Infection prevention
Reducing rates of ventilator associated pneumonia
St George’s University Hospitals Trust evaluated an intervention designed to reduce the incidence of Ventilator Associated Pneumonia (VAP) in mechanically ventilated patients. The analysis showed a 66% reduction in VAP, highlighting the potential for substantial cost savings and improved patient outcomes, through the implementation of preventative medical devices.
Ventilator Associated Pneumonia (VAP) is a term used to describe a complication affecting patients who have been on mechanical ventilation.1
In general, VAP may be considered
48-hours from commencement of mechanical ventilation.2
Roughly 8% to 28% of patients
receiving mechanical ventilation are affected by VAP.3
mortality, and healthcare costs.1,4
VAP significantly contributes to morbidity, This article
examines the impact of an intervention involving an Automatic Cuff Pressure Controller and an Automatic Subglottic Secretion Removal Device on VAP rates among mechanically ventilated patients in Adult ICU. VAP occurs due to the aspiration of bacteria laden secretions into the lower respiratory tract, often facilitated by improper management of the endotracheal tube and accumulation of secretions around the cuff.1,4
The National Health
Service (NHS) England has highlighted the substantial financial burden associated with VAP, estimating the cost per patient between £10,000 and £20,000.5
Therefore, effective interventions
are imperative for both patient outcomes and economic sustainability in healthcare.
Mechanism of VAP l Colonisation and micro aspiration: Potentially pathogenic bacteria colonise the oropharyngeal area and upper respiratory tract. These bacteria are then aspirated into the lower respiratory tract, leading to infection. Micro aspiration of contaminated secretions around the cuff of the endotracheal tube is a common route for these pathogens to enter the lungs.4
l Formation of biofilms: Biofilms form on the endotracheal tube and other respiratory equipment. These biofilms act as reservoirs for bacterial colonisation, being more resistant to antibiotics, such as ESKAPE pathogens (Enterococcus faecalis, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii,
Pseudomonas aeruginosa and Enterobacter spp.) and the host’s immune responses, which facilitates the persistence and proliferation of bacteria.6
l Impaired host defences: Patients on mechanical ventilation often have impaired cough reflexes and mucociliary clearance, crucial for removing pathogens from the lower respiratory tract. The presence of the endotracheal tube, sedation, and the underlying illness further compromise these defence mechanisms.1
l Inhalation and aspiration: Inhalation of aerosolised bacteria from contaminated equipment or the hospital environment can lead to VAP. Additionally, aspiration of gastric contents due to gastro-oesophageal reflux, often facilitated by lying flat or sedation, introduces pathogens into the lungs.1,4
l Bacterial overgrowth and invasion: Once pathogens reach the lower respiratory tract, they adhere to the epithelial cells, evade immune responses, and multiply. This results in inflammation and infection of the lung
tissue, leading to pneumonia.6
l Inflammatory response: The host’s immune response includes the release of inflammatory mediators, recruitment of neutrophils, and production of exudates. This inflammation causes alveolar damage and impairs gas exchange, manifesting as the clinical symptoms of pneumonia.1,4
Methodology The study involved a comparative analysis between two patient groups: pre-intervention and post-intervention. The pre-intervention group consisted of 78 patients who were mechanically ventilated without the implementation of the new intervention. In contrast, the post-intervention group included 83 patients who received the intervention.
Intervention details: cuff management Automatic Cuff Pressure Controller: This device ensures the endotracheal tube cuff maintains optimal pressure, preventing micro aspiration
December 2024 I
www.clinicalservicesjournal.com 29
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