You are leaving Medscape Education
Cancel Continue
Log in to save activities Your saved activities will show here so that you can easily access them whenever you're ready. Log in here CME & Education Log in to keep track of your credits.
 

 

CE

An Update on Preventing Ventilator-Associated Pneumonia in Adults

  • Authors: Laura A. Stokowski, RN, MS
  • THIS ACTIVITY HAS EXPIRED
Start Activity


Target Audience and Goal Statement

This activity is intended for critical care nurses, respiratory therapists, and other healthcare professionals interested in learning more about preventing ventilator-associated pneumonia (VAP).

The goal of this activity is to provide critical care health professionals with a current evidence base for interventions to prevent VAP.

Upon completion of this activity, participants will be able to:

  1. Explain the definition and pathophysiology of VAP
  2. List evidence-based interventions that are effective or ineffective in the prevention of VAP.


Disclosures

As an organization accredited by the ACCME, Medscape, LLC requires everyone who is in a position to control the content of an education activity to disclose all relevant financial relationships with any commercial interest. The ACCME defines "relevant financial relationships" as financial relationships in any amount, occurring within the past 12 months, including financial relationships of a spouse or life partner, that could create a conflict of interest.

Medscape, LLC encourages Authors to identify investigational products or off-label uses of products regulated by the US Food and Drug Administration, at first mention and where appropriate in the content.


Author

  • Laura A. Stokowski, RN, MS

    Staff Nurse, Inova Fairfax Hospital for Children, Falls Church, Virginia; Editor, Medscape Ask the Experts Advanced Practice Nurses

    Disclosures

    Disclosure: Laura A. Stokowski, RN, MS, has disclosed no relevant financial relationships.

Nurse Planner

  • Susan Yox, RN, EdD

    Site Editorial Director, Medscape Nurses

    Disclosures

    Disclosure: Susan Yox, RN, EdD, has disclosed no relevant financial relationships.

Editor

  • Susan Yox, RN, EdD

    Site Editorial Director, Medscape Nurses

    Disclosures

    Disclosure: Susan Yox, RN, EdD, has disclosed no relevant financial relationships.


Accreditation Statements

    For Nurses

  • Medscape, LLC is an approved provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation.

    Awarded 0.75 contact hour(s) of continuing nursing education for RNs and APNs; none of these credits is in the area of pharmacology.

    Contact This Provider

For questions regarding the content of this activity, contact the accredited provider for this CME/CE activity noted above. For technical assistance, contact [email protected]


Instructions for Participation and Credit

There are no fees for participating in or receiving credit for this online educational activity. For information on applicability and acceptance of continuing education credit for this activity, please consult your professional licensing board.

This activity is designed to be completed within the time designated on the title page; physicians should claim only those credits that reflect the time actually spent in the activity. To successfully earn credit, participants must complete the activity online during the valid credit period that is noted on the title page.

Follow these steps to earn CME/CE credit*:

  1. Read the target audience, learning objectives, and author disclosures.
  2. Study the educational content online or printed out.
  3. Online, choose the best answer to each test question. To receive a certificate, you must receive a passing score as designated at the top of the test. Medscape encourages you to complete the Activity Evaluation to provide feedback for future programming.

You may now view or print the certificate from your CME/CE Tracker. You may print the certificate but you cannot alter it. Credits will be tallied in your CME/CE Tracker and archived for 6 years; at any point within this time period you can print out the tally as well as the certificates by accessing "Edit Your Profile" at the top of your Medscape homepage.

*The credit that you receive is based on your user profile.

CE

An Update on Preventing Ventilator-Associated Pneumonia in Adults: Ventilator Bundles

processing....

Ventilator Bundles

A care "bundle" is a set of evidence-based clinical practices that individually improve care and, when combined, magnify improvement.[14] The scientific evidence for each element of a bundle is sufficient for that element to represent a standard of care.[14] The Institute for Healthcare Improvement's (IHI) ventilator bundle combines 4 components of care: elevating the head of the bed, daily sedative interruption and assessment of readiness to extubate, peptic ulcer disease prophylaxis, and deep vein thrombosis prophylaxis.[14] The ventilator bundle was initially designed as an overall strategy to improve care of ventilated patients, not necessarily to prevent VAP. However, many hospitals documented a reduction in VAP rates (by an average of 45%) following implementation of the bundle. When teams in some facilities unfailingly apply every bundle element on every patient every time, they have experienced months without a single case of VAP.[14]

The IHI ventilator bundle is not intended to be a comprehensive plan of care to prevent VAP. The IHI recognizes that oral care, subglottic suctioning, gut decontamination, and continuous lateral rotation are also important preventive strategies.[14] Many hospitals have added one or more of these strategies to their VAP prevention protocols. Care should be taken to avoid overly extensive care bundles, because care bundles are most effective when the number of elements is small.[14] The IHI emphasizes that implementing the ventilator bundle requires planning and takes time; it will not be achieved overnight.[14] Recommendations for how to implement and evaluate the ventilator bundle, including useful documentation forms, are available online from the IHI.

Other VAP prevention bundles have been published as well. A bundle of interventions collectively known as FASTHUG (daily evaluation of feeding, analgesia, sedation, thromboembolic prophylaxis, elevation of the head of the bed, ulcer prophylaxis, and glucose control), consistently applied for 2 years, led to a significant drop in VAP (from 19.3 to 7.3 per 1000 ventilator days) among surgical intensive care patients.[34]

Some experts recommend going "beyond the bundle," and employing other evidence-based processes that may lead to a zero VAP rate. Linda Greene emphasizes that hospitals should first "hardwire the basics," such as compliance with handwashing, and then gradually incorporate evidence-based practices into the routine standard of care. "Measure your basic processes, such as head-of-bed elevation, hand hygiene, and oral care, first," suggests Greene. "If you're not doing well there, introducing advanced, extensive protocols will not be successful."