A Short Note On Preventing Ventilator Associated Pneumonia

It has been repeatedly stated that oral care is important in the prevention of ventilator-associated pneumonia (VAP). Endotracheal intubation predisposes patients to developing VAP. The tube acts as a conduit from the mouth to the lungs – a perfect track for bacteria to descend upon. Khezeri, et al. (2014) suggest that “the presence of an endotracheal tube (ETT) inhibits normal coughing, normal swallowing, and the protection of the trachea contact by epiglottis closure.” In addition, an endotracheal tube keeps the patients mouth open – leading to dryness. Bacteria are not washed away by saliva. Also, Landgraf, et al. (2017) mention that the presence of an endotracheal tube in the mouth causes “changes in the oral epithelium” which “might indicate risk for infection in intensive care patients

The prevention of VAP through standardized care can reduce mortality rates, reduce mechanical ventilation days, and decrease costs and improve patient outcome.

According to Hunter (2012, p.40) “VAP is a hospital acquired pneumonia that occurs 48 hours or more after tracheal intubation or acute tracheostomisation”. VAP is one of the most common nosocomial infection responsible for one third of mortal respiratory infections in European ICUs (Adib-Hajbaghery et al. 2011).

To encourage physicians, ICU nurses, and respiratory therapist to use the ventilator associated pneumonia bundle in all ventilated patients in an intensive care unit.

Ventilator - associated pneumonia (VAP) is the second most common hospital acquired infection (HAI) and is associated with high morbidity and mortality rates for ventilated patients in intensive care units (Bingham, Ashley, Jong, & Swift, 2010). The VAP increases patients’ mortality rates, length of stay and hospital costs (Hiner, Kasuya, Cottingham, & Whitney, 2010). The VAP is the leading causes of death due to nosocomial infections and the

Patient 1: For DVT, contact physician for surgical or anticoagulant interventions. For Pneumonia, give medication as ordered, maintain fluids, bedrest, monitor temperature, and WBCs. For aspiration, turn patient to side due to decrease LOC and preform tracheal suctioning.

Even though the consequence of saline instillation on a ventilator patient in the acute care setting is pneumonia or the patient may become hemodynamically unstable, this practice remain contentious, the practice of this procedure will also decrease the oxygenation. (Ayhan, et al., 2015),

Among critically-ill patients in acute care facilities, pneumonia is one of the most frequently acquired hospital infections (Curtin, 2011). Ventilator-associated pneumonia (VAP) is the second most common healthcare-associated infection (HAI) in the United States and it is responsible for approximately 25% of infections that occur in intensive care units (Sedwick et al., 2012). VAP is defined as a hospital-acquired lung infection that develops in patients who are intubated and receiving mechanical ventilation at the time of or within 48 hours prior to the onset of infection (Sedwick et al., 2012; Gianakis et al., 2015). The definition of VAP, provided by the Centers for Disease Control and Prevention (CDC), encompasses a combination of radiological,

Karen Meunier, is the education consult for New Orleans’s Childrens Hospital Ventilator Assisted Care Program (VACP). Mrs. Meunier educated the audience on the history of ventilators. Next, Mrs. Meunier stated the criteria for the children who are enrolled in the Ventilator Assisted Care Program. Overall, these children either have a neuromuscular, brain and/or spinal cord injury, and/or birth related diagnosis. The children in the program live at home in Louisiana, under the age of 26, Medicaid eligible, and require daily mechanical support of respiratory efforts. Lastly, Mrs. Meunier informs the audience about each member in the VACP staff. The VACP staff includes an education consultant, respiratory therapist trainer, two case managers,

Ventilator-associated pneumonia is a bacterial infection that occurs in the lower respiratory system within the first 48 hours of endotrachal intubation (Lewis, Dirksen, Heitkemper, Bucher, & Camera, 2011). Although any hospital patient is susceptible to pneumonia, ventilator dependent patients are at the highest risk of acquiring pneumonia. The purpose of this paper is to identify the risk factors, incidences, and preventions of ventilator-associated pneumonia (VAP) using a quantitative research study performed in Malaysia. “The aim of this

Clinical problem: Oral care and ventilator-associated pneumonia (VAP) is extremely important in all healthcare organizations and has gained increased attention. For this reason, oral care has been introduced in many hospital settings. However, there is not enough evidence on critically ill patients concerning the effect of oral care interventions on the development of VAP. In order to evaluate the effect of oral care on VAP for hospitalized patients, additional studies are required.

From investigation in health practices, ventilator associated pneumonia caught my attention. “Ventilator Associated Pneumonia (VAP) is a leading cause of morbidity and mortality in intensive care units. Most episodes of VAP are thought to develop from the aspiration of oropharyngeal secretions containing potentially pathogenic organisms. Aspiration of gastric secretions may also contribute, though likely a lesser degree. Tracheal intubation interrupts the body’s anatomic and physiologic defenses against aspiration, making mechanical ventilation a major risk for Ventilator Associated Pneumonia. Semi-recumbent positioning of mechanically ventilated patients may help reduce the incidence of gastroesophageal reflux and lead to a decreased incidence of VAP. The one randomized trial to date of semi- recumbent positioning shows it to be an effective method of reducing VAP. Immobility in critically ill patients leads to atelectasis and decreased clearance of bronchopulmonary secretions. The accumulation of contaminated oropharyngeal secretions above the endotracheal tube cuff may contribute to the risk of aspiration. Removing these

A gastrostomy tube requires anesthesia during placement and has risks associated with the use of anesthesia. There is also a risk of infection of the abdominal wall and peritonitis which is a life threatening infection of the abdominal cavity. Also gastrointestinal bleeding, blockage of the bowel or perforation of the bowel may occur. Diarrhea from the feeding formula is fairly common. Aspiration pneumonia is also common and if the person requires restraints to keep from pulling the tube out, the same complications listed above can occur. There is no good evidence that demonstrates that gastrostomy tubes, or tubes into the small intestine, prevent aspiration pneumonia in a person who has difficulty swallowing. In fact, there is good evidence in persons with advanced Alzheimer’s disease that gastrostomy tubes actually cause more harm than if no tube has been placed. Moreover, other evidence shows that tube feeding may actually increase episodes of aspiration pneumonia. Careful feeding by hand is a better alternative (Arenella, n.d.).

Tracheostomy Care is essential for patients who are in respiratory distress. Nurses need to prevent complications and promote education to care for this device. Cleanliness of this device will keep the patient health from deteriorating, and ultimately prevent any infections that could possibly arise if the tracheotomy is not taken care of properly. The purpose of a tracheostomy may have a myriad of reasons. A couple of reasons to perform a tracheostomy may be due to a blocked airway, obstruction, or to be used to extended respiratory or ventilator support. Tracheostomy care is vital for patients because it prevents any complications. According to John Hopkins Medical Center (n.d), “Early complications that may arise during the tracheostomy procedure or soon thereafter include: bleeding, air trapped around the lungs (pneumothorax), air trapped in the deeper layers of the chest (pneumomediastinum), air trapped underneath the skin around the tracheostomy (subcutaneous emphysema), damage to the swallowing tube (esophagus), injury to the nerve that moves the vocal cords, tracheostomy tube can be blocked by blood clots, mucus, or pressure of the airways walls”.

The interventions for pneumonia are as follows. First, the patient must have oxygen administered to increase the blood's oxygenation level and ensure proper oxygenation to the body's organ systems. As the patient is treated with oxygen, she should be encouraged to breath deeply, as oxygen is the best cure of pneumonia. Next, vitals should be consistently monitored and oxygen treatment repeated whenever the oxygenation level drops below 90 percent. Finally, the on-call physician should be notified of the patient's condition so that