Preventing Ventilator Associated Pneumonia (VAP) - Pharmacy

53 Pages·2011·1.02 MB·English

Preventing Ventilator
Associated Pneumonia: A Six
Year Experience
Coretha Weaver, BSN, CIC
Erlanger Health System
Chattanooga, TN
1
Objectives
The participant will be able to
Describe the prevalence, economic and
1.
human costs associated with VAP;
Discuss best practices implemented
2.
during this project to prevent VAPs;
Discuss patient outcomes and factors
3.
affecting progress;
Discuss future work to prevent VAP
4.
2
A 533 bed, 5 facility

regional teaching
health system
Level 1 Trauma

Center
68 Adult ICU Beds-

7 Units
Epidemiology of VAP
VAP represents >25% of all ICU-

acquired infections
VAP cases occur at a rate of >100,000

cases of annually in the US
VAP accounts for more than one-half

the antibiotic use in the ICU
Attributable mortality of VAP can be as

high as 50%
Zilberberg M et al. Clinical Infectious Diseases 2010;51(S1):131-135
Dodek et al. Ann Intern Med,2004:141:305-313.
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VAP: TIME COURSE
Mean Daily Risk Of VAP
5
E 4
G
A
T
N 3
E
C
R
2
E
P
1
0
0 - 5 6 - 10 11 - 15 16 - 20 21 - 25 26 - 30
Number Days Intubated
Weber, J. 2006 APIC
Pathophysiology
Early VAP Late VAP
Timing Timing
 
Within 5 days Beyond 5 days
 
Bacteriology Bacteriology
 
S. pneumoniae P. aeruginosa
 
H. influenzae Acinetobacter
 
MSSA MRSA
 
Susceptible GNB Other multiresistant orgs
 
Prognosis Prognosis
 
Less severe, little High attributable
 
impact on outcome mortality and morbidity
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Kollef,M. N Eng J Med 1999;340(8): 627-34
Economic Impact
Non-Infected Patients with
VAP
Ventilator
Patients
ICU LOS 4 days 26 days
Hospital LOS 13 days 38 days
Hospital Costs $21,620 $70,568
Adjusted $12,000
Attributable
Cost for VAP
7
Warren et al. Crit Care Med 2003 May;31(5):1312-7
Pathogenesis of VAP
Organisms causing VAP arise from
endogenous and exogenous sources
Organisms causing VAP arising from both endogenous and exogenous
sources
Risk Factors For VAP
Enteral nutrition
 Duration of
 Supine position
intubation
Transport out of the ICU
 Emergent intubation
Cross contamination of
 Re-intubation
ventilatory equipment
 Insufficient oral
Nasal intubation
hygiene
 Elevated gastric PH Lack of healthcare
Prior antibiotic professional training in

 therapy VAP prevention
 Nasogastric tube
management
Kollef M. Crit Care Med 2004;32:1396
9
Pathogenesis of VAP
Bacterial Aspiration Altered
colonization of host
aerodigestive secretions defenses
tract
Prevention strategies focus on :
 Duration of
 Colonization  Aspiration
Ventilation
____________________________________________________________
Adapted from AACN VAP Practice Alert Presentation 2005
Adapted from AACN VAP Practice Alert