Ventilator-associated events (VAEs) are patients' complications of respiratory conditions including ventilator-associated pneumonia (VAP). Research shows that VAP is the most common hospital-acquired infection among ventilated patients and a leading source of mortality. With greater risk for complications among ventilated- supported patients, nurses working in the ICU must keep abreast of new knowledge and update expertise to develop technical and clinical skills in daily practice. The purpose of this project was to assess whether an educational intervention would increase the ICU nurses' level of knowledge of the evidence-based intervention. Knowles' adult learning theory was chosen for this project. A paired-samples t-test was conducted to examine nurses' knowledge of VAE/VAP using a questionnaire measuring knowledge of VAP; 58 ICU nurses participated an educational intervention. Findings showed that nurses had an increase in knowledge following the education (M = 11.43, SD = .775) compared to nurses prior to education (M = 9.55, SD = .976), t(57) = -26.884, p < .001. Results of this project may guide the use of an evidence-based practice educational intervention to improve the quality and safety of ventilated patients. The implications for positive social change include preventing VAEs/VAP among patients, thus decreasing the length of hospital stay, cost, and deaths related to ventilator infections.

Surveillance of ventilator-associated pneumonia (VAP) has been the common outcome measurement used for internal and external benchmarking for mechanically ventilated patients; and although not a clinical definition, it is commonly used as an outcome measurement for research studies. Criteria in the VAP definition include both subjective and objective components, leading to questions of validity. In addition, recent legislation has mandated the public reporting of healthcare-associated infections, including VAP, in many states. Infectious disease experts have recently recommended monitoring a new outcome, ventilator-associated events (VAE), that contain specific objective criteria. The Centers for Disease Prevention and Control (CDC) have refined this definition and released a new VAE protocol and algorithm, replacing the VAP surveillance definition, as a result. The VAE protocol assesses for ventilatorassociated conditions (VAC). The primary aims of this study were to determine the incidence of VAC; and to assess four predictors for VAC, including two VAP prevention strategies (use of the subglottic secretion drainage endotracheal-tube [SSD-ETT]), and daily sedation vacation); and two patient-related factors (alcohol withdrawal during mechanical ventilation, and history of COPD). In addition, the incidence for VAE, using a new national algorithm was determined. Using a retrospective study design, electronic medical records of 280 veterans were reviewed to identify cases of VAC using the VAE algorithm. The setting was two intensive care units (ICU) at a large Veterans Administration Healthcare System (VAHCS) from October 2009 to September 2011. In addition to demographic information, variables were collected to determine if cases met event criteria (VAC, infection-related ventilator-associated complication iii [IVAC], and possible or probable VAP). Incidence rates were calculated for VAC and IVAC. Comparative data between those with and without VAC were assessed with independent sample T-test or non-parametric equivalents. The study sample was predominantly male (97.1%), Caucasian (92.1%), non-Hispanic (90.7%); with a mean (SD) age of 67.2 (10.4) years. Twenty patients met the VAC definition resulting in a VAC incidence of 7.38 per 1000 ventilator days. There were no statistically significant differences in demographics or disease characteristics found between the two groups (patients with VAC and patients without VAC). Using logistic regression, the impact of the four predictors for VAC was assessed. None of the four explanatory variables were predictive of the occurrence of VAC. Secondary outcomes (e.g. mechanical ventilation days, ICU days, hospital days, and mortality) of veterans with VAC were compared to veterans without VAC. Results indicated that the VAC group was associated with a significantly longer duration of ICU stay, longer mechanical ventilation period, more likely to have a tracheostomy, and had a higher mortality during hospitalization. Expanding mechanical ventilation quality performance measures to include VAE/VAC provides a better representation of infectious and non-infectious ventilator-associated problems, and provides more accurate morbidity and mortality in this high-risk ICU population. Further research is necessary to explore patient characteristics and prevention strategies that impact the development of all VAC.

Aims: The purpose of this thesis was to synthesize the current literature on alpha amylase as an emerging biomarker of microaspiration in mechanically ventilated patient. Methods: The methodology included a review and synthesis of pertinent research articles from 1981-2018, written in English language. Criteria for inclusion in the review were all articles that evaluated α- amylase in tracheal secretions or bronchoalveolar lavage fluid (BAL) as a diagnostic tool for identifying microaspiration. The search yielded 11 studies that were reviewed. Findings: The findings suggest that once aspiration occurs, the duration of α-amylase in the lungs requires further exploration to assist in interpretation of positive values. After these values are identified they need be used consistently used throughout practice of mechanically ventilated patients. Inconsistencies in the defining parameters of α-amylase were used with the thirteen studies. Conclusion: Testing amylase levels can require financial stability, standardized training, and timeliness of collecting the specimen. Alpha-amylase is a biomarker of microaspiration. Further research should be conducted to evaluate the biomarker capabilities of α-amylase to assist in early identification and/or prevention of microaspiration in mechanically ventilated patients. Implications for nursing policy practice, education, and considerations for upcoming research of α-amylase were reviewed with limitations to the study.