Preventing Ventilator Associated Pneumonia

Ventilator associated pneumonia is among the highest nosocomial infections in ICU patients. Ventilator associated pneumonia is related to longer length of hospital stays, higher mortality rates, and higher costs. The issues with ventilator associated pneumonia are not limited to the United States, it is a global issue. A literature search of the evidence was conducted using PubMed, CINAHL Complete, and Cochrane Library databases on several separate days using keywords such as “ventilator associated pneumonia,” “ICU,” and “prevention.” Articles were excluded in which the population included children, patients already diagnosed with ventilator associated pneumonia, and articles older than 5 years. Research was centered on meta-analysis, systematic reviews, and case studies. Many articles reviewed that referenced the prevention of ventilator associated pneumonia investigated the use of single item prevention strategies and were not found to be statistically significant. Based on the evidence presented in multiple articles, it appears that a “bundle” method of prevention has the highest success rates. “Bundling” takes prevention measures that might not be statistically effective on their own, adding them together, and creating a single protocol that best reduces the chances of ventilated ICU patients from acquiring pneumonia. The elements of successful bundles include effective hand hygiene prior to initiating care for the endotracheal tube, comprehensive oral care, elevation of the head of the bed, daily sedation interruption (to evaluate the patient’s readiness to be weaned from mechanical ventilation), control of endotracheal cuff pressure, and subglottic suctioning. As with any protocol, these bundles work best when compliance to the preventative measures is high. Education on the topic is an important aspect of attaining high compliance rates, providers will be more willing to adhere to protocols when they understand the importance of the protocol. Along with skill and education, physical aspects of the technology/protocols used play a significant role in adherence to prevention protocols.