8 Tips For Infection Prevention In Ventilated Patients
Ventilator associated pneumonia (VAP) is the leading cause of mortality in intensive care units, (1) according to a study in the Annals of Clinical Microbiology and Antimicrobials.
Here are eight steps for infection preventionists to reduce the likelihood of VAP:
- Good hand hygiene: This basic practice can’t be emphasized enough—good hand hygiene is necessary to prevent the spread of microorganisms from clinician to patients (1). While soap and water may be a good start, a study in Clinical Infectious Diseases found that alcohol-based hand rubs did a better job of reducing the spread of microorganisms as compared to just soap and water. (2) Additionally, jewelry, such as rings and watches, can increase the frequency of hand transmission of bacteria and other pathogens. (2) Thus, it’s better to remove them. (2).
- Disinfect these parts of ventilator equipment: The key parts of ventilator equipment that require disinfecting are those that come in contact with patients’ mucous membranes, including resuscitation bags, spirometers, and oxygen analyzers (1). Additionally, the condensate fluid should be changed regularly as it tends to contain a high amount of pathogenic bacteria.(1)
- Humidify the air with an HME: Humidifying air that the patient breathes is important in ventilator management, but is also a risk factor, as condensate can attract infectious microorganisms. (1) Heat moisture exchange (HME) humidifiers have been to shown to reduce the amount of condensate that forms, and one in particular, the Pall Ultipor breathing circuit filter (PUBCF) was shown to prevent the passage of up to 99.99 percent of the bacteria for up to 24 hours in the unit.(3) Additionally, their bacterial filters don’t need to be changed daily.
- Use closed suctioning systems: Regular suctioning of secretions that form in the trachea is important in preventing VAP. (1) Closed suctioning systems, which allow suctioning without removing ventilation support, have been shown to cause fewer adverse effects, such as hypoxia, hypotension and arrhythmias, and less bacterial contamination. (4)
- Use non-invasive ventilation: Studies have shown that non-invasive ventilation is correlated with a lower risk of VAP, less antibiotic use, shorter ICU stays and lower mortality than invasive ventilation. (1)
- Apply Topical antibiotics on ET tubes: High concentrations of antibiotics on the surface of endotracheal tubes could prevent the formation of bacterially contaminated biofilms and reduce the incidence of VAP. (1)
- Selective digestive decontamination: Digestive tract decontamination using topical, non-absorbed antimicrobials has been shown to be one of the most effective methods at preventing gastrointestinal colonization of bacteria and other pathogens. (1) The effective combination includes polymyxin, aminoglycoside, and amphotericin B. It has not been shown to negatively affect the gut’s healthy bacteria. (1)
- Good oral care: Oral bacteria has long been identified as a leading risk factor in VAP. (5)Therefore good oral care is incredibly important. This involves brushing teeth, gums and tongue at minimum of twice a day, keeping the oral cavity and lips moist, and using oral rinses such as chlorhexidine and hydrogen peroxide to reduce bacterial biofilms that build up on the teeth and oral cavity of ventilated patients. (5)
- Emine, A. Ventilator associated pneumonia and infection control. Ann Clin Microbiol Antimicrob. 2006; 5: 7. Published online 2006 Apr 6. doi: 10.1186/1476-0711-5-7
- Trick, W. Impact of Ring Wearing on Hand Contamination and Comparison of Hand Hygiene Agents in a Hospital. Clinical Infectious Diseases, Volume 36, Issue 11, 1 June 2003, Pages 1383–1390, https://doi.org/10.1086/374852.
- Martin, C. Heat and moisture exchangers and vaporizing humidifiers in the intensive care unit. Chest. 1990 Jan;97(1):144-9. https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1365-2044.2010.06564.x
- Johnson, KL. Closed versus open endotracheal suctioning: costs and physiologic consequences. Crit Care Med. Egyptian Journal of Chest Diseases and Tuberculosis. Volume 66, Issue 3, July 2017. Pges 509-515. https://www.sciencedirect.com/science/article/pii/S0422763815300911
- Gupta, A. Role of oral care to prevent VAP in mechanically ventilated Intensive Care Unit patients. Saudi J Anaesth. 2016 Jan-Mar; 10(1): 95–97. doi: 10.4103/1658-354X.169484