Ventilator Associated

Pneumonia Prevention
Program

Our current and changing practice

 Lets make a difference

Our goal is to reach out to all health care

professionals who have direct patient contact.
With a little education and monthly infection
control rates (which will be provided via e-mail)
we can keep track of our current practice and
evaluate its effectiveness in minimizing our
monthly VAP rates.
 What is Ventilator associated
pneumonia ?
VAP is a nosocomial pneumonia that
develops from patients on mechanical
ventilatory support for over and equal to
48hrs.

At Sick Kids the most common way that

we diagnose VAP is by a modified BAL
 Why it matters:

Did you know that Sick kids average infection rate is

3.5 cases per month.

In adults VAP is the leading cause of death among

hospital acquired infections. The average mortality
rate is 30% and it’s very expensive due to the
increase length of stay (app. 13 days) costing an
estimated $40,000 per case.

A critically ill pt. who develops VAP is said to be twice

as likely to pass away than one without pneumonia. The
risk increases 6.5% if ventilated for over 10 days and
28% if ventilated for over 30 days
Simple, Cost effective approach
 EFFECTIVE hand washing and use of PPE.
Simple, but underused.
 The infection control team performed
monthly hand hygiene audits in the unit. Data
is based on number of times hand hygiene
was observed vs. the opportunity for hand
hygiene. The average for CCU RN’s was a
54% compliance rate. HSC MD’s had a 42%
compliance rate and all other health care
workers had a 58% compliance rate. (Not
that great!)
 Suggestion: Put bins for masks and gloves at
each bed spot, as well as hooks to hang face
shields.
 ALL patients except for our cardiac population
with open sternums, should be placed in the
semi-recumbent position to avoid the risk of
aspiration of upper airway secretions. I.E./ Head
of bed elevated 45 degrees
 Use restraints and keep endotracheal tubes as secure as
possible. This is very important considering our number of
accidental extubations in the past year (61 accidental
extubations)

 For cuffed ETTs use minimal occlusive volumes to

eliminate the potential of aspiration. Avoid gastric
overdistension for the same reason.

 Extubate as soon as clinically feasible because the ETT

promotes growth and proliferation of bacteria in the
bronchial tree
 Remove condensate from ventilator
circuits and monitor the circuits position
because studies show high amounts of
pathogenic bacteria in this fluid which can
cause pneumonia if aspirated.
 Eliminate and/or decrease the unnecessary usage of
antibiotics to prevent antibiotic-resistant nosocomial
infections.

 Routine prophylactic antibiotic therapy should be given

to ventilated pt’s that have neutropenic fevers until
neutrophil recovery occurs. This will decrease febrile
periods and reduce the risk of infection related events
 Promote proper oral hygiene. Use pink
dental swabs and moisten them with water
and/or sterisol oral rinse to control dental
plaque bacteria. Use chlorhexidine for
immunocomprimised pt’s. Avoid overusage
to prevent chlorhexidine-resistant
pathogens.
 Costly options that may be looked
into:
 Inline VS open suction catheters. (Does not
prevent nosocomial pneumonia’s but is more
cost effective with less environmental cross
contamination)

 Purchasing Hi-Lo Evac Tubes for our older kids

with cuffed ETTs. (Has a dorsal lumen attached
to the subglottic region which aspirates pooled
secretions.)

 Give pneumococcal and Influenza vaccinations

prior to discharge for patient’s at risk of
reoccurring resp. infections including VAP.
 SUMMARY
 Wash hands
 Elevate the head of bed 45 degrees
 Keep ETT’s secure
 Prevent gastric overdistension
 Remove condensate from ventilator
circuits
 Decrease unnecessary antibiotic usage
 Practice proper oral hygiene
 Monthly Table
Number Rate

September October September October

Admissions 120 151

Total Infections 12 8 10.00 5.3

Infected patients 8 8 6.67 5.30
BSI - Other 0 1 0 0.7
BSI - CVL 2 1 2.91/1000 CVL 1.49/1000 CVL
days days

Gastro 0 0 0 0
VAP 4 4 5.29/1000 Vent 5.15/1000 Vent
days days

Lets use this evidence based practice in our unit to see if

we can reduce ventilator associated pneumonia rates by
next month.
 References
Van Saene H.K.F., Baines P.B., Kollef M.H. (1999). The
prevention of Ventilator-Associated Pneumonia N Engl J Med
341: 293-294

Wray, R. (2004-2005). Infection Control Rates from the CCU

Infection Control Committee Minutes. The Hospital for Sick
Children

Kovach, D. (2004-2005) Hand Hygiene Audits performed at

the Hospital for Sick Children

Pictures:
www.nursingassistanteducation.com
www.chimed.it/ettube.htm
www.sher.co.uk/_antibiotics/
www.cancerhelp.org.uk
www.amershamhealth.com