PICOT Paper-Preventing VAP in ICU Settings.

Posted: December 17th, 2022

PICOT Paper-Preventing VAP in ICU Settings.


This is the requirements for the assignment copied and pasted from my instructor’s website. I have also included an attachment of my PICOT question in which my paper must be based upon.

APA Formatted paper will include –

Title Page

First Level Headings –

Title of the Paper – centered not bolded

Clinical Significance – centered bolded

Review of the Literature – centered bolded

Implications to Nursing Practice – centered bolded

Implications to Patient Outcomes – centered bolded

References – centered not bolded



Assignment Components–

Identify an area of interest and Clinical Significance
Formulate a PICO question.
Examination of current literature
Identify the implications to nursing practice and patient outcomes
Assignment Components Explained –

1. Identify an area of interest and Clinical Significance

Choose a topic of interest which you want to learn more about and that that you feel there is a need to provide evidence for within your clinical practice.PICOT Paper-Preventing VAP in ICU Settings.

2. Formulate a PICO question.

Frame your problem and focus on what it is you want to find out.

Use the P-I-C-O-T method of asking the question:

P – Population or disease of interest, for example age, gender, ethnicity, with certain disorder
I – Intervention or issue of interest for example- therapy, exposure to disease, risk behavior
C – Comparison intervention or issue of interest. What do you want to compare the intervention or issue against, for example alternative therapy, placebo, or no intervention/therapy, no disease, absence of risk factor?
O –Outcome of interest, for example outcome expected from therapy, risk of disease, accuracy of diagnosis, rate of occurrence or adverse outcome
T –Time. Some questions might include a time frame to demonstrate an outcome, such as the time it takes for the intervention to achieve the outcome, the time over which populations are observed for the outcome to occur; given a certain condition. PICOT Paper-Preventing VAP in ICU Settings.Examples:

In patients living in a long-term care facility who are at risk for pressure ulcers (P), how does a pressure ulcer prevention program (I) compared to the standard of care (e.g., turning every 2 hours) (C) affect signs of emerging pressure ulcers (O) during hospitalization (T)?

In patients who have a family history of obesity (BMI>30) (P), how does dietary carbohydrate intake (I) predict healthy weight maintenance (BMI<25) (O) over six months (T)?

3. Examination of current literature


Critique and synthesize the literature.

Research articles must be peer reviewed original nursing research articles. Meta-analysis, editorials, opinion pieces, systematic reviews, and reviews of the literature are NOT acceptable.

Look for articles written by researchers who are reporting on their original research that includes study purpose or aim, sample, method, findings or results, and discussion. You will see these exact words in both the abstract and the body of the paper.PICOT Paper-Preventing VAP in ICU Settings.

Analyze the research report by applying your research knowledge. Compare and contrast the results of the various studies in your literature review. Was the literature consistent? Were there various or perhaps contradictory results?

Critique and synthesize the literature. Analyze the research report by applying your research knowledge. Compare and contrast the results of the various studies in your literature review. Was the literature consistent? Were there various or perhaps contradictory results?

Extensive repetition or summarization of the research article will result in point deduction.

4. Identify the implications to nursing practice and patient outcomes –

Include with the poster a section describing the implications to nursing practice and patient outcomes.

There is also a component of a poster that must be done on a single powerpoint slide, I have also attached an example from the instructor’s page.

Preventing VAP In Adult Intubated Patients in ICU Settings

Patients who are critically ill, unconscious or under sedation during treatment in ICU settings require ventilator machines support to breathe properly. However, intubation or mechanical ventilation exceeding 48 hours can result in VAP, a life-threatening complication characterized by changes in sputum, signs of systemic infection and persistent infiltration (Alimi et al., 2016). VAP accounts for half of the nosocomial-acquired pneumonia incidences, with an estimated prevalence that ranges between 9-27% with the highest risk occurring within the first five days of admission (Hoshijima et al., 2013). VAP jeopardizes patient safety, causes inefficiencies in healthcare organizations and reduces the quality of care.PICOT Paper-Preventing VAP in ICU Settings.

According to the CDC, the most significant mechanism that is responsible for VAP is aspirating oropharyngeal organisms into the distal bronchi, a clear revelation that VAP is associated with contamination of the oral cavity with pathologic bacteria during the intubation process. Therefore, existing literature emphasizes on maintaining oral hygiene with 0.2% oral chlorhexidine before intubation to reduce the risks of VAP. According to Zuckerman (2016), chlorhexidine is notably an antibacterial agent with broad-spectrum properties extensively used as an oral rinse in healthy people to treat and prevent gingivitis and control dental plaque.PICOT Paper-Preventing VAP in ICU Settings.

Clinical Significance

As the most significant HAI in ICU settings. Its incidence ranges between 9-27% and the mortality rate among mechanically ventilated patients surpasses 50% (Hoshijima et al., 2013). VAP is linked to prolonged hospitalization, high mortality and morbidity rates and increases the costs of treatment. Thus, VAP is still a medical issue of significance that requires preventive interventions to limit its occurrence despite the advancements made in its diagnosis and treatment.

Review of Literature

According to Alimi et al. (2016), concurrent oronasal disinfection using chlorhexidine gives no significant outcomes in comparison to independent disinfection of the oral cavity, despite the clinical variations noted in the outcomes. Alimi et al. (2016) observed the following variables that indicate VAP in their study: leukopenia/leukocytosis, hypothermia/hyperthermia, pulmonary infiltration as observed in a chest radiograph and purulent tracheal discharge. In the intervention group, these variables were less frequent. They further recommend that to reduce the risks of VAP, VAP-associated morbidity and reduce the length of ICU stay, nurses should practice the routine use of oral chlorhexidine to maintain oral hygiene.PICOT Paper-Preventing VAP in ICU Settings.

Villar et al. (2016) had similar findings but emphasize that reducing VAP in adults is effective when oral chlorhexidine is administered four times daily or at 2%. However, due to the heterogeneity of the study and had a limited number of RCTs which examined the effectiveness and safety of 2% chlorhexidine or four times daily administration, they suggest the need to interpret their finding cautiously. Before making any definite recommendations, Villar et al. (2016) further recommend that further studies should investigate intervention protocols that implement oral chlorhexidine at high frequency and concentration to reduce VAP.PICOT Paper-Preventing VAP in ICU Settings.

The study by Zuckerman (2016) had a comprehensive outcome that supports using CHX for VAP prevention among adult patients in ICU settings. By using oral chlorhexidine, Zuckerman (2016) found a decrease patient VAP rates that was statistically significant. He further suggests that oral CHX is an essential component of VAP bundles that must be encouraged when managing patients in the ICU. However, Zuckerman (2016) emphasizes that providers should comprehend how it correctly. It must be given orally with a sponge swab round the oral cavity and tongue of patients under mechanical ventilated or intubation. Besides, therapy should start instantaneously following intubation and progress until extubation to prevent VAP. Zuckerman (2016) found that oral chlorhexidine should be administered four times daily to have the most beneficial outcomes for preventing VAP, a finding that is similar to that of Villar et al. (2016).PICOT Paper-Preventing VAP in ICU Settings.

Hoshijima et al. (2013) acknowledge VAP as the most common primary cause of deaths and in adult patients admitted in the ICU. They conducted a meta-analysis of RCTs that evaluated how effective and efficacious CHX is in preventing VAP. Their study illustrated that oral CHX reduced VAP incidences in intubated patients at a concentration of 0.12-0.2% and this was consistent in both non-surgical and post-cardiac patients. However, they found no overall reduction in VAP associated mortality from using oral chlorhexidine.

According to the study by Li et al., (2015), oral hygiene with CHX is linked with a 28% reduced risk of VAP and has an enhanced effectiveness to prevent early-onset than late-onset VAP. The findings further reveal that, in patients who have undergone cardiac surgery, chlorhexidine 0.12% is the recommended concentration. However, in non-cardiac patients in ICU settings, higher concentrations especially 2% is effective in reducing VAP prevalence.

Implications to Nursing Practice

Based on the findings of the literature review, it is right to conclude that the clinical criteria of VAP such as: pulmonary infiltration, purulent endotracheal discharge and WBC count outside the normal range decreased significantly in the intervention groups. The incidences of VAP, VAP-associated mortality and morbidity and reduced length of ICU stay also reduced significantly in the intervention groups, an outcome that was clinically significant. This outcome indicates the clinical significance and essence of nurses routinely disinfecting the oral cavity of adult patients in the ICU under mechanical ventilation or intubation with 2% oral chlorhexidine or oral chlorhexidine administered four times daily.

The findings of the literature also reveal that it is essential to be informed on the most recent literature that supports evidence-based practice to improve patient care and interventions. This increases nurses’ ability to conduct patient assessments and management as well as to educate other ICU staff on oral CHX to prevent VAP. This is a perfect example of a strategy that nurses can implement in clinical settings to prevent avoidable harm to patients.PICOT Paper-Preventing VAP in ICU Settings.

Besides, nurses should take part in daily rounds, assess patients, work with other ICU staff for system-wide implementation of this change, and cultivate a spirit of collaboration for VAP prevention. This promotes the ability of nurses to function as a link between patients and all ICU staff to ensure that patients receive complete care with positive outcomes in preventing VAP.

Implications for Patient Outcomes

VAP is a major contributor to mortality and morbidity of patients in ICU settings as well as a principal cause of HAIs deaths. Therefore, it is vital to consider it in discussions that involve patients’ outcomes. To minimize the risks, healthcare providers should focus on early extubation and using 2% oral chlorhexidine with most notable patient outcomes as reduced incidences of VAP, reduced length of ICU stay, decreases the intubation period, reduces healthcare costs, and decreases VAP-associated mortalities and morbidities.PICOT Paper-Preventing VAP in ICU Settings.

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