NR542-11252 Week 3 Course Project—Database Plan LT

NR542-11252 Week 3 Course Project—Database Plan LT

NR542-11252 Week 3 Course Project—Database Plan LT

Introduction

Hospital-acquired infections or nosocomial infections are contact-based infections that patients commonly acquire while hospitalized, especially in the ICU and CVICU, where patients typically have prolonged stays. Hospital-acquired pneumonia (HAP) account for 13-18% of all nosocomial infections, which makes them the second most common after urinary tract infections. The mortality rate for HAP is between 20% and 50%, and approximately 75% of these cases occur in mechanically ventilated patients (Liao et al., 2015). Statistics of NNIS (American National Nosocomial Infections Surveillance System) stated; when ventilator associated pneumonia take place at early phase of hospitalization, like one to five days after hospitalization, the contributing factor is probably the pharyngeal bacteria (Liao et al., 2015). 

Problem Identification

Ventilator-associated pneumonia is a renowned impediment of mechanical ventilation among ventilator dependent patients. Hence, the existence of an endotracheal tube is a significant contributor for VAP occurrence. Flow of air through ETT transfers pathogens to the distal airways, bypassing protective mechanisms of respiratory tract (Taylor et al., 2019). Risky factors involve weakened host fortifications, dirty equipment, prolonged mechanical ventilation, invasive observing devices, and aspiration of GI fillings especially among the patients getting enteral feedings (Taylor, Lynn, & Bartlett, 2019). VAP occurs because of the colonization of the lower respiratory tract with microorganisms because the mechanical ventilation bypasses the body’s protective mechanisms in the endotracheally intubated patient. I work at an intensive care unit (ICU) and on our unit, we often have patients who need mechanical ventilation as a patient support apparatus until they recuperate their ability to breathe freely, especially during the COVID-19 pandemic. Mechanical ventilation at the ICU also leads to long-term mechanical ventilation until the removal of ventilator support is decided. Like with any use of hospital equipment, there is a threat for HAI (Healthcare Associated Infection). 

NR542-11252 Week 3 Course Project—Database Plan LT

Conceptual Data Model For The Planned Database 

Ventilator-associated pneumonia (VAP) is a prominent HAI that occurs among patients that are dependent on mechanical ventilation. The prevalence of VAP calls for the development of a database to track ventilator-associated (VAP) rates as well as ventilator-associated complication (VAC) events. My database project focuses on efficient and objective surveillance of VAP. My database model will include an algorithm that allows electronic monitoring of VAP based on radiology reports, laboratory values, and trend data. 

These are the three questions I planned for this database;

1. Was a ventilator associated pneumonia (VAP) bundle used at the facility?

2. How many ventilator days did the patient have?

NR542-11252 Week 3 Course Project—Database Plan LT

3. Did the patient suffer any Complications the VAP?

This type of VAP surveillance will allow for higher positive predictive value and will identify more cases than hospital surveys. The database will also include the number of ventilator days and if the facility utilized a VAP prevention bundle.

Entities Planned For the Database and Rationale for Each Entity

The five entities I chose were patient, nurse, respiratory therapist, VAP prevention bundle, and environment. The reason I chose these five entities because they all are essential to VAP prevention.  The incidence of VAP is also dependent on the patient and that is why the patient is also considered an entity. The risk for health care–associated pneumonia is higher among patients requiring mechanical ventilation as tracheostomy or ET tube bypasses usual upper airway defenses. Moreover, deprivation of nutrition, immobility, and ultimate disease process (e.g., immunosuppression, organ failure) raise the chances of infection among patients (Taylor et al., 2019). The nurse is essential to VAP prevention. The Journal of Hospital Infection published an observational cohort research that was performed during 2014-2015 in a single tertiary-based teaching hospital of Finland. The relationship between nurse staffing, their workload and prognosis was identified using day-to-day nurse-to-patient ratios, Intensive Care Nursing Scoring System scores and Therapeutic Intervention Scoring System. Deprivation of nurse staffing and rising nursing workload are correlated with VAP and mortality hence, depicting that adequate staffing is a precondition for the accessibility and excellence of critical care services (Jansson et al., 2019). There are certain courses of action that contributes towards VAP prevention including;

 (1) Lessening sedation covering (SATs) and (SBTs), 

(2) Mobilization and early exercises

(3) Procedure of ET tubes with the subglottic emission drainage ports for patients who intubated more than 48 to 72 hours. 

NR542-11252 Week 3 Course Project—Database Plan LT

The respiratory therapist (RT) is essential to the above-mentioned guidelines. The RT collaborates with the nurse to ensure that the patient is receiving daily sedation vacations and spontaneous breathing trials (Taylor et al., 2019). I also included the VAP prevention bundle as an entity. The Korean Journal of Adult Nursing released a research that involved 3,224 intubated patients and was done between 2010 and 2015. 30 degrees head-of-bed elevation, prophylactic of intestinal ulcer, cuff pressure motorization, and prophylaxis of vein thrombosis were all part of VAP bundle given to Group 1 patients. The VAP bundle for Group 2 includes all of the items provided to Group 1 patients, plus 0.12 percent chlorhexidine oral care. The VAP bundle for Group 3 patients also included tranquillizing disruption and an assessment of desire to extubate, which was not included in the VAP bundle for Group 2. The occurrences of VAP differed dramatically between the groups. Group 3 had the lowest incidence of VAP and had lower mortality (Song & Kim, 2016). The environmental is an important entity because as mentioned above the prevalence of endotracheal tube significantly contributes towards VAP development. Flow of air through ETT transfers pathogens to the distal airways, bypassing protective mechanisms of respiratory tract (Taylor et al., 2019). Therefore, strict infection control measures and a clean environment is essential for preventing VAP. 

Conclusion

Healthcare related pneumonias particularly Ventilator-associated pneumonia are of great importance. The usual healthcare related infections, particularly national observation for VAP is challenging since so long due to lack of reliable definitions and ambiguous objectives. These problems suggest that we establish a national database for monitoring VAP. A national database will enable us to monitor trends in VAP incidences and therefore allowing us to establish risk factors for VAP.

References 

Jansson, M. M., Syrjälä, H. P., & Ala-Kokko, T. I. (2019). Association of Nurse Staffing and nursing workload with ventilator-associated pneumonia and mortality: A prospective, single-center cohort study. Journal of Hospital Infection101(3), 257–263. https://doi.org/10.1016/j.jhin.2018.12.001 

Song, U. R., & Kim, S. Y. (2016). Effects of a Ventilator-associated Pneumonia prevention program on incidence rate and ENDOTRACHEAL COLONIZATION. Korean Journal of Adult Nursing28(6), 628. https://doi.org/10.7475/kjan.2016.28.6.628 

Taylor, C., Lynn, P., & Bartlett, J. L. (2019). Fundamentals of nursing: The art and science of person-centered nursing care. Philadelphia, PA: Wolters Kluwer.

Appendix

ER Diagram 

 

Key Identifier for

  1. Patient is VAP event ID number /MRN
  2. Nurse is ID Number/License Number
  3. Respiratory therapist is ID Number/License Number
  4. VAP prevention bundle is components of the VAP bundle 
  5. Environment is Cleanliness of the ICU setting

Cardinalities

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