It may take a while to implement these basic practices, however once implemented into the nurse's schedule, it should be shown to significantly decrease a wide range of patients stay in the hospital. Oral care and increasing the HOB are not difficult interventions, that if encouraged by head nurses, could drastically decrease the risk of VAP across ICU floors. - CM

It would be difficult to create a national VAP bundle, since there are so many different patients across different ICU's, and many different ideas on how healthcare can be promoted, as well as conducted depending on the type of ICU. -CM

This seems like a liability just waiting to happen. As we have learned in class, daily readiness trials are important, and before a patient is extubated, there are several trials that must be performed, eg., making sure there's no respiratory distress, a weaning trial, a patent airway, and no hemodynamic instability. The lack of proper monitoring before extubating sounds like an awful process for the patients involved. - CM

Pseudomonas aeruginosa is a common bacteria species found in soil, so it is interesting to see its transferred to ventilated patients. There may be a clear connection to lack of hand hygiene inferred from that species. Meanwhile, staphylococcus aureus seems to be one of the most common micro-organisms appearing in the healthcare system, and it generally lives in humans noses. This bacteria seems harder to prevent. - CM

It would be interesting for the authors also to state the likelihood of VAP occurring had there been no oral care specifically. They do not seem to mention the outcomes of VAP from these 6 studies specifically that ignored oral care. - CM

The criteria the authors established are in order to ensure the pneumonia is actually resulting from their mechanical ventilation, and not from some other outside source. Hence, having been intubated for 48 hours, and calculating pre-and post interventions. - CM

Chlorhexidine is a powerful antiseptic which is used for skin disinfection before surgery and to sterilize surgical instruments. It is also used for cleaning wounds, preventing dental plaque, treating yeast infections of the mouth, and to keep urinary catheters from blocking. It makes sense that the IHI would implement this into the plan of care for a ventilator patient. - CM

Nurses in the ICU need to remember that VAP reduction requires several different components, including endotracheal tube cuff pressure and subglottic suctioning. Other interventions include keeping the head of the bed elevated, providing mouth care every 4 hours, and using proper hand hygiene. - CM