Ventilator-associated pneumonia (VAP)
Definition and Nursing Interventions
Ventilator-associated pneumonia (VAP) is an important safety issue in hospitalized patients. VAP is defined as,“in patients receiving mechanical ventilation, a new and persistent infiltrate seen on chest x-rays associated with fever, elevated or depressed white blood cell counts, and sputum that is either purulent or full of disease causing bacteria” (Venes, 2009).
Obviously, critically ill patients have increased outcomes when they don’t develop this secondary infection that also can cost the hospital $11,000-$57,000 dollars per patient (Bird, Burke, Agarwal, Zambuto, O'Donnell, Silva, Korn & Burke, 2010). Fortunately evidence based practice guidelines have been developed for healthcare workers that help to prevent VAP when caring for patients on a ventilator. These include:
1. The Ventilator bundle: which includes elevation of the HOB to 30°-45° unless medically contraindicated, administering medications to reduce the risk of developing DVTs, administering medications to reduce the incidence of peptic ulceration, and giving the ventilated patient periodic intermissions from sedation (Venes, 2009);
2. Washing hands before and after contact with each patient;
3. Continuous removal of subglottic secretions;
4. Change of ventilator circuit no more often than every 48 hours;
5. Not wearing rings or nail polish when caring for patients;
6. Oral care every 2 hours and PRN and use of a chlorhexidine oral rinse before intubation and while intubated;
7. Turning patient at least every 2 hours;
8. Checking residual volume in nasogastric tube to prevent pulmonary aspiration;
9. Staff education sessions on VAP and prevention strategies;
10. Consistent documentation of turning, HOB 30°-45°, suctioning secretions, oral care, and checking residual in NG tube (Tolentino-DelosReyes, Ruppert & Shiao, 2007).
VAP is a serious concern for patients, nurses, and healthcare systems...