Ventilator Associated Pneumonia: Treatment & Prevention

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 occurs in the hospital and increases hospital stays. The purpose of this lesson is to review VAP and discuss how it is treated and how it can be prevented.

Overview of VAP

Diagram of breathing tube
Diagram of breathing tube

Ventilator associated pneumonia (VAP) is a type of pneumonia that is contracted while on the breathing machine, or ventilator. 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. 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. This is where healthcare workers are important.

How VAP is Treated

So how can VAP be treated? Once a patient develops VAP, the microorganism causing the infection needs to be identified. This can be done by drawing blood cultures, which can be drawn like any other blood specimen and identify the type of microorganisms causing VAP. Other lab tests that should be performed include a complete blood count (CBC) to check the white blood cell count and baseline metabolic panel (BMP) to check kidney and liver function.

The BMP demonstrates whether or not certain types of antibiotics can be given. Antibiotics kill the microorganisms that cause infection and there are many different types of antibiotics for the different types of microorganisms. Unfortunately regular use of antibiotics has led to the development of drug-resistant microorganisms or super bugs like methicillin resistant staphyloccocus aureus (MRSA) and clostridium difficile (C-diff) so antibiotic use before the development of VAP is not routinely used. Doesn't it sound like it would be best to do everything we can as healthcare providers to prevent VAP?

How VAP can be Prevented

So it seems like it's difficult to treat VAP, so how can it be prevented? There are several things healthcare providers should to in order to prevent VAP. The most important thing healthcare providers must do is wash their hands. Every time they enter a patient's room and every time they leave a patient's room, they should wash their hands. Regularly clean hospital equipment, including the ventilator, before and after each patient use is also important.

For those patients who are intubated, there are a couple of things that nurses and respiratory therapists can do when they are caring for them. One action is to keep the head of the bed (HOB) elevated by 30-45 degrees. This is to assist in clearing secretions from the mouth and throat as long as the breathing tube is in.

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