Ventilator Associated Pneumonia: Definition & Guidelines

Instructor: Jennifer Mitchell

Jennifer is a clinical professor for nursing students in critical care and has several years of experience in teaching nursing.

Ventilator associated pneumonia (VAP) is a preventable infection that sometimes occurs in ventilated patients in the hospital. The purpose of this module is to define VAP and discuss guidelines on how to prevent and treat VAP.

Ventilator Associated Pneumonia: Definition & Guidelines

You're probably wondering what VAP is, as well as what the guidelines are around preventing and treating it. Let's start with defining VAP.

What is VAP?

Ventilator associated pneumonia (VAP) is a type of pneumonia that is contracted while on the breathing machine, or ventilator. Pneumonia is an infection in the lungs caused by bacteria that has been inhaled. You're more likely to get pneumonia after you've been sick with a cold or flu since the immune system is not as strong.

The ventilator is attached to an endotracheal tube or breathing tube in the throat which supports breathing for the patient who has had surgery or is unable to breathe on their own. After surgery and being in the hospital are times when the immune system is weakened due to stress. When the breathing tube is in place for longer than 2 days, it places patients at higher risk for developing VAP. This leads to longer stays in the hospital and can cost $40,000 per case! So you might be wondering-what are the signs and symptoms of pneumonia?

  • Cough with congestion
  • Fever
  • Shortness of breath
  • Chills
  • Chest pain when breathing in
  • Weakness or tiredness
  • Nausea and vomiting
  • Diarrhea

So with VAP, the patient is on a ventilator and has a fever, has difficulty breathing and coughs, and doesn't wake up very easily. So now you're probably asking, how can VAP be prevented? This is where healthcare workers and guidelines are important.

What are the Guidelines with VAP?

One of the most important guidelines with VAP is prevention. Healthcare workers are the most important piece in this puzzle. There are several guidelines for VAP prevention, including:

Handwashing
Handwashing

  • Handwashing before and after each patient encounter by healthcare workers
  • The head of the patient's bed must be kept between 30-45 degrees
  • Regular oral care including suctioning
  • Chlorhexidine oral rinse used for oral care
  • Get the patient off the ventilator as soon as possible (extubate)

So what if all that doesn't work, or the patient can't get off the ventilator after a couple of days? Once the patient develops an illness that is suspected to be VAP, there are guidelines around how VAP can be diagnosed:

  • Chest X-ray
  • Sputum cultures
  • Blood cultures
  • Signs and symptoms of VAP

The healthcare provider will look for certain things on a chest X-ray like fluid collections that indicate pneumonia. Sputum cultures are sent by suctioning the patient and sending a specimen to the lab, where they will test for microorganisms that can cause pneumonia. Those two tests in combination with the signs and symptoms of VAP (listed above) almost undoubtedly lead to a diagnosis of VAP. So what happens next? You probably guessed it-there are guidelines around treatment of VAP!

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