Ventilator Associated Pneumonia

For our public reporting purposes, ventilator associated pneumonia (VAP) is defined as a pneumonia (lung infection) occurring in patients in an intensive care unit (ICU), requiring, external mechanical breathing support (a ventilator) intermittently or continuously, through a breathing tube for more than 48 hours.

VAP can develop in patients for many reasons. Because they are relying on an external machine to breath, their normal coughing, yawning, and deep breath reflexes are suppressed. Furthermore, they may have a depressed immune system, making them more vulnerable to infection. ICU teams have many ways to try to assist patients with these normal breathing reflexes, but despite this, patients are still at risk for developing pneumonia.

All hospitals with ICUs are required to report into the Critical Care Information System (CCIS) – a centralized data collection system where hospitals report a variety of critical care information – must publicly report the VAP indicator data. These hospitals are considered "eligible" for VAP reporting.

These Ontario hospitals are posting their quarterly VAP rate and case count for those infections acquired in their facility, using the following formula:

total # of ICU cases of VAP after 48 hours of mechanical ventilation x 100
total # of ventilator days for ICU patients 18 years and older

Due to the low number of ICU patients on a ventilator (ventilator days) at STEGH, we recognize that even one new case of ventilator associated pneumonia will result in a high VAP rate.

VAP is defined as pneumonia (a serious lung infection) that can occur in patients (specifically ICU patients) who need assistance breathing with a mechanical ventilator for at least 48 hours.

The most important symptoms include:

• Fever
• Low body temperature
• New purulent sputum (foul smelling infectious mucous or phlegm coughed up from the lungs or airway into the mouth)
• Hypoxia (decreasing amounts of oxygen in the blood)

Risk factors include:

• Being on a ventilator for more than five days Recent hospitalization (last 90 days) Residence in a nursing home
• Prior antibiotic use (last 90 days)
• Dialysis treatment in a clinic

Health care providers are:

• Practicing proper handwashing techniques
• Keeping the patient’s head of the bed elevated at a 30 to 45 degree angle Discontinuing mechanical ventilation as soon as possible

Families of patients can:

• Ask lots of questions. Ask what precautions your hospital is taking to prevent VAP.
• Wash their own hands often. Use soap and water or an alcohol-based hand rub containing at least 60 per cent alcohol.

STEGH is participating in the VAP CLI Canadian ICU collaborative. This collaborative involves hospitals across Canada who by using and sharing evidence based learning has developed key methods aimed at reducing central line infections. STEGH has a multidisciplinary health care team who are actively working through the implementation of all components and measuring our VAP data to identify our compliance and infection rates.

STEGH continues to implement the ‘Just Clean Your Hands’ hand hygiene program through out the hospital. We audit our compliance with this program and share the results with staff so that we can identify any areas of improvement.

For all patients who are ventilated, we are keeping the head of bed greater than 30 degrees day and night unless medically contra-indicated. If you notice the head of bed lower, please ask the staff why the head of bed is down, as a reminder.

Frequent hand cleaning is a good way to prevent the spread of infection. Hand hygiene involves everyone in the hospital, including patients.

More patient-specific information is available at:

• www.ontario.ca/patientsafety

Visit the Ministry of Health Care and Long-Term Care website to view other hospital's rates<

If you have any questions about this ;information or about our hospital’s infection prevention and control program, please contact us.