Technical patient safety solutions for prevention of ventilator-associated pneumonia in adults
Best practice, Review
Pneumonia is an inflammatory condition of the lungs caused by bacterial, viral or fungal infection. Ventilator-associated pneumonia (VAP) can occur as a complication of mechanical ventilation, particularly when ventilation is required for a prolonged period of time and in patients who are critically ill. VAP is a significant problem - data from the USA suggests that it represents 31% of all intensive care unit (ICU)-acquired infections, and that it occurs in 9–27% of all intubated patients. Patients who develop VAP are at risk of serious complications (for example, acute respiratory distress syndrome) and have a significantly longer stay on ventilator machines and in ICU. NICE/NPSA have recommended that for patients who are on a ventilator and have a tube placed into their mouth, nose or through the neck and down into their windpipe, healthcare professionals should: - position patients with their upper body elevated (in a semi-recumbent or seated position) for as much of the time as possible. For some patients this will not be appropriate (for example, those with spinal injuries). - Include oral antiseptics (for example, chlorhexidine) as part of the oral hygiene regimen for all patients who are intubated and receiving mechanical ventilation. The guidance for the prevention of ventilator-associated pneumonia for adults was expected to be issued in December 2007. The guidance publication was delayed as a result of a decision made by the Resolution panel that further analysis on one of the interventions was needed. This was upheld by NICE's Guidance Executive. Currently, further assessment is being done on the intervention selective decontamination of the digestive tract. Once the assessment report is complete and additional clinical and patient advice has been collected, the committee will review the guidance.