Pneumonia Quality Measures
Respiratory failure is the primary reason for mechanical
ventilation (also called ventilator, respirator, or breathing machine). Patients
who are on a ventilator are at risk for ventilator-associated pneumonia, and
those with weakened immune systems have the greatest risk.
Ventilator-associated pneumonia (VAP) is an infection that
develops 48 hours or more after being on a ventilator (breathing machine that
performs the work of moving gases into and out of the lungs). Community-acquired
pneumonia (CAP) is more common and generally less severe than ventilator-associated
pneumonia (VAP). The bacteria that cause VAP may be resistant to antibiotics
and therefore more difficult to effectively treat. VAP requires vigilant preventive
efforts by intensive care staff members who care for patients on ventilators.
The following list contains guidelines for the prevention
of VAP from the Infectious Diseases Society
of America (IDSA) and the American
Thoracic Society (ATS).
- Intubation (insertion of a breathing tube into the windpipe to connect to
a mechanical ventilator) is avoided when possible.
- Non-invasive ventilation (pressurized face mask oxygenation) is used when
possible.
- Orotracheal (mouth to windpipe) breathing tubes and orogastric (mouth to
stomach) feeding tubes are chosen over breathing and feeding tubes that are
inserted into the nose for patients who are on a mechanical ventilator when
possible.
- Continuous aspiration of subglottic (below tongue) secretion (CASS) tubes
are used when possible to remove secretions where harmful bacteria can grow.
- Condensation from oxygen tubing is removed routinely to prevent growth
of harmful bacteria and accidental pouring of condensed water and bacteria
into the patient's airway.
- Effort is made to maintain blood sugar levels between 80-110 mg/dl to reduce
infection risk when appropriate.
- The head of the bed is elevated 30 to 45 degrees when possible.
- Protocols for getting patients off of the ventilator as soon as possible
(early weaning) are used to reduce time on the ventilator when possible.
- Routine oral care is provided to prevent the growth of harmful bacteria
in the mouth, which could further infect the lungs.
- Effort is made to maintain adequate staffing levels in order to promote
an optimal environment for patient care.
St. Mary's Hospital Medical Center has established protocols for the prevention of ventilator-associated
pneumonia based on the guidelines from the Infectious Diseases Society of America
(IDSA) and/or the American Thoracic Society (ATS). Your physician may recommend
different treatments to meet your individual needs.