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Draft Proposal for Capstone Project on Pneumonia


Ventilator associated pneumonia develops after 48 hours after the first intubation. The condition is mainly known for its increased morbidity and mortality rates. It is especially relates to ill adverse patients. This research is peer-reviewed, and the source illustrates the importance of the topic. It is because the authors describe how the occurrence, as well as the frequencies of the interpretations rise in the incidences of medical and clinical errors.

Change Plan Overview

Ventilator associated pneumonia is one of the major sources of nosocomial infection that affects about 27% of almost all critically ill patients. An attempt is made in this study to try and estimate the effect of oral decontamination which contains 0.2% chlorhexidine gluconate solution alongside hydrogen peroxide solution on incidence pertaining oropharyngal colonization and ventilator-associated pneumonia. A conclusion was arrived at that ventilator-associated pneumonia was of higher levels in the patients that were given oral care that contained hydrogen peroxide than those on the 0.2% chlorhexidine, which happens to be more effective in the reduction of orophyryngeal colonization (Gantz, 2006).

Interventions that are included for healthcare improvement in ventilator bundle to reduce the risks that are involved in the complications of the patients that are treated with mechanical ventilations include prophylaxis for the peptic ulcer disease as well as vein thrombosis, elevation of the head to thirty degrees or more and the interpretation of the day in day out sedation vaccination. Several studies have also shown that the application of topical oral chlorhexidine, when initiated before incubation have led to the reduced nosocomial infections in the patients that are having elective cardiac surgery. Meta-data analysis of recent times shows that chlorhexidine does not reduce the nosocomial pneumonia or even the rate of mortality which makes it a good recommendation.

Design Practice Change

A design strategy to curb the occurrence of the disease is necessary. However, there are recommended preventions strategies that will ensure that the rates of ventilator associated pneumonia in care units for adults are drastically reduced. Some of this design prevention practices include but are not limited to the following; patients should be encouraged to avoid intubation and re-intubation whenever possible. Orotrachel intubation should not be resulted into in the favor of nasotracheal intubation. It is because the intubation will increase the risk to the patients. Patients should also have a continuous aspiration of secretions and specifically subglottic ones. The head or the bed should be elevated to a 30 to 45 degrees angle. It should be foreseen by the doctors. As a result, internal feeding will be viable for patients with the post-pyloric tube. Also, to ensure that the risks are minimized, the infection standards control measures should as well be upgraded. It will ensure that when the standards are raised, the transfusion policy of the hospital will be raised. The health of the patients will be more paramount as a result. Stress ulcer will be maintained by the use of Sulcralfate and H2 blockers other than the common proton pump inhibitors.

Implementation and Evaluation of Change

Recent advances such as the decreasing of bacteria in the oropharynx. It is done by the decontamination of the trachea with antibiotics and selected decontamination. A different way to brush the teeth should also be adopted to ensure that better results will be yielded in the prevention of the disease. According to research, the number of patients involved that received such an intervention ended up having higher values of CPIS on the third, fifth and seventh day as opposed to patients of the other groups. Another design practice that is to be implemented is the educating and the mentoring of the nurses in strategies used to detect warning signs at an early stage and thereafter communicating the findings to other members of the healthcare team.

Integration and Maintenance Change

The integration and maintenance of changes in the practice of reducing the risks of ventilator associated pneumonia mainly lies with the patients and the practitioners as well. As of recent times, the evidence that exists does not support the integration in practice but adequately building as well as fortifying systems that are used in knowing of the patients better identifying changes at early stages and communicating as well as managing changes in the status of the patients in a timely manner. If the patients are familiar with the prevention methods that have been previously discussed, there would be reduced chances of risking the lives of majority to the disease. It is based on the fact that more than three quarters of the patients suffer from the disease due to lack of better prevention strategies. When these strategies are integrated in the routine of treatment, then the risks would be reduced.


It can be concluded that carrying out prevention strategies is the best practice in the medical arena. It is mainly because the strategies do not only reduce the risks to the patients but also reduce the common errors that occur when handling ventilation pneumonia. Analyzing the causes of the distractions and thereafter separating those causes into categories on which ones can be eliminated and which ones can be reduced, will improve the quality of patients handling.

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