Analysis of Current Health Issues Essay Discussion Paper

Ventilator-Associated Pneumonia

Introduction

Ventilator-associated Pneumonia is regarded as the most common hospital-acquired Infection that occurs more than 48 hours after mechanical ventilation and is known to result in a high mortality rate among the patients admitted to the Intensive Care Unit. Research by Luyt et al. (2020), states that Ventilator Associated Pneumonia can cause patients to have difficulty weaning off the ventilator, which makes them to stay more prolonged in the hospital resulting in an accumulated financial burden. Its incidence has decreased with the implementation of various evidence-based strategies in healthcare; some of the most implemented systems of care include the administration of antibiotics, oral hygiene, and head elevation. This task aims to analyze the problem I selected and provide a brief description of its solutions and the ethical principles that should be considered when providing care for such individuals. Analysis of Current Health Issues Essay Discussion Paper

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Body

The incidence of Ventilator-associated Pneumonia is known to increase with the existence of chronic underlying diseases in the body. Some of the predisposing factors to Ventilator-Associated Pneumonia include Chronic renal failure, prior antibiotic therapy, disorders of consciousness, invasive operations, and prolonged length of hospital stay (Wu et al.,2019). Each risk factor has an appropriate prevention strategy that will aid in the reduction of the illness severity, head of the bed elevation to 30-45 degrees will help reduce the occurrence of disorders of consciousness. In contrast, Nasal Intermittent Positive Pressure Ventilation will help decrease the increased mechanical ventilation time of the patient. Mechanical ventilation is usually performed to facilitate effective gaseous exchange without causing lung trauma. High volume and pressure usually exerted during the process may eventually cause barotrauma and volutrauma to the lungs, ultimately resulting in atelectrauma and biotrauma. Pneumonia is the host responsible for bacterial invasion in the lungs, which might later contribute to the reduced immune system.

Ventilator-Associated Pneumonia is a critical issue to me since it is through it that many individuals lose their lives while being cared for. It is a nosocomial pneumonia that also increases mortality rates among the critically ill patients. Besides that, the Infection is actually preventable, and it is caused to be caused by both patient and healthcare factors at the facility. It is therefore crucial that the healthcare workers are aggressive when they are caring for patients hospitalized in intensive care units. The increased mortality rates can actually be decreased once the exact prevention strategies are implemented in the workplace. A study by Fernando et al. (2020) states that individuals with chronic illness, more so the respiratory disease, are at more risk of succumbing to death. Chronic Obstructive Pulmonary Disease (COPD), is a recognized risk factor for Ventilator Associated Pneumonia and usually emerges from patients’ advanced age, high colonization of the lower airways and inhibition of the mucociliary function due to smoking. Additionally, ventilated patients generally cannot feed independently, meaning most feeds will be via the enteral route. The enteral feeds increase the gastric secretions and the PH, leading to gram-negative bacilli colonization of the stomach, thus increasing the probability of aspiration of the stomach contents, hence Pneumonia. Analysis of Current Health Issues Essay Discussion Paper

The prevention strategies for the Infection can be mitigated by implementing both the medical and non-medical interventions. Despite the increased prevalence of the antimicrobial resistance, bacteriostatic drugs, for instance, the aminoglycosides and colistin, should be administered in large amounts to achieve the maximum efficacy. Early antimicrobial therapy reduces the mortality rate among the Ventilator Associated patients as compared to those who do not receive adequate treatment. For those patients who develop VAP due to Methicillin Resistant Staphylococcus Aureus, administration of both Vancomycin and Linezolid has a therapeutic advantage over the other drugs. One of the non-pharmacological prevention interventions is the proper positioning, keeping the head of the bed elevated between 30-45 degrees and also encouraging the mobility of the mechanically ventilated patients to prevent the occurrence of VAP. Early mobility protocols include a progressive approach that transitions from dangling off the edge of the bed to standing at the bed (Papazian et al.,2020). Subglottic suctioning of secretions when performing an oral care may also be a good cluster care for the patient as it will minimize the risk of aspirating stomach contents to the respiratory system. Last intervention is the performance of adequate oral care for the patient to reduce the overgrowth of bacteria and the Risk of Infection. Analysis of Current Health Issues Essay Discussion Paper

For the strategies to be effective, some of the resources that would be required will include the following, human resources, finances and analytical resources. A well-competent and trained workforce will help in the implementation of various evidence-based strategies that will facilitate the decrease in the severity of the Infection. Finances would aid in purchasing machines, for instance, the Ventilators at the Intensive care unit. Modern Ventilator machines are better positioned to provide sufficient oxygen demands based on the patient’s requirements, thus decreasing the disease exacerbation. One of the most suitable preventive strategies is antimicrobial therapy; other than vancomycin and aminoglycosides, other drugs that can aid in preventing VAP include Ceftazidime, imipenem and meropenem. Nebulized antibiotics have been proposed to provide a high amount of drug concentration in the lungs, thus reducing the systemic toxicity associated with intravenous antibiotics (Wu et al.,2019). Their efficacy helps minimize the bacterial overgrowth of the microorganisms in the cells resulting in decreased colonization. A disadvantage of antimicrobial therapy is the high risk of causing antimicrobial resistance, which would deter the drugs’ efficacy when administered in the body system.

When the Ventilator Associated Infection is Ignored, there is a high risk that the patient will die or even develop other types of infections. Examples of other conditions that an individual admitted to the ICU can develop include Gastrointestinal infections and even the development of bed sores due to the prolonged immobility. The occurrence of the infections mentioned earlier may contribute to an ethical dilemma that might result in ethical issues in the caregiving process. Occurrence of infections when the patient is receiving care is a breach of the ethical principle of non-maleficence. All healthcare providers should always ensure that they respect the various ethical principles when they are providing care for the patient regardless of race and ethnicity.

Conclusion

Since the diagnostic method available for Ventilator Associated Pneumonia is not universal, there is a greater need for adopting a proper infection control policy with an appropriate antibiotic regimen that can reduce the mortality among the ventilated patients. The host and intervention factors must be continuously monitored to minimize the VAP rates. The main focus should actually be on decreasing the aspiration of the secretions and an effective antibiotic therapy for all the patients admitted to the Intensive Care Units. Further research needs to be conducted to gain better insight into the global epidemiological characteristics of Ventilator-Associated Pneumonia. Analysis of Current Health Issues Essay Discussion Paper

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References

Fernando, S. M., Tran, A., Cheng, W., Klompas, M., Kyeremanteng, K., Mehta, S., … & Rochwerg, B. (2020). Diagnosis of ventilator-associated Pneumonia in critically ill adult patients—a systematic review and meta-analysis. Intensive care medicine, 46(6), 1170-1179.

Luyt, C. E., Sahnoun, T., Gautier, M., Vidal, P., Burrel, S., Pineton de Chambrun, M., … & Chastre, J. (2020). Ventilator-associated Pneumonia in patients with SARS-CoV-2-associated acute respiratory distress syndrome requiring ECMO: a retrospective cohort study. Annals of Intensive Care, 10(1), 1-10.

Papazian, L., Klompas, M., & Luyt, C. E. (2020). Ventilator-associated Pneumonia in adults: a narrative review. Intensive care medicine, 46(5), 888-906.

Wu, D., Wu, C., Zhang, S., & Zhong, Y. (2019). Risk factors of ventilator-associated Pneumonia in critically III patients. Frontiers in pharmacology, 10, 482 Analysis of Current Health Issues Essay Discussion Paper