Prevention of Nosocomial Pneumonia in the Intensive Care Unit: Beyond the Use of Bundles

Abstract

Background: The occurrence of nosocomial pneumonia (NP) in the hospital setting is especially problematic, as it is associated with a greater risk of in-hospital death, longer stays on mechanical ventilation and in the intensive care unit (ICU), more need for tracheostomy, and significantly higher medical care costs. Methods: Review of the pertinent English-language literature. Results: The adverse effect of NP on healthcare outcomes has increased pressure on clinicians and hospital systems to prevent this infection. This brief review provides an overview of the current approaches to the prevention of NP, focusing primarily on ventilator-associated pneumonia (VAP). Conclusion: Clinicians working in ICUs should consider the following recommendations: (1) Develop a VAP prevention bundle based on evidence-based guidelines; (2) monitor the rates of VAP prior to and during implementation of the program; (3) make adjustments according to VAP occurrence; and (4) integrate VAP prevention with other quality improvement programs.

Clinical experience and incidence of ventilator‐associated pneumonia using closed versus open suction‐system

“…Shortcomings in quality of care and risk factors for the development of VAP have been successfully targeted by introducing evidenced-based 'care bundles' for the care of ventilated patients (Dodek et al, 2004;Arabi et al, 2008;Rello et al, 2010;Berenholtz et al, 2011). The implementation of such bundles, have been strongly recommended as well as continuous monitoring of results and staff compliance with implemented guidelines (Kollef, 2011). Among the adjuncts included in those guidelines, the use of closed suction systems (CSS) has been advocated (Muscedere et al, 2008).…”

What is new in the prevention of ventilator-associated pneumonia?

“…The selected items are showed in Table 1. Finally, as mentioned by Kollef, the work is not accomplished by implementing a care bundle [35]. Implementation of a care bundle should be accompanied by a surveillance program to closely monitor VAP rates.…”

Making the Case for De-Escalation Therapy in Ventilator-Associated Pneumonia Once Again*

“…However, VAP protocols and guidelines must be combined with physician buy in, ongoing monitoring, feedback, and quality initiatives (12,13) to improve outcomes in VAP. Indeed, as infections such as VAP often do not occur in isolation and as critically ül patients may have more than one suspected infection, knowing when to stop empiric antibiotics can be difficult.…”