disease, in particular in hospitalized patient Unfortunately compliance to hand hygiene recommended standard procedures by the health care workers (HCWs) has been unacceptably poor. In order to design education program, identification of several risk factors associated with poor hand hygiene (HH) compliance is of extreme importance. Objective: The purpose of this study is to implement a hand hygiene program for increase compliance with hand hygiene among health care worker in 97 beds hospital. The key target for compliance to HH is not only health-care workers but also policy-makers and organizational leaders and managers. Methods.: Compliance to hand hygiene will be evaluated through direct observation of HCWs ,to helps pinpoint areas of strength or weaknesses in HH behavior, so as to develop training program that will help HCWs to complaint with HH . Evaluation will be based on direct observation and survey audit, observing the HCWs during routine patient care to ensure that hands hygiene are performed before and after getting in contact with patient and patient environment. In addition, survey audit based on the HCWs perception, knowledge and attitude...
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...work, and explain one or more negative outcomes that may result if this role is not fulfilled. This paper will also analyze the skills, dispositions, and strategies necessary to help this author fulfill this role, and explain this author’s motivation for taking a stand. Role as an Advocate Advocacy has been described in ethical and legal frameworks, and as a philosophical foundation for practice (Negarandeh et al., 2007). Malik (1997) states that “the core condition which demands advocacy action is the vulnerability of a patient, either personal vulnerability due to illness and/or the vulnerability to risks inherent in the institutional processes to which the patient is exposed in the health care system.” As a nurse discharge planner case manager, part of this author’s job is to identify potential barriers to patient care and safe discharge. As a nurse, this author also has the responsibility to speak for those who cannot speak for themselves. A few years ago an 85-year-old woman was admitted to the orthopedic floor with a fractured hip. She had fallen at home trying to stand from her wheelchair. The family noted that she experienced some dementia, and the paid caregiver had...
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...Evaluation of a Health Care Legislative Bill There is currently a bill in the legislature entitled “Access to Appropriate Immunizations for Veterans Act of 2011” that proposes that the government should make all vaccinations suggested by the Advisory Committee on Immunization Practices available to all veterans in a timely manner as suggested on their immunization schedule. It also proposes that the Secretary of Health and Human Services will be responsible for setting and monitoring goals for compliance of the new program. The following is an evaluation of this bill and subsequent recommendation of whether or not it should be enacted. In order to evaluate this bill, we must take into account the economic impact that it will have on the country. Using the adult immunization schedule as recommended by the Centers for Disease Control and Prevention (CDC) and the Vaccine Price List also by the CDC, the initial cost of vaccines would be $85.48/person for normal healthy adults and a maximum of $113.21/person for high risk adults needing additional immunizations (CDC, 2011c; CDC, 2011a, p. 2). According to the National Center for Veterans Analysis and Statistics (NCVAS), as of September 20, 2010, there were 22.7 million veterans (2010). If you calculate this, the total cost of initial immunizations would be $1.94-$2.57 billion. According to the National Business Group on Health (NBGH), the lifetime cost of adult immunizations is between $380 and $480 per adult (Lindley & Bhatt...
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...Courtesy of L E K A R SPECIAL EDITION Authors: Marino, Paul L. Title: ICU Book, The, 3rd Edition Copyright ©2007 Lippincott Williams & Wilkins ISBN: 0-7817-4802-X Authors Dedication Quote Preface to Third Edition Preface to First Edition Acknowledgments Table of Contents Section I - Basic Science Review Basic Science Review Chapter 1 - Circulatory Blood Flow Chapter 2 - Oxygen and Carbon Dioxide Transport Section II - Preventive Practices in the Critically Ill Preventive Practices in the Critically Ill Chapter 3 - Infection Control in the ICU Chapter 4 - Alimentary Prophylaxis Chapter 5 - Venous Thromboembolism Section III - Vascular Access Vascular Access Chapter 6 - Establishing Venous Access Chapter 7 - The Indwelling Vascular Catheter Section IV - Hemodynamic Monitoring Hemodynamic Monitoring Chapter 8 - Arterial Blood Pressure Chapter 9 - The Pulmonary Artery Catheter Chapter 10 - Central Venous Pressure and Wedge Pressure Chapter 11 - Tissue Oxygenation Section V - Disorders of Circulatory Flow Disorders of Circulatory Flow Chapter 12 - Hemorrhage and Hypovolemia Chapter 13 - Colloid and Crystalloid Resuscitation Chapter 14 - Acute Heart Failure Syndromes Chapter 15 - Cardiac Arrest Chapter 16 - Hemodynamic Drug Infusions Section VI - Critical Care Cardiology Critical Care Cardiology Chapter 17 - Early Management of Acute Coronary Syndromes Chapter 18 - Tachyarrhythmias Section VII - Acute Respiratory Failure Acute Respiratory Failure Chapter 19 - Hypoxemia...
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