Ventilator-associated pneumonia or VAP is one of the challenging complications in intensive care units and contributes to significant health care costs, morbidity and mortality. Hence, it is very important to prevent ventilator-associated pneumonia to optimize patient outcomes…
Microbiological surveillance is important because it prevents emergence of multi-drug resistant bacteria and also in determining empirical therapy for patients with VAP. According to Babcock et al (2004), educating health professionals about prevention of VAP is critical for prevention of not only VAP, but also various nosocomial infections. Similar reports were delivered by Needleman et al (2002) and Cho et al (2003).
Another important strategy for prevention of VAP is early extubation and this is possible by following certain extubation protocols like interruption of sedation every day. According to Cook et al (2000), decreased time of mechanical ventilation decreases the risk of aspiration and consequently decreases VAP risk.
The third strategy useful to prevent VAP is prevention of aspiration. Nieuwenhoven et al (2006) have reported that evevation of bed at 45 degrees prevents aspiration. Timely drainage of secretions in the subglottic region which get contaminated easily (Bonten et al. 2004), avoiding manipulation of fluids in the ventilator circuits (Han and Liu, 2010) and use appropriate endotracheal cuff pressure (Valencia et al. 2007) also prevent aspiration of contaminated fluids and secretions.
There are several decontamination strategies which have been advocated for prevention of VAP. Some drugs like chlorhexidine are useful for oral decontamination. Selective decontamination of the intestines is possible by using antibiotics like polymyxin which are non-absorbable (Bonten and Krueger, 2006).
Babcock, H.M., Zack, J.E., Garrison, T., Trovillion, E., Jones, M., Fraser, V.J. et al. (2004) An educational intervention to reduce ventilator-associated pneumonia in an integrated health system: a comparison of effects. Chest, 125, 2224–2231.
Tablan, O.C., Anderson, L.J., Besser, R., Bridges, C. and Hajjeh, R. (2004) Guidelines for preventing health-care–associated pneumonia, 2003: ...
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The VAP bundle includes four components of care and they are: 1. Elevation of the head of the bed of the patient This is the most integral part of VAP bundle and has been strongly associated with decrease in the rate of VAP. The elevation level that is recommended is 30-45 degrees.
It is a disease of the lung tissue occurring forty eight hours after procedures like tracheostomy or placement of an endotracheal tube to the patient is done. These procedures impair the integrity of the respiratory tree (CDC, 2012). Various journals have been published on other various VAP issues affecting its severity and outcome.
Ventilator acquired pneumonia (VAP) is pneumonia that occurs in patients on endotracheal intubation or tracheostomy tube after 48 hours or more which was not originally present before the ventilation. It is the most common ICU infection and the most fatal of all.
VAP is the commonest type of nosocomial infection, occurring forty eight hours after the initiation of mechanical ventilation. It affects between 10 to 20% of patients under mechanical ventilation. VAP leads to increased ventilator duration, increased hospital stays, increased mortality and increased cost.
Ventilator Associated Pneumonia (VAP) refers explicitly to nosocomial bacterial pneumonia that has developed in patients who are under mechanical ventilation. VAP can be segregated into two types – early onset pneumonia and late onset pneumonia. One that occurs within 48 to 72 hours after tracheal intubation and is mostly the result of aspiration is termed early onset VAP and the one that occurs after this period is termed late-onset pneumonia (Kollef, 2005).
The goal is geared towards the prevention of ventilator associated-pneumonia using ventilator bundle in long term care. The title of the project is Evidence-based Practice for the Prevention of Ventilator -associated Pneumonia using Ventilator Bundle in Long Term Care.
The improvement of care for patients suffering from CAP has been the focus by many organizations. CAP is a major health concern in various parts of the world. It is the seventh leading course of mortality rate worldwide, with an approximate of 1.7 million annual hospital admissions, and annual economic costs of approximately $9 billion.
Early onset of pneumonia is caused by infection of staphylococcus, haemophilus or streptococcus gram-positive bacteria. These strains of bacteria are antibiotic sensitive. The late onset of VAP occurs after 72hours of ventilation (Booker et al., 2013). Methicilin resistant staphylococcus, pseudomona and enterobactor bacteria normally cause it.
rts (American Thoracic Society, 2005) exhibit that over three million individuals develop pneumonia yearly while 17% of the victims receive treatment in hospitals. Therefore, most victims recuperate, making it apparent that at least 5% of the patients always accede the illness
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