Ventilator-associated pneumonia (VAP) accounts for 60 percent of healthcare-associated infection (HAI) deaths. According to 2015 research from the Centers for Disease Control (CDC), VAP accounts for 32 percent of all healthcare-related pneumonia cases. People on ventilators are often medically fragile, battling serious respiratory illnesses or chronic medical conditions. So the death rate for this form of pneumonia is extraordinarily high—between 20 and 33 percent, according to most estimates. Healthcare providers can take a number of proactive steps to protect their patients from this potentially lethal infection.
CDC VAP Guidelines for Diagnosing Pneumonia
Diagnosing VAP is critical to both treating and preventing it. Prompt diagnosis alerts healthcare facilities to a potential problem, and enables them to track changes in VAP rates over time. For adults, the CDC’s VAP diagnostic guidelines require at least one of the following:
- Fever greater than 100.4 degrees Fahrenheit
- Leukopenia defined as a white blood cell count higher than 4,000, or leukocytosis defined as a white blood cell count higher than 12,000.
- In adults 70 or older, an altered state with no other clear cause.
Two of the following must also be present:
- Change in character of sputum, or newly purulent sputum
- Increased airway secretions
- Increased need for suctioning
- New or worsening cough, tachypnea, or dyspnea
- Rattling breathing or abnormal bronchial sounds
- Worse gas exchange that may require more oxygen or ventilator use
The patient must also have been on a ventilator for at least two calendar days, and the ventilator must be present either on the day of the pneumonia diagnosis or the day prior.
Diagnostic criteria for children and neonates are similar, but also emphasize bradycardia, tachycardia, and common symptoms of infant respiratory distress such as nostril flaring and chest wall retractions with grunting.
Preventing Ventilator-Associated Pneumonia
A number of simple interventions can improve safety in ventilated patients. The CDC recommends the following:
- Minimize the time a patient spends on the ventilator. Assess the patient’s ability to breathe on their own each day.
- Practice diligent hygiene. Wash hands with warm water and soap before and after touching the patient or their ventilator. When handwashing stations are unavailable, use alcohol-based sanitizers.
- Elevate the patient's head to 30-45 degrees unless the patient has medical contraindications for this intervention.
- Regularly clean the patient’s mouth.
- Between patients, clean and/or replace equipment according to agency guidelines or manufacturer instructions.
Additionally, healthcare providers should suction ventilated patients when the patients show clear suctioning indications. This removes potentially harmful secretions that accumulate in the airway.
Patients and their family members can further reduce the risk of infection by:
- Asking for daily evaluations of the patient’s ability to breathe
- Reminding healthcare providers to wash their hands
- Frequently washing their own hands, including immediately before or after touching the patient or any ventilation equipment
- Quitting smoking, and never smoking around a patient on a ventilator
CDC VAP Treatment Guidelines
Many forms of VAP are bacterial, which means that they respond well to antibiotics. Diagnosing the specific pathogens involved is important because this guides treatment recommendations. A doctor may take a sputum sample and prescribe broad-spectrum antibiotics, or even several different broad-spectrum antibiotics, until the sample returns from the lab.
Healthcare providers should not assume that every case of pneumonia in a ventilated patient is related to the ventilator. Aspiration pneumonia is also common in this population, particularly without adequate suctioning. Similarly, viruses and occasionally fungal infections may also trigger lung infections, particularly in vulnerable groups such as those in the ICU. Conduct a thorough evaluation and exam, and get a sample of the patient’s sputum.
Why Quality Equipment Matters
Regular suctioning of ventilated patients can reduce the risk of pneumonia, including VAP. Patients on long-term ventilation may receive care at home. Others must occasionally be transported to different medical facilities to address chronic or critical care needs. Portable suction devices ensure that healthcare providers can promptly suction patients whenever they demonstrate a need. Furthermore, portable suction removes the need to transport these patients, opening access to prompt care and preventing treatment delays. For help selecting the right portable suction device for your healthcare organization, download our free guide, The Ultimate Guide to Purchasing a Portable Emergency Suction Device.