Simple interventions for ventilator-associated pneumonia
Debra Bayer BSN, RN
Eric M. Wiech RN, CCRN

$1.99 		Nursing2013 Critical Care
May 2012 
Volume 7  Number 3
Pages 18 - 21
 
  PDF Version Available!

ABSTRACT
Because different criteria are used to diagnose ventilator-associated pneumonia (VAP) (see Defining VAP), incidence can vary widely. For example, using microbiological criteria can lower the perceived VAP rate from a range of 6% to 31% to a range of 3.5% to 15%.1 Using broader criteria, including clinical criteria, can lead to higher reported rates of VAP and could create an incentive for healthcare facilities to underreport VAP cases.No matter how it's defined, VAP is an ongoing issue for all healthcare systems. The National Healthcare Safety Network (NHSN) reported 8,872 VAP events in 1,326 CCUs from 2006-2008. VAP rates are traditionally reported as cases per 1,000 ventilator days, and NHSN reports ranged from as low as 0.5 per 1,000 in respiratory critical care areas to as high as 10.7 per 1,000 in the trauma ICUs tracked.2 At an estimated cost of $10,000 per incidence and 15% to 50% overall mortality, VAP at these rates reflects additional healthcare costs of $88.7 million and the deaths of anywhere from 1,331 to 4,436 patients in a 2-year period.3 VAP nearly doubles a patient's risk of death, compared to equally matched patients without VAP.3This article describes VAP and the bundle of interventions our facility uses to reduce VAP rates.Risk factors for VAP are related to the invasive nature of an endotracheal (ET) tube and the fact that it bypasses the body's natural defense mechanisms. * Patient-related risk factors include a history of chronic obstructive pulmonary disease, immunosuppression, anything that increases the risk of aspiration (such as patient positioning with the head of the bed lower than 30 degrees, gastric overdistension, and prolonged ET intubation or reintubation).4 * Device-related factors include underinflation of ET tube cuffs (which can allow migration of bacterial pathogens around the cuff into the lower respiratory tract), contaminated equipment (such as contaminated condensate in ventilator circuits), or use of a nasogastric or orogastric

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