Importance of Infection Prevention from VAP and Use of Care Bundle Checklist

Nosocomial Pneumonia:

Hospital Acquired Pneumonia (HAP)/ Nosocomial Pneumonia is defined as Pneumonia which develops after 48 hours or more after hospital admission, which was not incubating at the time of admission. HAP is second most common HAI after CAUTI.

Diagnosis Criteria for Nosocomial Pneumonia:

• Fever
• Cough
• Development of purulent sputum, in combination with radiologic evidence of a new or progressive pulmonary infiltrate
• Leukocytes (Increased WBC Count)
• Growth of bacteria in cultures of sputum, tracheal aspirate, pleural fluid and Blood

Risk Factors:

• Mechanical Ventilation (Endotracheal Intubation)
• Critical Illness with prolonged immobilization
• Disease of Central Venous System
• Thoraco- abdominal surgery
• Depressed level of consciousness
• Underlying Chronic lung disease
• Age more than 70
• Severe trauma

Meaning of Ventilator Associated Pneumonia (VAP):

Pneumonia is one of the most serious of HAIs. Ventilator-associated pneumonia (VAP) is the most important infection in patients on ventilators in intensive care units. It has a high case fatality rate and is often associated with serious comorbidities.

VAP refers to pneumonia which develops more than 48 to 72 hours after endotracheal intubation. VAP rate is calculated by dividing number of VAPs by the number of ventilator days.

Prevention From VAP:

• Keep The head of the patient’s bed raised between 30 to 45 degrees unless other medical conditions do not allow this to occur.
• Daily oral care with chlorhexidine solution of strength 0.12%.
• Clean hands with antiseptic soap and water or an alcohol-based hand rub before and after touching the patient or ventilator.
• Daily sedation vacation, check the patient’s ability to breathe on his own every day so that the patient can be taken off of the ventilator as soon as possible.
• Avoid re intubation whenever possible.
• Monitor endotracheal tube cuff pressure ( Keep it more than 20 cm H2 O) to avoid air leaks around the cuff, which can allow entry of bacterial pathogens into the lower respiratory tract.
• Prefer endotracheal tubes with a subglottic  suction port to prevent pooling of secretions around the cuff leading to micro aspiration.
• The heat moisture exchanger may be better than the heated humidifier.
• Closed endotracheal suction systems may be better than the open suction.
• Periodically drain and discard any condensate that collects in the tubing of a mechanical ventilator.
• Avoid intubation whenever possible.
• Consider non-invasive ventilation whenever possible.
• Prefer oral intubations to nasal unless contraindicated.  

Major Interventions used in Prevention of Ventilator Associated Pneumonia: 

Written by:

Dr. Praveen Bajpai

Director of Ingenious Healthcare Consultants Pvt. Ltd.
Founder of Skill Sathi

MBA in Hospital administration, PG Diploma in Quality Accreditation, PG Diploma in Medico Legal System, M. Phil in Hospital Mgmt. from BITS Pilani, P.hD in Management, Certified NABH Auditor, Certified NABL Auditor, Certified Auditor for Clinical Audits, Green Belt in Six Sigma, Certified in Hospital Infection Control Practices, Certified trainer for International Patient Safety Goals, Certified Auditor for JCI 7th Edition Standards 

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