Critically ill patients are highly susceptible to develop hospital-acquired infections. Pneumonia is touted to be the 2nd the most widespread nosocomial infection in patients admitted in intensive care unit (ICU). Out of the 25% patients in ICU afflicted with pneumonia, more than 85% are connected to mechanical ventilation. This significant percentage considering critically ill patients in intensive care setting, more often than not, are hooked to a mechanical ventilator. If a patient is with an endotracheal tube for more than 48 hours, ventilator-associated pneumonia (VAP) is likely to be suspected, although specific patients are considered to have a higher chance of acquiring such than the others. Risk factors can be related to the host itself (such as immunosuppression, standing illness such as a chronic obstructive pulmonary disease (COPD) and an acute respiratory distress syndrome (ARDS), present medications, and etc), the device (in form of endotracheal tube, ventilator circuit, and the incidence of a nasogastric or orogastric tube or the personnel in direct contact (such as contaminated hands and gloves) with the patient.
Prompt discovery of VAP is highly essential. Methods such as critical bedside inspection, radiographic examination, clinical observation and laboratory analysis of secretions are the tools to diagnose ventilator-associated pneumonia. Treatment is focused on the complete antibiotic therapy. However, VAP can be prevented by using basic nursing and respiratory interventions.
In America, reported cases of ventilator-associated pneumonia are thought to be between 250,000 to 300,000 every year. Mortality rates are reported to run from 0% to 50%. Because of the newly acquired VAP on top of a standing illness, families of critically-ill patients should expect extended length of hospital stay and high health care costs. A patient can stay for 13 days more in the ICU and pay extra $20,000 because of VAP. This is a serious challenge to all members of the health care team, especially the nurses who are in frequent contact with patients.
The consequences of ventilator-associated pneumonia in mortality, morbidity, span of hospital stay and costs in health care are alarming. Nurses, together with the rest of health-care providers, play a major role in the intervention and decrease of incidence of ventilator-associated pneumonia. The presence of a nurse outcome manager in the intensive care setting is highly recommended. A comprehensive approach in preventing VAP utilized by the hospital will be ineffective if there is no 100% compliance from the health-care members. The nurse outcome manager is responsible for ensuring that the standard protocols on infection control and VAP prevention are strictly adhered in the area. The usage of ventilator pathways and guidelines are strongly recommended too, because they serve as friendly reminders to all health-care professionals on the magnitude of interventions in preventing VAP.
Ventilator-associated pneumonia is a not a new problem and many of the known effective preventive measures are part of the routine nursing procedures. The developed monitoring tools and protocols must be complied to help to reduce the incidences of a life-threatening ventilator-associated pneumonia.