Ventilator-Associated Pneumonia Prevention
Leonard, T. N.
Thomas Edison State College
Abstract
Ventilator-associated pneumonia (VAP) remains a big drawback within the hospital setting, with terribly high morbidity, mortality, and cost. Some people tend to perform an evidence-based review of the literature that specializes in clinically relevant pharmacological and non-pharmacological interventions to prevent VAP. Thanks to the importance of this condition the implementation of preventive measures is predominant within the care of mechanically ventilated patients. There is proof that these measures decrease the incidence of VAP and improve outcomes within the intensive care unit. A multidisciplinary approach, continuing
…show more content…
VAP has been seen to cause up to 71% of hospital pneumonia deaths. According to Koenig (2006),
Ventilator-associated pneumonia is defined as pneumonia occurring more than 48 hours after patients have been intubated and received mechanical ventilation. Diagnosing VAP requires a high clinical suspicion combined with bedside-examination, radiographic-examination, and microbiologic analysis of respiratory secretions. Aggressive surveillance is vital in under-standing local factors leading to VAP and the microbiologic milieu of a given unit. Judicious antibiotic usage is essential, as resistant organisms continue to plague intensive care units and critically ill patients. Simple nursing and respiratory therapy interventions for prevention should be adopted. (para.2) VAP has two types, early on set (within the first 48 hours), and late on set VAP (after 90 hours). VAP will usually appear within the first 48 hours after intubation. Diagnosis of VAP can sometimes be very difficult. The usual and best way to diagnose VAP is to have a portable chest radiograph performed. According to Koenig (2006),
While the portable chest radiograph still remains a mandatory component in the diagnosis of ventilated patients with suspected pneumonia, as with clinical criteria for diagnosing VAP, it too has problems with both sensitivity and specificity. Poor-quality films further compromise the accuracy of chest X rays.
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
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.
This paper explores Pneumonia and the respiratory disease process associated with bacterial and viral pathogens most commonly located in the lung. The paper examines the process, symptoms and treatments most commonly viewed in patient cases of Pneumonia. My goal is to educate the reader and to warn of the
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
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,
File, T. (2017). Treatment of community-acquired pneumonia in adults in the outpatient setting. Retrieved from https://www.uptodate.com/contents/treatment-of-community-acquired-pneumonia-in-adults-in-the-outpatient-setting?source=search_result&search=treating%20community-acquired%20pneumonia%20in%20adults&selectedTitle=2~150#H11
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
The purpose of this paper is to assess the effects of oral care on ventilator-associated pneumonia for inpatient
Pneumonia is an inflammation of the lung which results into an excess of fluid or pus accumulating into the alveoli of the lung. Pneumonia impairs gas exchange which leads to hypoxemia and is acquire by inhaling a contagious organism or an irritating agent. (Ignatavicius & Workman, 2013). Fungal, bacteria and viruses are the most common organisms that can be inhale. Pneumonia could be community-acquired or health care associated. Community –acquired pneumonia (CAP) occurs out of a healthcare facility while health care associated pneumonia (HAP) is acquired in a healthcare facility. HAP are more resistant to antibiotic and patients on ventilators and those receiving kidney dialysis have a higher risk factor. Infants, children and the elderly also have a higher risk of acquiring pneumonia due to their immune system inability to fight the virus. Pneumonia can also be classified as aspiration pneumonia if it arises by inhaling saliva, vomit, food or drink into the lungs. Patients with abnormal gag reflex, dysphagia, brain injury, and are abusing drug or alcohol have a higher risk of aspiration pneumonia (Mayo Clinic, 2013). In the case of patient E.O., this patient had rhonchi in the lower lobe and the upper lobe sound was coarse and diminished. Signs and symptoms of pneumonia include difficulty breathing, chest pain, wheezing, fever, headache, chills, cough, confusion, pain in muscle or
It is important for healthcare providers to acknowledge the evidence base that drives our clinical practice. Evidence-based practice (EBP) is at the forefront of our ability to deliver high quality care and is utilized when making clinical decisions concerning patient care. Ventilator-associated pneumonia (VAP) is a hospital-acquired infection that occurs in mechanically ventilated (MV) patients and contributes to increased levels of morbidity and mortality. VAP is a preventable condition and many efforts have been instituted to curb its incidence. A clinical care approach adopted by many
According to Safer healthcare now (2012), “Ventilator-associated pneumonia (VAP) is defined as a pneumonia occurring in patients requiring a device intermittently or continuously to assist respiration through a tracheostomy or endotracheal tube” p11.The development of VAP has many potential causes some of which included aspiration, intubation procedure, biofilm formation,
In the ICU, an area of practice that has seen improved patient outcomes is through the use of Ventilator Associated Pneumonia (VAP) bundles. VAP is a pneumonia that affects patients who are on ventilation. It occurs when pathogens enter the patient’s lungs through the mouth, nose or throat. A ventilator strategy bundle was developed. In 1994, the Healthcare Infection Control Practices Advisory Committee (HICPAC) revised the CDC Guideline for Prevention of Nosocomial Pneumonia to address VAP, as there was growing concern regarding the mortality and morbidity associated with healthcare related pneumonia. In the report, the VAP strategy bundle was developed and included in the bundle are: elevation head of bed to help prevent aspiration, oral
The clinical manifestations of pneumonia will be different according to the causative organism and the patient’s underlying conditions and/or comorbidities (Smeltzer, et al). Some of the manifestations are
The patient's overall symptoms and lab work suggest that she is suffering from hospital acquired pneumonia. Currently the patient is presenting a moist chesty cough. Additionally, her heart rate is elevated, her oxygenation is low, and her RR is high. She has a raised white blood cell count, which indicates infection. Finally, the patient is acting confused and disoriented, which can be the direct result of a lack of oxygenation to the brain. All of these symptoms point to pneumonia (Torres, 1999).