In a paper of 500-750 words, clearly identify the clinical problem and how it can result in a positive patient outcome. Describe the problem in the PICOT question as it relates to the following: Evidence-based solution Nursing intervention Patient care Health care agency Nursing practice Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

In a paper of 500-750 words, clearly identify the clinical problem and how it can result in a positive patient outcome. Describe the problem in the PICOT question as it relates to the following: Evidence-based solution Nursing intervention Patient care Health care agency Nursing practice Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

PICOT Question Example

The human body comprises complex systems that perform various functions that promote life. The immune system is among the essential systems that prevent the body from infections. Immunity is not limited to the lymphoid system, intact skin, initial inflammatory response, and oral mucosa (Bankanie et al., 2021). Unlike healthy individuals who have improved immunity, patients in the intensive unit (ICU) are at increased risk of several infections due to reduced immunity and invasive life-saving procedures such as endotracheal intubation, central lines, and mechanical ventilation (Chen et al., 2022). As a result, they are susceptible to most infections, including bacteremia, periodontal disease, central line infections, infective endocarditis, and ventilator-acquired pneumonia (VAP). Reducing such infections requires nurse-led interventions to reduce incidences while improving patient outcomes. Among the common interventions aimed at improving oral hygiene, preventing aspiration of micro-biota, and reducing colonization by micro-organisms. To get more insight, I came up with a PICOT question that will aid in improving my knowledge of this subject.

PICOT: In adult patients intubated in ICU (P), how does daily use of Chlorohexidine (I) compared to not using (C) reduce the risk of ventilator-acquired pneumonia (VAP) (O) over three months? (T)

Clinical Problem

VAP is a lung infection that develops more than 48 hours after intubation for mechanical ventilation. It is the most common nosocomial infection among intubated ICU patients, accounting for 9-27% of infections in the ICU (Bankanie et al., 2021). Endotracheal intubation is performed to save the lives of critically ill patients who are unable to breathe, unconscious, or sedated by medications. It helps by maintaining the patency of the airway and supplying oxygen for metabolic demands. Despite being useful, they act as a breach through which microorganisms access the respiratory tract, causing VAP.

VAP is caused by various micro-organisms that invade the respiratory tract. Among the most common isolated bacteria include Staphylococcus aureus, Pseudomonas aeruginosa, and Enterobacteriaceae (Chen et al., 2022). These pathogens inoculate either in the oropharynx, gastrointestinal, subglottic, or oral mucosa, where they spread to the lower respiratory system, causing the infection. In addition to endotracheal intubation, other risk factors increase the risk of VAP, including advanced age, immobilization, supine body positioning, certain medications, and ventilatory support (Dale et al., 2019). The development of VAP negatively impairs patient outcomes. It increases the risk of mortality, hospital stay, and morbidity, consequently increasing the cost of care. Reducing the negative outcomes requires the installation of preventive methods that improve outcomes.

Nursing Intervention

Despite the adverse effects caused by VAP, nurses have a vital role in devising preventive measures to reduce incidences. Among the various preventive measures, the use of chlorhexidine gluconate (CHG) is an evidence-based practice that has been used in various settings (Kocaçal et al., 2019). CHG is an antiseptic agent that has a bactericidal effect against harmful bacteria. It is effective against both gram-positive and gram-negative bacteria. It acts by binding to the cell wall of bacteria, thus inhibiting cell wall integrity and causing bacterial death (Niedzwiecka et al., 2019). Therefore, it leads to a reduction in microbial load while reducing incidences of nosocomial infections, including VAP. This leads to improved patient outcomes while reducing morbidity and mortality.

Summary

VAP is a common clinical problem yet preventable. Integration of using CHG in clinical practice has proved to be effective in reducing the incidences. Therefore, it is paramount that all nurses adhere to preventive methods while managing patients. This will help in reducing the cost of care, reduce hospital stays, improve patient satisfaction, reduce mortality and morbidity, and improve patient outcomes. Finally, prevention of VAP will reduce the rate of drug-resistant organisms that are difficult to treat.

References

Bankanie, V., Outwater, A. H., Wan, L., & Yinglan, L. (2021). Assessment of knowledge and compliance to evidence-based guidelines for VAP prevention among ICU nurses in Tanzania. BMC Nursing, 20(1), 209. https://doi.org/10.1186/s12912-021-00735-8