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 its 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 RNs was a
54% compliance rate. HSC MDs 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 pts 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 pts. Avoid overusage
to prevent chlorhexidine-resistant
pathogens.

Costly options that may be looked

into:

Inline VS open suction catheters. (Does not

prevent nosocomial pneumonias 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 patients at risk of

reoccurring resp. infections including VAP.

SUMMARY
Wash hands
Elevate the head of bed 45 degrees
Keep ETTs 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

10.00

5.3

Infected patients

6.67

5.30

BSI - Other

0.7

BSI - CVL

2.91/1000 CVL
days

1.49/1000 CVL
days

Gastro

VAP

5.29/1000 Vent days

5.15/1000 Vent 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