Prevent healthcare-associated infection
1-There are many areas in nursing where evidence-based practice has improved care processes and patient outcomes including the bundles of checklist to prevent pneumonia related to mechanical ventilation and central line-associated blood stream infection or CLABSI.
To prevent healthcare-associated infection such as the ventilator-associated pneumonia (VAP) for patient who had been intubated for more than 48 hours, the VAP bundles of care are often used. Recommended bundle of interventions for the prevention of VAP includes elevation of the head of the bed at a 30° to 45° angle to prevent aspiration of gastric content, reducing the duration of mechanical ventilation by daily sedation interruption (DSI) and daily spontaneous breathing trials (SBT), peptic ulcer disease (PUD) prophylaxis, and deep-vein thrombosis (DVT) prophylaxis. Moreover, performing oral care every two hours and as needed, maintaining ET tube cuff pressure above 20 cm H20, and managing ventilator circuits and changing only when visibly soiled showed improvements in VAP in critically ill patients.
Another area where evidence-based practice has improved patient outcome is through the use of bundles or interventions to prevent or decreased central line-associated blood stream infections. Those recommended bundle of interventions for the prevention of CLABSI includes proper hand hygiene, skin preparation using chlorhexidine solution greater than 0.5%, adhering to aseptic technique and use of sterile gloves, regular assessment and inspection of site, and daily evaluation whether the use of central line is still necessary.
According to the ANA (2018), when patient received the optimal intervention bundle, the expected time for any ventilator-associated pneumonia to occur takes almost 3.5 times longer that those who did not. At the hospital I work for, when we chart our lines/drains/airways one of the question we are asked is if the patient still meets the criteria for continuing the line. When no longer necessary, it prompts immediate consideration for removal. The bundles/checklist does not only act as a learning tool but also serves as a guideline. By knowing the bundles of interventions we can better care for our patients and avoid unnecessary and preventable infections.
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