Keywords: Ventilator-associated pneumonia/Silver-coated endotracheal
tubes/Mechanical ventilation/Intubation ●This article has been double-blind peer reviewed
Nursing Practice Research
Ventilation
A review of the literature determined whether silver-coated endotracheal tubes were effective in preventing ventilator-associated pneumonia
Silver tube coatings in pneumonia prevention
In this article...
The efficacy of silver-coated endotracheal tubes in preventing ventilator-associated pneumonia Strategies to help staff deliver best practice in preventing VAP
Authors Tabatha Kane is nurse at Virginia Hospital Center, Arlington, VA, US; Faith Claman is assistant professor at Marymount University, Arlington, VA, US. Abstract Kane T, Claman F (2012) Silver tube coatings in pneumonia prevention. Nursing Times; 108: 36, 21-23. Background Ventilator-associated pneumonia (VAP) is a common hospital- acquired infection that is associated with higher mortality rates, increased healthcare costs and longer hospitalisations. One intervention that has recently been used to reduce the prevalence of VAP is a new type of endotracheal tube impregnated with silver sulfadiazine. Aim To investigate whether the use of silver-coated endotracheal tubes reduces VAP in adult intubated patients. Method A thorough evidence-based literature review was conducted to investigate whether the use of silver-coated endotracheal tubes reduces the incidence of VAP. The following databases were consulted: CINAHL; Medline; Health Source: Nursing and Academic edition; ProQuest Nursing and Allied Health Source; Cochrane Database of Systematic Reviews; TRIP Database; and National Guideline Clearinghouse. Results The use of silver-coated endotracheal tubes reduces the prevalence of VAP in intubated patients but should not be used as an isolated intervention. Conclusion More research is needed to assess whether the benefits of silver- coated endotracheal tubes, coupled with additional VAP prevention strategies, outweigh the costs incurred.
V
entilator-associated pneu- monia (VAP) is the leading cause of hospital-acquired infections in intensive care unit
settings (Chastre, 2008; Chastre and Fagon, 2002). Around one third of hos- pital-acquired pneumonia occurs in inten- sive care units with more than 85% of these cases occurring in patients on mechanical ventilation (Rotstein et al, 2008). The prevention of VAP continues to be a
priority as it is associated with longer hos- pital stays, mortality, morbidity and increased healthcare costs (Chastre, 2008; Kollef et al, 2008; American Thoracic Society and Infectious Diseases Society of America, 2005; Chastre and Fagon, 2002; Rello et al, 2002). The length of time spent in hospital for patients with VAP is esti- mated to increase by 5-7 days in ICU, with an additional stay of 10-12 days in hospital overall (Shorr et al, 2009). Furthermore, the additional hospital costs associated with the management of VAP range from approximately £6,500 to £16,000 (Shorr et al, 2009). There is evidence that using an endotra-
cheal tube (ETT) for mechanical ventila- tion increases the occurrence of VAP (Chastre, 2008). The infection can occur as a result of aspiration of contaminated secretions from the colonisation of patho- gens in the oropharyngeal mucosa (Chastre, 2008; Kollef et al, 2008; AMS and IDSA, 2005). In addition, biofilms of colo- nised bacteria that form on both the inner and outer lumens of the ETT can be dis- lodged during suctioning and can migrate to the lungs (Chastre, 2008). There is a variety of techniques that can help reduce the occurrence of VAP in adult patients who are receiving mechanical
5 key points
1
Ventilator- associated pneumonia is a nursing-specific quality indicator
2 3 4
tubes may be a cost-effective intervention but more research is needed to confirm this
5
Active surveillance is
considered best practice in the prevention of VAP
A lack of staff education is a
key barrier to effective VAP bundles
Silver-coated endotracheal
tubes need to be studied in combination with VAP prevention bundles to fully appreciate their true impact on VAP prevention
Silver-coated endotracheal
Endotracheal tubes may increase infection risk
www.nursingtimes.net / Vol 108 No 36 / Nursing Times 04.09.12 21
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