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Ventilator-Associated Pneumonia



Abstract

Health is one of the greatest concerns in the world today since it guarantees human welfare in the world. The World Health Organization published a list of the greatest health concerns in the world. This list was compiled considering the diseases and infections that claimed most of the lives according to reported cases in hospitals globally. Pneumonia is on the list as the cause of mortality and morbidity in the world. This is not only for children under the age of five years, but also for adults. Pneumonia can be acquired in the community or in hospitals during treatment. Current essay seeks to explore studies that have been carried out for both community-acquired pneumonia and hospital-associated pneumonia. It uses studies that have been carried by nursing organizations in the United States and the rest of the world. It examines why pneumonia is a global health concern using these studies. The essay also gives recommendations for the role of nurses and health experts in control and treatment of pneumonia.

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Introduction

Pneumonia is continuing to be a major cause of death for both adults and children in the world. Therefore, it is important to carry out different studies on different forms of pneumonia, especially among children under the age of five in order to determine the risk factors associated with the problem. Nursing studies on the disease is important to also determine the best treatment and vaccination procedures in the nursing practice. It is crucial to carry out studies to enable control of the disease. Pneumonia is still a major killer, especially for children under the age of five years. This is prevalent especially in low and middle income countries.

However, this does not mean that the disease has been ruled out as a threat in developed countries. These countries still report annual deaths caused by some forms of pneumonia such as ventilator-associated pneumonia. Therefore, clinical research on pneumonia will help in the reduction of infant mortality rates before the end of 2015 as projected in the millennium development goals. It will also help to determine the most efficient methods to curb pneumonia in the world. This will eliminate it from being on the top list of the global health concerns in the world.

Pneumonia

Pneumonia is a respiratory infection associated with signs of bronchiolitis. It is still among the leading causes of childhood mortality all over the world. It is an acute respiratory infection, which causes multiple deaths in the world, especially for children under the age of five years. The annual number of deaths related to acute respiratory infections according to nursing research in 2010 is about 2.1 million children under the age of five. This is about 20% of the total childhood deaths globally. In fact, this number is according to deaths that were reported by hospitals all over the world after conclusive studies. The incidences of clinical pneumonia, which cause deaths for children is prevalent, especially among developing countries. About 90% of these deaths are in developing countries.

This can be explained by the lack of adequate healthcare for children in developing countries. It can also be explained by the fact that about 90% of the total number of children under the age of five years live in developing countries. Pneumonia is a lower respiratory infection since it affects the airways that are below the epiglottis. They are manifestations of laryngitis, bronchitis, tracheitis, lung infections and any combinations of these with other upper infections such as influenza. Pneumonia is the major lower respiratory infection, which leaves the body at risk of other respiratory infections.

In developed countries such as the US, another form of pneumonia, Ventilator-associated pneumonia, is the cause of adult deaths. It is the most common hospital-acquired infection in the US, which raises concerns for critical care nurses. This is common for patients who receive mechanical ventilation in hospitals for more than 48 hours. It is associated with mortality, morbidity and excess healthcare costs for both hospitals and patients involved. Ventilator-associated pneumonia is a health concern in the world since it is responsible for adult deaths, especially for people undergoing healthcare and in intensive care centers. It is the role of nurses in the world to undertake intensive care for patients.

Therefore, they have undertaken research to determine the risk factors for ventilator-acquired pneumonia in order to avoid it in hospitals and care centers all over the world. This will reduce the mortality rates for the adult population receiving healthcare not only in the US, but also in other countries. This is not only a concern for developed countries, but also a major problem for developing economies. It is evident that pneumonia is a health concern not only for the younger population, but also for the adults in the world. According to the World Health Organization, lack of control of pneumonia can make it as the leading cause of mortality in the world. Therefore, studies show how different patients acquire pneumonia and appropriate methods of control.

Case Study #1

A study has been carried out in the US hospitals to determine the practices that hospitals use in order to prevent ventilator-associated pneumonia. This study applies qualitative methods with the aim of understanding why hospitals use certain practices to prevent this type of pneumonia in the US, and how these practices are able to prevent pneumonia in the country. It investigates the dangers that Ventilator-acquired pneumonia pose to the US population and the effective control and preventive methods. This was a nurse-conducted survey to determine the efficient methods that medical professional use in order to prevent this type of pneumonia with appropriate recommendations on the methods to apply in hospitals in the US.

In the country, up to 20% of patients who receive care in hospitals are infected with pneumonia. This is the main cause of death for these patients since it leaves their bodies vulnerable to other respiratory infections. The study focuses on the fatality of the disease with gastric colonization by pathogens in the body and contaminated secretions. The study is meant to collect more data regarding the strategies that hospitals in the US use in order to control Ventilator Acquired pneumonia.

This study was undertaken as a part of a larger program to control and prevent pneumonia in the country. It applied qualitative as well as quantitative analysis of data in order to determine the most appropriate strategies that hospitals use to control pneumonia in the population of the US. This study does not use primary data from the general population. Rather, it uses data that is already in hospitals as well as other health institutions in the country. Therefore, hospitals in the country participate in data collection. The nurses in these hospitals also participate in the study to show how they manage pneumonia and prevent patients from acquiring it in hospitals.

In total, 719 hospitals in the US take part in the research. The total sample also includes 119 healthcare delivery centers in the country. The hospitals are chosen at random with regional considerations. However, the sample is limited to hospitals, which offer in-patient services with 50 or more beds obtained from the database of the American Hospital Association in 2005 and healthcare centers obtained from Area Resource Files in 203.

The primary method used in data collection was to send a survey team of lead infection control professionals to the hospitals selected at random. These were to review the hospital databases on the number of pneumonia cases reported in hospitals. The study also applied telephone interviews with structured questions. These interviews were taken in 14 different hospitals and recorded. The interviews were performed especially with nurses and pneumonia patients, which ranged from about 30 to 90 minutes. This was to get raw data on the positions of different staff and patients on pneumonia control in the country. The interviews were conducted on a scope of ten months with different staff members being interviewed more than twice on the development of pneumonia patients and other patients who had acquired pneumonia during the course of healthcare. The study also applied the Snowball technique whereby each interviewee was asked to recommend another person whom they felt helpful in the study.

There were a total of 48 additional interviews after recommendation by staff and patients, 16 of whom had acquired pneumonia during treatment. Moreover, 10 of the 48 were already in the treatment for pneumonia with the rest being nurses. After obtaining data on the number of reported cases of pneumonia in hospitals as well as the number of acquired cases during treatment, the study recommended some changes for nurses in a total of 10 hospitals and five care centers. First, the research experts suggested the use of some preventive and control programs that were applied in some other hospitals, which had proven to be a success in reducing pneumonia infections. The experts then observed the influence of these changes in the study. The qualitative data was collected and analyzed. The groups where these suggestions were made were selected randomly from those that reported high cases of pneumonia infections.

After statistical analysis of qualitative and quantitative data, the study found out that there were many reported cases of pneumonia in hospitals in the US. This was for both infants and adults. About 200,000 cases of children under the age of five reported to have pneumonia even after the vaccination. Therefore, 5% of these did not receive medical treatment in time and succumbed to the illness. For adults, most of the pneumonia cases in the country were acquired in hospitals. The hospitals that applied strategies recommended by the CDC were able to control acquired pneumonia. These strategies include kinetic beds, antimicrobial mouth rinse and subrogation secretion drainage. These strategies are used by fewer hospitals in the country. About 20% of hospitals use subglottic secretion drainage with about 80% using semi-recumbent positioning. Since both methods are recommended by the CDC, they are applicable for use in the country.

However, the former is not used as successful as the latter. This happens because it still showed high rates of acquired pneumonia in the country. The study shows that both ventilator-acquired pneumonia and clinical pneumonia are infections that are still prevalent in the country. It is a credible study since it shows similar findings to a CDC study on the same. There are still concerns about pneumonia in the country. Without proper control, it can spread to be a major mortality cause. This study has been published in a peer-reviewed journal, Infection Control and Hospital Epidemiology in the October of 2008 volume 29. It is easily available in healthcare websites exploring pneumonia in the world. The data obtained is sufficient to answer the questions the study explores. The research findings are not influenced in any way in the study since the researchers do not have personal interests in the area (Krein, Kowalski, Damschroder, Forman, Kaufman, & Sain, 2008).

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Case Study #2

Another study on the practices to control and prevent pneumonia has been undertaken in Canada, in hospitals and other healthcare facilities for critically ill patients. There is the increased health risk that ventilator-associated pneumonia causes for ill patients, especially for patients in mechanical ventilation. The study also focuses on the most efficient methods to control and prevent pneumonia for the general population in Canada. The study examines the reported cases of pneumonia in the country. It also focuses on specific scientific advances that have been made towards improving the outcomes for ill patients who have a great risk of having ventilator-associated pneumonia.

This is a part of a larger survey by the Canadian Nursing Association to examine to a larger extent the strategies that are efficient in diagnosing, treatment and prevention of pneumonia in the country. The study is aimed at determining the most efficient strategies that hospitals can use in general control of pneumonia, an infection that is the cause of mortality in the country. The research questions in the study are: how many cases of clinical pneumonia and ventilator-associated pneumonia are reported to Canadian hospitals each year; which are the most efficient strategies to diagnose, treat as well as prevent these types of pneumonia in the country?

The main participants in the study are the hospitals in the region. These hospitals are chosen randomly from the hospital database in the country. They include private and public hospitals as well as healthcare centers. The study is not limited to any type of hospitals in the region. The research targets the general Canadian population to determine how many cases of pneumonia are reported each year in the country. It uses a representative sample with 500 hospitals picked at random. This is about 20% of the hospitals and healthcare centers in the country.

The study then takes the percentage of the pneumonia cases reported in comparison to other diseases and infections. Later, it focuses on the strategies that each hospital applies in control, prevention as well as diagnosis of the disease. The study then recommends certain strategies to a sample obtained from the hospitals chosen. This sample is collected at random and used to carry out a trial of strategies that are most appropriate for clinical application. The final sample size is 500 since all the hospitals remain in the study for the research period, which is one and a half years. In the last six months of the study, the sample picked from these hospitals is tested to determine the most appropriate strategies.

Like the study in the US, this study also applies data collection methods from the already collected data in hospitals. It sends out five audit and pneumonia experts per hospital in the sample. The experts carry out a survey of hospital records to determine the number of reported cases annually. Among the five members is a nurse who reviews treatment, healthcare, control and diagnosis strategies that each hospital uses. Data collection also involves interviewing of staff and patients in all the hospitals. The five members of each team also interview nurses, healthcare providers and pneumonia patients with structured questionnaires in order to determine the conditions of the patients as well as strategies used in the hospitals. The researchers group the data in terms of cases reported with factors such as age and medical history in consideration. It should be done to ensure that they determine whether the reported cases are either clinical or acquired pneumonia.

The study reviews the percentage of patients that have been vaccinated before as well as the factors surrounding each patient. This is to bridge the gap of knowledge of several types of pneumonia and their effects on the population. There were interventions tested on patients with recommended treatment and prevention strategies from medical research. The sample for the intervention was determined randomly with 10 hospitals from the total sample. The data collected underwent qualitative and quantitative statistical analysis for easier understanding of the sample.

The main findings from the research were that pneumonia is still prevalent in Canada. There were about 100,000 cases of pneumonia reported annually in average in the total sample. Among these cases, 40% were children under the age of five years. Therefore, 90% of these children had received vaccination, but were still infected with the disease. From the total population, 40% of the cases of pneumonia reported that they were infected during treatment. These patients were required to stay in hospitals for more than 48 hours for operations and other treatments. During this treatment, they had to use mechanical ventilation either in the ICU or in wards where they were admitted.

This was also the case for healthcare facilities such as military care centers for the veterans. Among the total cases of pneumonia reported, 30% developed to fatal infections with about 10% succumbing to the illness. On the interventions tested, the experts gave the nurses optimal strategies to apply during mechanical ventilation to prevent infection of pneumonia. In clinical pneumonia, introduction of newer treatment methods assisted in preventing fatal infections, especially for children. This study shows that it is possible for health experts to include other methods for diagnosing, control, prevention and treatment of pneumonia to prevent its spread.

The research is credible since it applies research methodologies and designs approved for nursing research. It is also printed in a peer-reviewed journal, the Journal of Critical Care, volume 23 in 2008. The researchers are from the Nursing Association of Canada, an organization whose main objective is control of diseases and infections in the country. Therefore, it is a valid as well as reliable and is easily available on their website (Sinuff, Muscedere, Cook, Dodek, & Heyland, 2008).

Case Study #3

A different research has been carried out to examine community-acquired pneumonia in the US. This type of pneumonia has been found to be the leading cause for older adults in the country. A survey in 2006 concluded that adults in the US who are 65 years and above were highly affected by community-acquired pneumonia. The total number of people at this age who were discharged from hospitals in the US had about 57% suffering from pneumonia. The study is aimed at identifying risk factors for community-acquired pneumonia as well as implementing the most appropriate strategies to reduce the exposure as well as determining the modifiable conditions in order to reduce morbidity and mortality. The study examines risk factors, which have been found to be associated with pneumonia for the adult population.

These factors include asthma, chronic obstructive pulmonary disease, diabetes mellitus, smoking, congestive heart failure, aspiration and malnutrition. This study is meant to determine the factors that accelerate or influence pneumonia significantly. The study also relates hospital-acquired pneumonia with community-acquired one. This is through the investigation of association between PPI with pharmacotherapy, atypical antipsychotics, corticosteroids and the increased risk of community-acquired pneumonia with known risk factors such as serum albumin levels.

The participant of the research is a community hospital staff and patients. The trained research assistants retrieved medical records from the community hospital. These records were in the period of 2004 to 2006. The records from the year 2005 were not available since they had been sent out from the hospital for microfilm storage. The assistants recorded the data on standardized forms and all the medical records on pneumonia were verified and reviewed by the principal investigator. This is to ensure that the data was valid and accurate for the study. The hospital was chosen at random from a list of hospitals that reported most of the cases of pneumonia in the country. It is a community hospital from the State of Ohio in Athens County.

This is a community hospital that provides healthcare for about 62,000 residents in the emergency department and hospitalizations. The study was also approved by the Ohio University Institutional Review Board in the nursing division. The research also identified adults who were 65 years or older using these records. They excluded patients who had a diagnosis of pneumonitis or aspiration pneumonia. These patients have different risk factors with community. The study analyzed different factors such as sex, demographic data, smoking status, medication prior to admission, past medication history, discharge diagnosis and laboratory test results during admission. These were obtained from medical records and recorded differently.

The case-control design was used with 194 patients being investigated with radiographic evidence of pneumonia on admission. The control sample was a total of 952 patients. These were those without diagnosis of pneumonia on discharge or acute exacerbation or chronic obstructive pulmonary disease. The research also excluded patients with ventilator support, gastric tube feeding, those that required haemodialysis, active lung cancers as well as metastatic diseases. The main findings using multiple logistic regression analysis show that the use of inhaled corticosteroids was about 2.89%. The main risk factor for community acquired pneumonia was use of atypical antipsychotics at a level of 95% of the total sample.

The other adjusting co-founders were age, sex, serum albumin levels, smoking status, coronary artery diseases, history of congestive heart failure as well as the current use of PPI. The study confirms that the use of atypical antipsychotics and inhaled corticosteroids are both associated with increased risk of community acquired pneumonia. This is especially for older adults that are hospitalized in community hospitals. The study also concluded that the use of PPI is not a risk factor for this type of pneumonia. Other co-founders were found to affect the patients with community acquired pneumonia and were general risk factors.

The implications of this study are such factors as pharmacotherapy and malnutrition, which play a key role in developing community acquired pneumonia in the population of older adults than PPI. This study also confirmed that older people in the population with 65 years and above were at a greater risk of acquiring pneumonia in the community than other younger people. About 60% of people in the population that were admitted in the hospitals being 65 years and above were reported to being infected with pneumonia.

The article “Pharmacotherapy and the risk for community-acquired pneumonia” has been carried out by a renowned nursing organization and has been approved by the University of Ohio. The study utilizes research methodologies and strategies that have been approved by medical researchers. The research also utilizes medical records in the hospital. This means that the population selected is not determined by the researchers. Rather, the population is already selected with patients that have reported to the hospital involuntarily. According to the study, pneumonia is a disease that is prevalent in the US population. It is the role of the nurses to observe the risk factors for each patient and assist the patient in control and treatment. This will stop the spread of the disease significantly in the country. The study is also consistent with other studies on the same carried out by other organizations (Gau et al., 2010).

Case Study #4

The final study is standardized child health project undertaken by seven countries in order to evaluate the etiological agents, which cause severe pneumonia in children, especially in developing countries. This study evaluates sensitive diagnostic techniques, which are innovative and were not available previously in research programs. This occurs because previous researches in etiology studies had about a quarter to a third of patients not yielding to the expected etiology. The research is meant to employ these innovative epidemiologic and analytic methods in order to establish a causal relationship existing between pneumonia and the potential pathogens.

The study selects strategically sites that broadly represent the regions, which have the greatest burden as far as childhood pneumonia is concerned. This research also provides data that reflects broadly the epidemiologic situation in the third world countries in 2015. This is by use of pneumococcal and vaccine known as Haemophilus influenzae type b. The study also examines differences in hosts, geographical and environmental factors, which determine etiology of pneumonia. It preserves specimens of these samples in order to create a resource that will assist in future research and discovery of pathogens.

The study utilizes a case-control design, which involved the enrollment of about 6,000 patients who had been hospitalized with for pneumonia, whether severe or very severe. The control sample was selected randomly from different communities that the research was undertaken. The main reason for this method of research is to use the patients who were hospitalized other than those in facilities outside the hospital. It is necessary to ensure that the collection of different specimens from patients can be done safely. This is also to ensure that testing is only done for the sample with severe pneumonia, which is efficient for hospitalized patients.

The design also allows the researchers to include control, which is crucial in guiding the interpretation of results from use of highly sensitive tests on the respiratory tract specimens. The researchers can identify the risk factors for pneumonia and other etiologies. The countries that the studies are undertaken are developed economies, especially in Africa and South-East Asia. These are Gambia, Mali, Kenya, Bangladesh, South Africa, Zambia and Thailand. All the sites that the research is undertaken are recognized and chosen at random in the countries.

The study provides results that are important in public health, scientific and policy communities. Also it helps in influencing the algorithms of treatment, diagnostic approaches as well as development of vaccines from the year 2015. This is in line with the millennium development goal number four on the reduction of infant mortality rates and infectious diseases in the world. The study identifies that pneumonia is still a health concern for the population of the third world countries. This is in comparison to the control sample that was identified.

The study isolated 6,000 patients with severe pneumonia in these countries. The control population also showed risk factors that were present in the cases of patients with pneumonia. These included lack of vaccination, lack of proper medical care as well as ignorance from community members. The members of the community who were not infected were still at risk of infection. Therefore, they did not take any preventive measures. Health facilities in the country did not have the adequate pneumonia control efforts. These observations from the study show that pneumonia will continue to be a leading cause for infant mortality rates for developing economies. The fact is that there are not efficient infection control methods for pneumonia.

The data obtained in the data analysis is valid and credible. Moreover, the research was carried out with the help of the World Health Organization, the largest organization in the world dealing with child health. Furthermore, the research was also carried out with supervision of nursing organizations in the countries involved. The findings in the research are valid and have been printed in a peer-review journal, Clinical Infectious Diseases.

Summary

In summary, the research identifies the estimates of the severe pneumonia etiologies in children, especially ones with severe pneumonia with different etiological settings. It comes up with different behavioral and environmental risk factors for each region in the developing economies. This research is meant to determine these factors to enable future control of the disease. It is a study that will be of great importance in developing countries by 2015. The study has taken the right samples, and utilized the correct designs. It applied knowledge and consultancy from over ten countries in the world. The authors and research assistants have no conflicts of interests. This is also the case for the editors in the journal as well as the sponsors. The main sponsor for the research is PERCH (Pneumonia Etiology Research for Child Health) with different independent donors. The measuring instruments are all valid since all the studies are carried out in health centers in different countries. These studies are consistent with other studies on the same subject. These include studies by individual governments as well as other international organizations such as UNICEF (Levine et al., 2012).

Conclusion

The studies above are all associated with pneumonia in the world. They show that pneumonia continues to be a health concern globally. The first study shows that ventilator-acquired pneumonia is a concern for patients undergoing treatment in hospitals in the US. The second study is carried out in Canada to investigate on the same problem. The third study examines community-acquired pneumonia in the US, while the fourth study shows that pneumonia is a great cause of infant deaths in developing countries. All the studies are valid and have different recommendations for health experts as well as nurses.

Therefore, it is the role of nurses in the world to take these studies seriously. They should review each and every study carefully in different countries. All the articles are available in different peer-reviewed journals. It is evident from the articles that health experts including nurses can play a crucial role in children with pneumonia, community-acquired pneumonia as well as hospital-acquired pneumonia control. The nurses should review these studies to determine the best methods of diagnose, control, prevent as well as treat pneumonia in the world. This way, the world will be able to eliminate one of its greatest health concerns, pneumonia.

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