Reduction in the Incidence of Ventilator-Associated Pneumonia: A Multidisciplinary Approach



Reduction in the Incidence of Ventilator-Associated Pneumonia: A Multidisciplinary Approach

Summary

Research work on the reduction in the incidence of Ventilator-Associated Pneumonia was an outcome of several researchers, whose combined effort provided an in-depth knowledge and information about the VAP-Ventilator Associated Pneumonia. The systematic implementation of a package of preventive interventions can reduce the incidence of VAP, with consequent effects on antibiotic use among patients at highest risk (Vincent & Marshall, 2009). The United Status-Based Institute for Healthcare Improvement (IHI) (Institute for Healthcare Improvement in the United States) has defended the approach of the "package" to improve medical practice and emphasizes the need to achieve high rates of overall compliance (preferably 95% compliance of all elements of the package) (Ranes & Gordon, 2006). The implementation of care packages has been advocated strongly in ventilated patients in intensive care units (ICU) at risk of ventilator-associated pneumonia (VAP). VAP is associated with prolonged mechanical ventilation, admission to an ICU and hospital stay, and increased costs due to illness and possibly higher mortality figures (Herzig & Marcantonio, 2009). 

Introduction

By pneumonia understood infectious disease characterized by focal lesions of the lungs with respiratory intraalveolar exudation and is accompanied by fever and intoxication. Distinguish between community-acquired and nosocomial (hospital, nosocomial) pneumonia. Hospital-acquired pneumonia (HP) - pneumonia that develops after 48 or more hours after admission the patient to the hospital, with any infection during the incubation period at the time of admission to the hospital should be absent (Hancock, 2004). Ventilator-associated pneumonia (VAP) - is a special case of SOEs, developing in patients who require prosthetic pulmonary function, i.e. requires long-term hardware artificial or assisted ventilation (AV). As shown by clinical studies, the occurrence of VAP perhaps sooner than 48 hours, especially in patients who are in critical condition? According to BR Gelfand, with respect to this period of VAP should be reduced to 24 hours (McKenna & Cutcliffe, 2000). According to many authors, the department general incidence of SE does not exceed 1% (0.5 - 1.0%), in resuscitation and intensive care unit (ICU) - a 15 - 40%, and remains consistently high ranking leader among all infectious complications, regardless of the profile of the hospital and patients. During mechanical ventilation rate of VAP cannot exceed 60%. Each day, the patient's stay in the ICU for mechanical ventilation increases the risk of VAP by 1-3%. Crude mortality of patients with VAP is 60-80%. According to data the incidence of nosocomial VAP during mechanical ventilation for more than 5-days was about 70% in 2000, about 80%) (Lorenz, Morton & Shekelle, 2005). Crude mortality of patients with VAP is 50% (2000 70%). Mortality directly related to pneumonia, is around 30% of the total number of deaths in patients with VAP (Jennings, 2001).

Key Points of the Article

It is believed that in-hospital pneumonia develops in the interaction of a sufficient number of virulent microorganisms from the microorganism, which initially or by microbial action violated safeguards. Patients undergoing mechanical ventilation are particularly at risk of ...