Ventilator Associated Pneumonia: Incidence, Microbiological Profile, And Measures Taken To Reduce

Abstract

Background: One of the most common hospital acquired infection in intensive care units is 
ventilator- associated pneumonia (VAP). The reported incidences range greatly, from 5 to 
40%, depending upon the diagnostic criteria used and hospital setting. Extended periods of 
mechanical ventilation and lengthy ICU stays are linked to VAP. Ventilator associated 
pneumonia (VAP) accounts for 9-27% of mechanically ventilated patients. 
Aim and Objective: To measure the incidence of VAP, the implicated pathogens, and efficacy 
of measures taken to reduce the incidence of VAP in a Tertiary care Hospital. 
Material and methods: This was a combined retrospective and prospective active surveillance 
study carried out in a tertiary care setting in southern part of India over a period of four years. 
The study was performed in two phases. First phase was the assessment phase which was 
retrospective in nature while second phase was the intervention phase and was prospective in 
nature. In first phase CDC criteria were followed to identify VAP cases retrospectively from 
hospital data, lab reports and patient records (Hospital Information System [HIS]). 
In the second phase multiple interventional measures were applied including introducing 
services of the above three mentioned health care professionals and effect on VAP rate was 
studied thereafter. 
Results: In the present study the VAP rates in first phase were observed to be 12.83 per 1000 
ventilator days. Modifications in the VAP treatment protocol like implementing VAP care 
bundle, use of frequent subglottic aspiration/suctioning technique, early weaning protocols, 
titrated sedation and presence of a full time intensivist, daily microbiologist rounds and 
involvement of a dedicated HICC nurse helped in reduction of incidence to 7.39 per 1000 
ventilator days. 
Conclusion: A multi-speciality approach along with strict adherence to standard protocols 
revealed reduction in VAP rate (p <0.001).