Treating Patients With Ventilator-Associated Pneumonia (VAP): The Challenges Of Implementing Nursing Bundles Of Care

Abstract

A ventilator is any device used to support, assist, or control respiration. Ventilator Associated Pneumonia (VAP) can result from long term mechanical ventilation and causes a major life-threatening infection that has a high prevalence in patients in the Intensive Care Unit (ICU) within our hospitals today. Despite having life-saving benefits, mechanical ventilation puts patients at a high risk of developing VAP; this increases the length of hospital stay, increases the cost of treatment, and decreases patient quality of life. Therefore, hospitals have implemented standardized preventative care interventions or “bundles” for mechanically ventilated patients in attempts to reduce the overall VAP prevalence, and infection rate. A systemic literature review was performed using the CINAHL Plus database to investigate the challenges posed to nurses when implementing VAP care bundle interventions in ICU patients. Major themes are (a) VAP bundles significantly reduce days on a ventilator and days in the ICU, (b) What is in the care bundle matters, (c) Nursing compliance is related to education and years of experience, (d) Barriers to nursing adherence is related to the use of bundles, (e) Institutional barriers that affect nursing adherence to the use of bundles. The registered nurse is in a key position to mitigate the risk of VAP. Hospitals must provide standardized nursing policies that emerge from interpersonal communication with bedside nurses to enforce Evidence Based Practices. In the future, to provide optimal care for mechanically ventilated patients, hospitals must take action to create changes to overcome institutional barriers which impact patient care.