Whapping pneumonia by reducing patient risk
These recommendations to reduce ventilator-associated pneumonia (VAP) are from educational handouts developed for the WHAP VAP! program at Barnes-Jewish Hospital in St. Louis:
Risk Factors
- Age: Infants, young children, people over 65
- Disease: People with chronic disease, immunosuppressed, depressed level of consciousness, and cardiothoracic patients
- Position: Lying flat in bed
- Ventilation: Prolonged ventilation, reintubation
- Nasal intubation associated with sinusitis, VAP
- Gastric overdistention
- Inadequate pressure in endotracheal-tube cuff
- Collection of condensate in ventilator circuits or improper drainage of condensate
- Routine changing of ventilator circuits (tubing)
- Nonspecific antibiotic therapy or use of multiple antibiotics
- Stress ulcer treatment
- Nasogastric (NG) tubes promote gastric reflux and aspiration of contaminated secretions into the lower airway
VAP Causes
- Contaminated hands of health care workers
- Colonization of the aero-digestive tract
- Contaminated respiratory equipment
- Aspiration of contaminated secretions into the lower airway. These bacteria thrive in warm moist environments, such as respiratory therapy equipment.
Decreasing the Risk to Patients
The primary intervention associated with preventing all nosocomial infections is hand washing. Meticulous infection control practices related to respiratory care services also are essential to preventing VAP. The following recommendations are for all ventilated patients:
- Wash hands before/after patient or ventilator contact; the primary intervention for preventing nosocomial infections is hand washing.
- Do not change ventilator circuits and in-line suction catheters unless visibly soiled or malfunctioning.
- Do not use HMEs for patients with excessive secretions or hemoptysis (be sure to provide alternative form of humidification).
- Change HME every 24 hours.
- Maintain adequate ventilation and cuff pressure.
- Drain ventilator circuit condensate before repositioning patient.
- Place ventilated patients in semi-recumbent position with head of bed elevated 30 degrees, as tolerated, even during transport.
- Avoid nasal intubation.
- Adequately secure endotracheal tube and/ or restrain the patient to prevent accidental self-extubation.
- Monitor gastric residual volumes before initiating feedings to avoid gastric overdistention (residual maximum < or equal to 200 cc).
- Drain condensate from ventilator circuits regularly using appropriate technique to avoid contamination of circuit.
- Avoid overuse of multiple antibiotics.
- Limit stress ulcer treatment if possible.
- Use daily chlorhexidine oral rinse (only for patients undergoing cardiac surgery).
- Provide immunizations (Influenza, Pneumococcal, Haemophilus B vaccines).
- Remove NG tubes as soon as possible.
- Extubate patient as soon as clinically indicated.
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