Keeping Our Patients Free of Infection

Share our blog: Add to Facebook Add to Google Bookmarks Add to Twitter

October 22, 2010 by host


The physicians and staff at Springhill Medical Center are committed to providing the safest environment for our patients’ medical care. Ventilator associated pneumonia (VAP) prevention and reduction is but one of the infection control challenges that we have undertaken. In the past 5 years, our VAP rate has fallen by 88%. 

VAP is a healthcare-associated infection of the lungs. It occurs as a complication of ventilator support in critically ill patients. The term is somewhat misleading in that the major risk is not from the ventilator itself, but from the tube required for traditional artificial ventilation, which bypasses some of the body’s natural protections against infection.

The risk for developing VAP is highly dependent on a patient’s condition and the underlying disease process. Post-surgical, trauma, burn, and neurosurgical patients are particularly vulnerable as are patients with chronic lung, heart, or kidney disease. Other risk factors include the length of time on a ventilator, immunosuppression, naso-gastric tube placement, tube feedings, the use of antacids and H2 blockers and the chronic use of steroids or antibiotics.
 
The diagnosis of VAP is sometimes difficult in these critically ill patients. Signs and symptoms such as fever, purulent secretions, high white blood cell counts and abnormal chest x-ray findings are non-specific for pneumonia and often altered by ongoing therapy that a patient is receiving. Other lung conditions can mimic pneumonia. Laboratory cultures of sputum from the lower respiratory tract are often obtained to help in the diagnosis of VAP.
 
When ventilator-associated pneumonia occurs, treatment usually consists of antibiotic therapy, mobilization of lung secretions and supportive care.
 
The best strategy for dealing with VAP is prevention. Some of the preventive strategies used at Springhill Medical Center and other leading hospitals include:
·      Effective hand washing
·      Elevation of the head of the bed if no contraindication exists
·      The use of best practice “bundles”
·      Adoption of new technologies such as specialized breathing tubes and holders that help prevent aspiration
·      Use of mask ventilators that do not require breathing tubes whenever possible
·      Safe air policies for construction
·      Proper oral and nasal hygiene
·      Timely discontinuance of artificial ventilation as early as possible by the development and use of standardized protocols
·      Good antibiotic stewardship to reduce antibiotic resistance
·      Promotion of pneumococcal and influenza vaccination
 
In the fall of 2007, our hospital’s efforts to prevent VAP were recognized by the Alabama Productivity Center by its presentation of a Silver Level Quality Award.
Springhill Medical Center has achieved Excellent Status for Infection Prevention and Control through Blue Cross and Blue Shield of Alabama’s Tier Network.
 
Joe Woulard, BS, RRT, Director, Respiratory Therapy
Beth Beck, BS, CIC, Director of Infection Control
 

 
References
  1. Chastre, J, Fagon, J. Ventilator-associated pneumonia. Am J Respir Crit Care Med. 2002;165: 867-903.
  2. Kollef, MH. The prevention of ventilator-associated pneumonia. N Engl J Med 1999; 340:627-634.
  3. Tablan, OC; Anderson, LJ; Arden NH, Besser, R; Hajjeh, R, Bridges, C. Centers for Disease Control and Prevention: Guidelines for preventing health-care associated pneumonia. 2004;53(RR03);1-36.
  4. Niedermann, M S, Craven, D E, etal.   Guidelines for the Management of Adults with Hospital-acquired, Ventilator-associated, and Healthcare-associated Pneumonia. AJRCCM. 2005; Vol. 171; 388-416.
  5. Hess, D R. Patient Positioning and Ventilator-Associated Pneumonia. Respiratory Care. 2005; 7 vol. 50; 892-909.
  6. Diaz, E. Ventilator-Associated Pneumonia: Issues Related to the Artificial Airway. Respiratory Care. 2005; 7 vol. 50; 900-923.
  7. Kallet, R H. The Gastrointestinal Tract and Ventilator-Associated Pneumonia. Respiratory Care. 2005; 7 vol. 50; 910-923.
Comments
Blog post currently doesn't have any comments.