Uses of Statistical Information

“Statistics is a mathematical science pertaining to collection, analysis, interpretation and presentation of data” (Wikipedia contributors, 2006). Statistics are a valuable kind of information because they can provide data for making comparisons and determining trends. There are many uses for statistics, “but perhaps its most important purpose is to help us make good decisions about issues that involve uncertainty” (Bennett, Briggs, & Triola, 2003, p. 8).

Kinds of Statistical Information Collected in the Intensive Care Unit (ICU)

There are two primary areas of statistical information collected in the ICU. These two areas are:

1.Central line infections

2.Ventilator associated pneumonias (VAP)

Central Line Infections

Central venous catheters (CVCs) are being used with increasing frequency in the ICU to provide long-term venous access. The goal of collecting statistical information in regard to CVCs is for the prevention of catheter-related bloodstream infections. Approximately 95% percent of clients in the ICU have CVCs in place and are potential candidates for catheter- related bloodstream infections (S. Peaks, personal communication, June 8 and 9, 2006).

There are five components to the central line bundle:

1.”Hand hygiene

2.Maximal barrier precautions

3.Chlorhexidine skin antisepsis

4.Optimal catheter site selection, with subclavian vein as the preferred site for non-tunneled catheters

5.Daily review of line necessity, with prompt removal of unnecessary lines”

(100,000 Lives Campaign, 2006, p. 3).

According to Peaks, interventions from the central line bundle, resourced from the 100,000 lives campaign is being used in order to provide better outcomes for clients with CVCs. Strict compliance with hand hygiene, maximal barrier precautions (cap, mask, sterile gown and gloves), use of Chlorhexidine skin antisepsis, and catheter site selection are all being used in the ICU according to Peaks (personal communication, June 8 and 9, 2006).

According to Peaks, the only area not being implemented at this time is daily review of line necessity. This component is not being done due to a lack of available personnel and time restraints by available personnel (personal communication, June 8 and 9, 2006).

Ventilator-Associated Pneumonia

Ventilator-associated pneumonia (VAP) is an infection of the airway that developed 48 hours or more after the client was intubated (100,000 Lives Campaign, 2006, p. 2). Preventing pneumonia of any type is a primary concern but collecting statistical data for the prevention of VAP is particularly concerning because:

*”VAP is the leading cause of death among hospital-acquired infections.

*VAP prolongs time spent on the ventilator, length of ICU stay, and length of hospital stay after discharge from the ICU.

*VAP adds an estimated cost of $40,000 to a typical hospital admission”

(100,000 Lives Campaign, 2006, p. 2).

According to Peaks, 100% of clients on the ventilator in the ICU are potential candidates for developing VAP. The ventilator bundle provided by the 100,000 lives campaign is a group of evidenced-based practices that are being used in the ICU (S. Peaks, personal communication, June 8 and 9, 2006).

The four components to the ventilator bundle are:

1.”Elevation of the head of the bed to between 30 and 45 degrees

2.Daily “sedation vacation” and daily assessment of readiness to extubate

3.Peptic ulcer disease (PUD) prophylaxis

4.Deep venous thrombosis (DVT) prophylaxis (unless contraindicated)”

(100,000 Lives Campaign, 2006, p. 3).

Elevation of the head to 30 degrees has been a part of the ongoing trials to help decrease the incidence of VAP among the client population in the ICU according to Peaks. Both respiratory and nursing staff has been educated on the need for strict compliance with this intervention (personal communication, June 8 and 9, 2006). According to the 100,000 lives campaign (2006), the elevation of the head of bed intervention was suggested for several reasons which are as follows: decreases the risk of aspiration of gastric contents or oropharyngeal and nasopharyngeal secretions (primary reason for initial recommendation), and may aid ventilatory efforts and decrease atelectasis (p. 5).

Daily “sedation vacations” and assessing the clients potential to extubate is a necessary part of the ventilator bundle that is also strictly adhered to in the ICU according to Peaks (personal communication, June 8 and 9, 2006). Decreasing the amount of sedation for a ventilator dependent client appears to decrease the amount of time spent on mechanical ventilation and therefore decreases the risk of VAP according to the 100,000 lives campaign (p. 7).

Due to there being no documented association between PUD and DVT prophylaxis in VAP these components of the bundle are not being monitored in the ICU according to Peaks. Although these components are important considerations man-power and time constraints do not allow for these interventions to be monitored according to Peaks (personal communication, June 8 and 9, 2006).

Why All Bundle Components Should be Collected

Daily review of line necessity should be collected because the information will help prevent delays in removing a CVC that is no longer needed for the care of the client. Delays in the removal of CVCs will increase the risk of infection over time and the sooner the CVC is removed the risk of infection decreases

Daily monitoring of PUD and DVT prophylaxis should be collected in order to assist in establishing documented association with VAP. Even though no clear association has been established between PUD and DVT prophylaxis, the 100,000 lives campaign has noted that the rate of pneumonia has decreased when these interventions were applied (p, 9 & 11).

The advantages of accurate interpretation of statistical information to improve decision-making in the ICU allows for decreased length of stay for the client, decreased cost for the care of the client, and a safer and more effective health care experience for the client.

In conclusion, all possible efforts should be made in order to comply with the components of the central line bundle and the ventilator bundle. Compliance will allow for a better, safer, shorter, and more cost-effective hospital experience for the client.

References

100,000 Lives Campaign (2006). How-to-guide: prevent ventilator-associated pneumonia. Retrieved June 11, 2006, from

http://www.ihi.org/NR/rdonlyres/A448DDb1-E2A4-4D13-8F02-16417EC52990/0/VAPGettingHowTo GuideFINAL.pdf

100,000 Lives Campaign (2006). How-to-guide: prevent central line infections. Retrieved June 11, 2006, from

http://www.ihi.org/NR/rdonlyres/BF4CC102-C564-4436-AC3A-0C57B1202872/0/CentralLinesHowtoGuideFINAL.pdf

Bennett, J., Briggs, W., & Triola, M. (2003). Statistical Reasoning for Everyday Life, 2nd ed., Addison Wesley, a Pearson Education Imprint. Retrieved June 12, 2006, from https://ecampus.phoenix.edu/seure/resource/resource.asp

Wikipedia contributors, (2006). Statistics. Retrieved June 12, 2006, from http://en.wikipedia.org/w/index.php?title=Statistics&oldid=58123141