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Patients who require mechanical ventilation (MV) are at risk for developing ventilator associated pneumonia (VAP). Nurses’ adherence to sedation vacations (SVs) has a direct impact on the development of VAP, because SVs have been shown to reduce patients’ average duration of MV and length of stay (LOS) in the intensive care unit (ICU). The purposes of this study guided by Donabedian’s (1966) model were to quantify nurses’ level of adherence to SVs, in relation to the health outcomes of critically ill patients, and identify the barriers and facilitators to performing SVs. A correlational design was used. The design included three components: abstraction of patient data from the electronic medical record (EMR) (n=79 with VAP and n=79 without VAP), administration of surveys to ICU nurses (N =34), and vignettes related to SVs. Analyses included descriptive statistics, t-tests, correlations, and analyses of covariance. Most nurses held a Bachelors degree (70.6%), had < 9 years of ICU experience (52.9%), worked in a medical ICU (47.1%), and reported high confidence in managing SVs (M =8.88, SD =1.25). The majority of patients (N =158) were Black (58.2%), males (56.3%), and on average middle-aged (M =61.5, SD =14.91), with a long ICU LOS (M =15.5, SD =11.84), extended duration of MV (M =9.5, SD =8.47), and high acuity (APACHE III) (M =70.2, SD =25.42). The nurses’ education, advanced certification, and ICU experience were not associated with the appropriate implementation of SVs in the vignettes. On average nurses’ had low scores on the vignettes (M =6.97, SD =2.21; possible range =0-14). The adherence rate of nurses’ implementation of SVs, determined using EMR data, was also low (M =24%; SD =23%). There were higher rates of SV adherence in patients without VAP (p (p < .01), and a duration of MV < 6 days (p =.04). These findings indicate that even with established protocols, nurses may not consistently implement the evidenced-based interventions that have been shown to prevent nosocomial infections. Future research is needed to improve nursing practice and the quality of care in this patient population.

Bakgrund: Intuberade patienter inom intensivvården har en hög risk för att erhålla en ventilator-associerad pneumoni (VAP). Det finns evidensbaserade riktlinjer för vuxna somförebygger VAP. För barn behövs det däremot mer forskning för att klargöra vilka omvårdnadsåtgärder som kan standardiseras. Syfte: Syftet är att beskriva vilka omvårdnadsåtgärder som förebygger VAP hos barn inom intensivvården, en litteraturöversikt. Metod: En deskriptiv litteraturstudie med kvantitativ induktiv ansats valdes. 16 kvantitativa studier analyserades med en innehållsanalys. Det samlade materialet kvalitetsgranskades med hjälp av GRADE. Resultat: Fem huvudteman identifierades utifrån studiernas resultat. Huvudteman var VAP-omvårdnadspaket, munvård med klorhexidin, skötsel av endotrakealtub, olika nutritionssonder, omvårdnadsutbildning. VAP-omvårdnadspaket och omvårdnadsutbildning visade sig statistiskt signifikant sänka VAP-prevalensen hos barn. Munvård med klorhexidin kunde inte sänka VAP-prevalensen. Slutsats: Med rätt evidensbaserad vård kan VAP-prevalensen sänkas. Forskning kring VAP-prevention till barn saknar evidens i nuläget och kan ej anses vara evidensbaserad vård. För att göra vården evidensbaserad, rekommenderas att globala riktlinjer för VAP-prevention till barn tas fram. / Background: Intubated patients admitted to an intensive care unit have a higher risk ofacquiring ventilator-associated pneumonia (VAP). There are evidence-based guidelines for adults that prevent VAP. For children there is a need for more research in this area to clarifywhich nursing methods can be standardized. Aim: The aim was to describe which nursing care measures prevent VAP in children admitted to the intensive care unit, a literature review. Method: A descriptive literature study with a quantitative inductive approach was used. A total of 16 quantitative studies was analysed with a content analysis. A GRADE system was used to assess the quality of the included studies. Results: Five main themes were identified from the study’s results. The main themes where VAP-care bundles, oral care with chlorhexidine, care of endotracheal tube, different nutritional catheters, and nursing care education. VAP-care bundles and nursing care education showed to have statistically and significantly lowered the prevalence of VAP in children. Oral care with Chlorhexidine did not lower the prevalence significantly of VAP. Conclusion: The prevalence of VAP can be lowered with the right evidence-based practice. At the current situation research on preventing VAP in children lack evidence and can’t be considered as evidence-based practice. To make the nursing care evidence based, it´s recommended to create global guidelines of VAP-prevention for children.

Bakgrund: Munhälsan hos intuberade patienter försämras successivt under vårdtiden. Risken att drabbas av VAP ökar dagligen och VAP anses vara en av de vanligaste komplikationerna till respiratorvård och patienter som drabbas kräver längre vårdtid. Munvård är en del av VAP-preventionen men det framgår inte vilka specifika munvårdsåtgärder som har effekt.    Syfte: Syftet med denna uppsats är att beskriva vilka munvårdsåtgärder som är mest effektiva avseende preventionen av VAP och därmed bör användas i intensivvårdssjuksköterskans dagliga arbete.   Metod: En systematisk litteraturöversikt med kvantitativ induktiv ansats. Sammanlagt 17 studier inkluderades i denna uppsats.    Resultat: Två huvudkategorier identifierades samt två subkategorier. Införandet av munvårdsprotokoll gav en statistiskt signifikant minskning av VAP-prevalens, klorhexidin kan vara effektivt mot VAP men det finns även andra antibakteriella lösningar som effektivt förebygger VAP.    Slutsats: För att bidra till ökad patientsäkerhet borde specialistsjuksköterskor inom intensivvård använda ett munvårdsprotokoll för att arbeta preventivt mot VAP. Utöver detta ska tandborstar regelbundet bytas ut, verksamheten borde även se över möjligheten att inkludera tandläkare. Dock är det aktuellt med ytterligare forskning om munvård för att i framtiden använda endast de munvårdsåtgärder som bevisats vara effektiva. / Background: The oral hygiene in intubated patients successively deteriorates during the period of care. The risk of contracting a VAP increases daily and VAP is considered to be one of the most common complications related to mechanical ventilation. The patients who are afflicted require a prolonged hospital stay. Oral hygiene is a part of VAP-prevention but it remains unclear as to which specific oral care measures are effective.    Aim: The aim of this study is to describe which oral care measures are the most effective in the prevention of VAP and therefore should be used by the intensive care nurse in the daily working routine.    Method: A systematic literature study with a qualitative inductive approach was used. A total of 17 studies were included in this essay.   Results: Two main categories were identified as well as two subcategories. The adoption of oral care protocols showed a statistically significant decrease of VAP, and chlorhexidine can be effective against VAP however there are also other antibacterial solutions which effectively prevent VAP.   Conclusion: In order to contribute to increased patient safety intensive care nurses should use an oral care protocol to prevent VAP. In addition to the protocol toothbrushes should be replaced regularly, and the ward should oversee the possibility of including dentists to optimize the oral care. Oral care requires additional research so that in the future it is possible to use only the oral care procedures that have been proven to be effective.

Made available in DSpace on 2014-12-17T14:46:36Z (GMT). No. of bitstreams: 1 CristianeRM.pdf: 5245197 bytes, checksum: e2a591b692b29f0a98a345fa8cdc01ad (MD5) Previous issue date: 2008-05-29 / Quasi-experimental study, prospective with quantitative approach, performed at the Hospital do Cora??o in Natal, aimed at verified the existence of difference between the care given by health professionals to the patients under mechanical ventilation (MV) in the Intensive Care Unit, before and after an educative intervention. The population was of 31 professionals, with data collected between november 05 of 2007 to march 27 of 2008. The results show a yong population, female gender, middle level of education, nursing technique, working between 05 and 09 years on nursing profession, and 01 to 04 years on Intensive Care Unit; almost all, never had an kind of training over prevent pneumonia associated to mechanical ventilation; from those that had training, occur on the work place with duration from 12 to 24 hours. About endotracheal intubation, the cuff was tested with a sterilized syringe had a positive change after a educative intervention, increased from 75,0% to 100,0%; the sterile guide was used on 75,0% before and 100,0% after an educative intervention. Regarding endotracheal suction procedure, was not informed to the patient on 72,7% before, however was informed on 56,7% after; the hands was not previously washed 68,5% before, however was 63,3% after the procedure; mask was used on 74,2 % opportunities before and 76,7% after; the aspiration catheter had adequated size on 98,9% observation before and 100,0% after; the gaze was sterilized on 95,7% before and 100,0% after; the ventilator was connected to the patient during the aspiration intervals on 94,4% observation before and 100,0% after; the ambu bag was clean and protected on 76,1% before and 85,7% after; the aspiration catheter was discarded after be used on 98,9% before and 100,0% after; FIO2 was turned to the begging value on 32,9% observation before and 12,0% after; before the procedure 71,9% professions washed their hands and 73,3% after; before, notes of aspiration results were performed on 70,8% observation and 86,7% after. Regarding devices used on respiratory tract, aspirator flasks were not swapped on 84,6% observations before and 71,0% after; daily l?tex extention change was not performed on 93,6% observation before and 87,1% after; the ambu bag change was not performed on 50,0% observation before even if was duty or unprotected and on 75,8% opportunities was changed, after; nebulization was not prepared with sterile fluids or manipulated aseptically on 65,2% observation before, perhaps was on 71,7% after; before nebulizers were not changed on 65,2% observations, perhaps were on 60,9% after. Concerning ventilator breathing circuits, condense fluids cumulated on circuits were removed on 55,0% opportunities before, and 64,0% after; moisturizer was not filled with sterile water when already had small amount of liquid inside on 78,4% observations before, and 90,2% after; MV circuits were changed on 97,0% observations on presence of visible duty or when presents some kind of failure, before and 98,4% after. About body position, on 51,3% observations the decubitus position change were done before and 78,2% after; fowler position was maitened on 95,5% observations before and 98,2% after; Regarding respiratory physiotherapy, enteral diet was not interrupted before respiratory physiotherapy on 94,9% before and 90,0% after; respiratory physiotherapy devices were not disinfected or sterile on 69,6% observations before but they re on 60,0% after; before the cateter was not tested before introduction enteral diet or medications on 100,0% but after was done on 15,2%. About enteral feeding, intestine motility and measure of stomach contents were not done on 100,0% observations before, but was 15,2% after. We conclude that 05 of 07 valuated procedures in relation to MV, had a significant improvement on quality of care given after educative intervention, when compared before intervention / Estudo quase-experimental, com abordagem quantitativa, delineamento tempo-s?rie e dados prospectivos, realizado no Hospital do Cora??o de Natal, objetivando verificar a exist?ncia de diferen?a entre a assist?ncia prestada pelos profissionais de sa?de aos pacientes sob ventila??o mec?nica (VM) internados na UTI, antes e ap?s uma interven??o educativa. A popula??o fo de 31 profissionais, com dados coletados entre 05 de novembro de 2007 e 27 de mar?o de 2008. Os resultados mostram uma popula??o jovem, entre 20 e 30 anos de idade, do sexo feminino, ensino n?vel m?dio completo, na maioria, t?cnicos de enfermagem, trabalhando entre 05 e 09 anos na profiss?o, e 01 e 04 anos em UTI; a maioria nunca realizou treinamento acerca da preven??o de PAV; dos que realizaram, participaram em eventos da institui??o com dura??o entre 12 e 24 horas. Quanto ? intuba??o endotraqueal, o teste do cuff com seringa est?ril sofreu modifica??o positiva, ap?s a interven??o educativa, aumentando de 75,0% para 100,0%; o fio guia est?ril foi usado em 75,0% das ocasi?es antes e em 100,0% ap?s. Sobre aaspira??o endotraqueal, n?o foi explicado ao paciente sobre esse procedimento em 72,7% das situa??es antes, mas foi em 56,7% das vezes ap?s; a higieniza??o das m?os n?o foi realizada previamente em 68,5% das vezes antes, mas foi em 63,3% ap?s; a m?scara foi utilizada em 74,2% das oportunidades antes e em 76,7% ap?s; o cateter de aspira??o tinha o tamanho adequado em 98,9% das observa??es antes e em 100,0% ap?s; a gaze usada estava est?ril em 95,7% antes e em 100,0% ap?s; o ventilador foi conectado ao paciente durante os intervalos da aspira??o em 94,4% das oportunidades antes e em 100,0% ap?s; o ambu estava limpo e protegido em 76,1% das situa??es antes e em 85,7% ap?s; o cateter de aspira??o foi descartado ap?s o uso em 98,9% das oportunidades antes e em 100,0% ap?s; a extens?o de l?tex foi limpa em 86,5% das observa??es antes e em 93,3% ap?s; a FIO2 foi retornada ao valor inicial em 32,9% das vezes antes e em 12,0% ap?s; a higieniza??o das m?os ao t?rmino do procedimento foi feita em 71,9% das situa??es antes e em 73,3% ap?s; as anota??es referentes ? aspira??o foram feitas em 70,8% das observa??es antes e em 86,7% ap?s. Quanto aos dispositivos, a troca di?ria dos frascos aspiradores n?o foi obedecida em 84,6% das oportunidades antes e em 71,0% ap?s; a troca di?ria da extens?o de l?tex n?o foi realizada em 93,6% das vezes antes e em 87,1% ap?s; o ambu n?o foi trocado em 50,0% das observa??es, embora estivesse sujo e/ou desprotegido antes, mas em 75,8% das oportunidades esse dispositivo foi trocado ap?s; a nebuliza??o n?o foi preparada com flu?dos n?o est?reis e/ou manipulada assepticamente em 65,2% das ocasi?es antes; entretanto em 71,7% das vezes foram realizados ap?s; os nebulizadores n?o foram trocados em 65,2% das situa??es antes, mas foram em 60,9% ap?s. Acerca dos circuitos do VM, o condensado acumulado nos circuitos foi descartado em 55,0% das vezes antes e em 64,0% ap?s; o preenchimento do umidificador com ?gua, n?o foi feito em 78,4% das vezes em que possu?a l?quidos remanescentes antes e em 90,2% ap?s; os circuitos do VM foram trocados em 97,0% das oportunidades em que apresentavam sujidade vis?vel ou estavam defeituosos antes e em 98,4% ap?s. Quanto ? mudan?a de dec?bito, em 51,3% das vezes antes foi realizada e em 78,2% ap?s; a cabeceira do leito do paciente foi mantida elevada em 95,5% das observa??es antes e em 98,2% ap?s. Sobre a fisioterapia, a dieta enteral n?o foi interrompida antes das manobras fisioter?picas em 94,9% das situa??es antes e em 90,0% ap?s; os materiais usados durante a fisioterapia n?o estavam desinfetados e/ou est?reis em 69,6% das observa??es antes, mas estavam em 60,0% ap?s. Quanto ? nutri??o enteral, o teste da sonda antes de iniciar a dieta enteral ou de administrar medicamentos n?o foi realizado em nenhuma das oportunidades antes, entretanto foi em 15,2% ap?s; a motilidade intestinal e aferi??o do conte?do (residual) g?strico n?o foram verificadas em nenhuma das observa??es, mas foi em 15,2%, ap?s. Conclu?mos que, em 05 dos 07 procedimentos avaliados em rela??o ? VM, houve melhora significativa na qualidade da assist?ncia prestada quando comparados ao momento anterior ? interven??o educativa

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