Ventilator-Associated Pneumonia

Pneumonia is an infection of the airways and lungs and is a leading cause of death. Pneumonia is defined by using a combination of radiologic, clinical, and laboratory criteria. A pneumonia where the patient is on mechanical ventilation for more than 2 calendar days when all elements of the pneumonia infection criterion were first present together and the ventilator was in place on the date of the event or the day before is considered to be a ventilator-associated pneumonia (VAP). Preventing pneumonia of any variety is important but there are reasons to be particularly concerned about pneumonia associated with ventilator use. VAP is the leading cause of death among healthcare-associated infections. The biggest concern about VAP is the high rate of death in these patients. The chance of death of ventilated patients who develop VAP is 46 percent compared to 32 percent for ventilated patients who do not develop VAP. In addition, VAP can extend the time patients spend on the ventilator, increase the length of stay in the Intensive Care Unit, and extend the overall hospital stay after discharge from the ICU. VAP increases costs to patients and can add up to $40,000 to a typical hospital admission. Reducing mortality due to ventilator-associated pneumonia requires an organized process that guarantees early recognition of pneumonia and consistent application of the best evidence-based practices.

Naval Medical Center Portsmouth recognizes the importance of preventing VAP and has implemented a number of clinical practices to improve the outcomes for patients who need ventilator support. These actions include:

• Elevation of the head of the bed
• Careful use of sedation and use of periods where the sedation is decreased (called sedation vacation)
• Daily assessments to determine if the breathing tube can be removed
• Use of medications to prevent peptic ulcer disease
• Preventing development of blood clots in the legs (Deep Venous Thrombosis)
• Daily oral care with a special solution (eg., Chlorhexidine)

We use a multi-disciplinary, teamwork approach with specific communication strategies and daily goal setting for our patients. Our ultimate goal is to provide excellent care based on proven medical practices and to wean and remove our patients from ventilators as quickly as possible. We have a robust infection surveillance program that allows us to quickly identify and treat infections, identify the cause, and collect infection data that is reported internally and to appropriate external organizations.