The nursing profession constitutes the largest portion of the nation's health care workforce; nurses have a direct effect on patient care and outcome as frontline caregivers, ICU nurses can help their ventilated patients avoid VAP. To do this, we need to know how VAP develops, which prevention strategies are recommended, and why it’s critical to follow the guidelines.

1. Nurses role in Prevention of
Ventilator Associated
Pneumonia (VAP)

2. BY
MRS. SANGEETA .S. BHUJBAL
TUTOR
C.O.N.B.J.G.M.C & SASSOON GENERAL
HOSPITAL
PUNE.

3. Content
Epidemiology of VAP.
Risk factors.
 Prevention strategies
 HOB elevation
 Ventilator equipment changes
 Continuous removal of subglottic secretions
 Handwashing
Mouth wash

4. Epidemiology of
Ventilator Associated Pneumonia (VAP)
Account for 15% of all hospital associated infections
• Accounts for 27% of all MICU acquired infection
• Primary risk factor is mechanical ventilation (risk 6
to 21 times the rate for nonventilated patients).
• Within 48 hours of intubation, the upper respiratory
tract is colonized with bacteria, most commonly
Gram negative bacilli.

6. Susceptibility to Nosocomial
Pneumonias

7. Micro or macro aspiration of
oropharyngeal pathogens
 Leakage of secretions
containing bacteria around
the ET cuff

8. Significance of
Nosocomial Pneumonias
Mortality ranges from 20 to 41%, depending
on infecting organism, antecedent
antimicrobial therapy, and underlying
disease(s)
Leading cause of mortality from nosocomial
infections in hospitals
Increases ventilatory support requirements
and ICU stay by 4.3 days
Increases hospital LOS by 4 to 9 days

10. VAP Prevention
• Studies have shown a
dramatic decrease in VAP
when a simple HOB
elevation is done
• VAP was detected in 2 of 39
patients (5%) in the HOB
elevation to 45 degree
group and 11 of 47 patients
(23%) of the 0 degree HOB
elevation.
• The risk reduction was 78%
for patients placed in the
HOB elevation to 45 degrees
HOB elevation
• HOB at 30-45º

11. No
Routine
Changes
Ventilator
Tubing
Inner
Cannulas of
Tracheostomy
tube
Ambu
Bags
Not
Enough
Data
Between
Patients

12. Continuous removal of
subglottic secretions
• ET tubes with an
additional lumen for the
removal of subglottic
secretions have been
found to decrease VAP
in some studies by as
much as 20 to 40%
• Extra cost of the tubes
will more than be paid
for by the decrease in
VAP costs.

13. Hand washing
• The best method to prevent healthcare
acquired infections including VAP is to practice
good Hand Hygiene including use of
• Antimicrobial soap and water

14. Wash hands or use an alcohol-based waterless
antiseptic agent before and after suctioning,
touching ventilator equipment, and/or coming
into contact with respiratory secretions.
Use a continuous subglottic suction ET tube for
intubations expected to be > 24 hours.
Maintain adequate cuff pressure of at least 20
cm2 H2O
Keep the HOB elevated to at least 30 degrees
unless medically contraindicated.
Turn the patient atleast every two hours.

15. Oral Care
• Role of oral care, colonization of the oropharynx,
and VAP unclear – dental plaque may be involved
as a reservoir.
• Oropharyngeal colonization linked to the
development of ventilator-associated pneumonia
(VAP)Remains the most deadly hospital acquired
infection in intensive care units (8-15% estimated
mortality rate)
• Surveys indicate most nurses use foam swabs
rather than toothbrushes in intubated patients
Using a sponge toothette soaked in an alcohol-
free chlorhexidine gluconate(0.12%) swab the

16. Prior to beginning the oral care protocol and
immediately following oral care it is important to
suction the patients mouth and the subglottic space
in order to prevent aspiration of pooled secretions
–Suctioning should be repeated as needed during
oral care.
–eliminate the need for saline lavage.