Ventilator-associated pneumonia (VAP) is a leading cause of death in critically ill patients. Every year, many patients are diagnosed VAP. Those patients with VAP have both an increased length of stay, and a higher mortality risk.
It is important for caregivers, patients, and family members to understand the risks of VAP, as well as possible care techniques for reducing the likelihood of infection.
Did you know?
63%
of nurses in Europe feel they don’t have appropriate tools to provide oral care to their patients.1
VAP affects 5 to 40% of patients ventilated for more than 2 days.2
Studies suggest that VAP increases the length of ICU stay by 6 to 10 days.3
Researchers report that VAP can cost between €10,800 and €51,000 to treat.4
Main causes and risks of VAP
Main cause of VAP
When a patient has been intubated with an endotracheal or tracheostomy tube for at least 48 hours, VAP can develop. VAP is the most common ICU-acquired infection amongst mechanically ventilated patients. When patients are intubated, the coughing, chewing and swallowing actions are limited. Microorganisms can grow quickly and pool above the tracheal tube cuff. After pooling, with micro-aspiration, bacteria can enter the respiratory tract, which can develop into pneumonia.
Who is at risk?
There are certain traits, conditions or habits that may raise the risk for VAP; these conditions are known as risk factors. Risk factors for the development of VAP can be based on the patients themselves or their other diagnoses and circumstances. Risk factors can include older age, chronic lung disease, prolonged mechanical ventilation and other injuries like burns or trauma. Patients have the highest risk of developing VAP during days 1 to 5 of ventilation, and the risk is reduced each following day.6
Prevention of VAP
Setting educational programs for the healthcare staff, setting clinical guidelines and protocols for prevention of VAP and implementing standard precautions such as ensuring the hand hygiene, ensuring the usage of personal protective equipment are important steps. Beside these standard measures, there are various other measures that play a very important role in reducing the risk of VAP.
Elevation of the head
Position of the patient has a strategic effect on the VAP risks. If there are no other contradictions, the patients should be in semi-recumbent position (30 to 45 degrees) as a prevention measure.6
Minimisation of ventilator exposure
It is important to avoid mechanical ventilation if possible. Encouraging the use of non-invasive mechanical ventilation is one way to decrease mechanical ventilation.7 If mechanical ventilation is unavoidable, it is important to try to minimise the duration of ventilation by following evidence-based weaning protocols.7
Prevention of aspiration
VAP can be caused by aspiration of secretions that build around the endotracheal tube in mechanically ventilated patients. The use of subglottic drainage is recommended to reduce the risk of aspiration. 6
Oral Care
A comprehensive oral care is a vital component in reducing the risk of infection. To prevent the colonization, performing regular oral hygiene with a soft toothbrush and swabs to clean the oral mucosa at least 12-hourly and topical application of chlorhexidine gluconate (0.12%-2%) plays an important role in prevention of VAP.7 Research shows that oral care protocols can reduce VAP by 46%.8
Stress ulcers prophylaxis
Although the gastric ulcer treatment itself is not related to VAP, it does have an impact on the possible occurrence of VAP. There is strong evidence that lowering gastric acid using various treatments, such as antacids and H2 antagonists used for stress ulcer prophylaxis in ICU patients on ventilation, raises the risk of VAP.6 It is recommended that where stress ulcer prophylaxis is indicated, sucralfate is to be preferred in order to reduce the risk of VAP.6
Medline VAPrevent Solutions
You can check out Medline’s oral care portfolio to help reduce the risks of VAP.
24-Hour Oral Care Kits
Our 24-Hour kits offer you all necessary components for a full day of oral care on one patient.
Single Tray Kits
All that is needed for once assisted oral care episode packed in one convenient tray with integrated cup.
Individual Items
Specifically designed tools to help the healthcare staff to provide exceptional oral hygiene to the patient.
References
[1] Rello, J. et al. Oral care practices in intensive care units: A survey of 59 European ICUs. Intensive Care Medicine 33, 1066–1070 (2007).
[2] Papazian, L., Klompas, M., & Luyt, C. E. (2020). Ventilator-associated pneumonia in adults: a narrative review. Intensive Care Medicine, 46(5), 888–906. https://doi.org/10.1007/s00134-020-05980-0.
[3] Safdar N, Crnich CJ, Maki DG (2005). The pathogenesis of ventilator-associated pneumonia: its relevance to developing effective strategies for prevention. Respiratory Care 50(6):725–741.
[4] Leistner R, Kankura L, Bloch A, Sohr D, Gastmeier P, Geffers C (2013). Attributable costs of ventilator-associated lower respiratory tract infection (LRTI) acquired on intensive care units: a retrospectively matched cohort study. Antimicrobial Resistance and Infection Control 2(1):13.
[5] Pneumonia prevention systems which are designed to stop ventilator-associated pneumonia. (2022). Wessex Academic Health Science Network. https://wessexahsn.org.uk/projects/148/pneumonia-prevention-systems-which-are-designed-to-stop-ventilator-associated-pneumonia
[6] Masterton, R. G., Galloway, A., French, G., Street, M., Armstrong, J., Brown, E., Cleverley, J., Dilworth, P., Fry, C., Gascoigne, A. D., Knox, A., Nathwani, D., Spencer, R., & Wilcox, M. (2008). Guidelines for the management of hospital-acquired pneumonia in the UK: Report of the Working Party on Hospital-Acquired Pneumonia of the British Society for Antimicrobial Chemotherapy. Journal of Antimicrobial Chemotherapy, 62(1), 5–34. https://doi.org/10.1093/jac/dkn162
[7] Health Protection Surveillance Centre. (2011, February). Guidelines for the prevention of ventilator-associated pneumonia in adults in Ireland. https://www.hpsc.ie/a-z/microbiologyantimicrobialresistance/infectioncontrolandhai/guidelines/File,12530,en.pdf
[8] Sona, C. S., Zack, J. E., Schallom, M. E., McSweeney, M., McMullen, K., Thomas, J., Coopersmith, C. M., Boyle, W. A., Buchman, T. G., Mazuski, J. E., & Schuerer, D. J. E. (2008b). The Impact of a Simple, Low-cost Oral Care Protocol on Ventilator-associated Pneumonia Rates in a Surgical Intensive Care Unit. Journal of Intensive Care Medicine, 24(1), 54–62. https://doi.org/10.1177/0885066608326972