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Respiratory Therapy Specific Infection
Control Considerations

Ventilator-Associated Pneumonia (VAP)

Ventilator-associated pneumonia (VAP) is the leading cause of death among hospital-acquired infections. Hospital mortality of ventilated patients who developed VAP is 46% compared to 32% for ventilated patients who do not develop VAP (Canadian Patient Safety Institute).

VAP Diagnostic Criteria

In a patient who has been invasively mechanically ventilated for greater than 48 hours, the diagnostic criteria for VAP are as follows:
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New, worsening or persistent infiltrate consolidation or cavitation on CXR compatible with pneumonia and 1 of:

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White Blood Cells ≥ 12,000 or < 4,000

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Temperature greater than 38 degrees Celsius or less than 36 degrees Celsius with no other recognized cause
and both of the following:
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New onset of purulent sputum, or change in character of sputum, or increase in respiratory secretions or increase in suctioning requirements
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Worsening gas exchange (e.g., increasing oxygen requirements, worsening PaO2/FiO2 ratio, increasing in minute ventilation)

and

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The patient is being treated with antibiotics for ventilator-associated pneumonia

Critical Care Services Ontario (criticalcareontario.ca). Ventilator Associated Pneumonia and Central Line Infection Prevention Toolkit. Critical Care Secretariat

VAP Bundles

VAP Bundles are a variety of evidence-based practices that, when implemented together, have the potential to result in dramatic reductions in the incidence of VAP.
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Adult VAP

  1. Elevate the head of the bed to 45° when possible; otherwise, attempt to maintain the head of the bed at more than 30°
  2. Evaluate readiness for extubation daily
  3. Use endotracheal tubes with subglottic secretion drainage
  4. Conduct oral care and decontamination with chlorhexidine
  5. Initiate safe enteral nutrition within 24–48 hours of ICU admission
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Pediatric VAP Bundle

  1. Elevate the head of the bed
  2. Properly position oral or nasal gastric tubes
  3. Perform oral care
  4. Eliminate the routine use of instil for suctioning

RESOURCE

Measures: Ventilator-Associated Pneumonia (VAP) (patientsafetyinstitute.ca)

Aseptic Practice

When needed, adherence to aseptic practice is critical in protecting patients from common and serious hospital-acquired infections such as line-associated tissue and blood stream infections as well as ventilator-associated pneumonia (VAP). For more information on VAP visit Safer Health Care Now!

RESOURCE

Centers for Disease Control and Prevention’s Central Line-associated Bloodstream Infections: Resources for Patients and Healthcare Providers

References

Association for the Advancement of Medical Instrumentation (AAMI). (2015). FDA proposes new criteria for surgical gowns. Retrieved from Association for the Advancement of Medical Instrumentation website: www.aami.org/newsviews/newsdetail.aspx?ItemNumber=2650

Canadian Patient Safety Institute. (n.d.). Ventilator-associated pneumonia (VAP). Retrieved from Canadian Patient Safety Institute website: www.patientsafetyinstitute.ca/en/topic/pages/ventilator-associatedpneumonia-(vap).aspx

Centers for Disease Control and Prevention. (2011). Central line-associated bloodstream infections: Resources for patients and healthcare providers. Retrieved from Centers for Disease Control and Prevention website: www.cdc.gov/HAI/bsi/CLABSI-resources.html

Critical Care Secretariat. (2012). Ventilator associated pneumonia and central line infection prevention toolkit. Retrieved from Critical Care Services Ontario website: www.criticalcareontario.ca/EN/Toolbox/Performance%20Improvement%20Collaborative/VAP%20and%2 0CLI%20Toolkit%20(2012).pdf

Immunize Canada. (2016). ImmunizeCA app. Retrieved from Immunize Canada website: http://immunize.ca/en/app.aspx

Loeb, M., Dafoe, N., Mahony J., John, M., Sarabia, A., Glavin, V., Walter, S.S. (2009). Surgical mask vs N95 respirator for preventing influenza among health care workers: A randomized trial. JAMA, 302(17), 1865- 1871. doi:10.1001/jama.2009.1466. Retrieved from http://jama.jamanetwork.com/article.aspx?articleid=184819

PIDAC. (2012a). Best practices for infection prevention and control programs in Ontario (3rd ed.). Retrieved from Public Health Ontario website: www.publichealthontario.ca/en/eRepository/BP_IPAC_Ontario_HCSettings_2012.pdf

PIDAC. (2012b). Routine practices and additional precautions in all health care settings (3rd ed.). Retrieved from Public Health Ontario website: www.publichealthontario.ca/en/eRepository/RPAP_All_HealthCare_Settings_Eng2012.pdf

PIDAC. (2013). Annex B: Best practices for prevention of transmission of acute respiratory infection in all health care settings. Retrieved from Public Health Ontario website: www.publichealthontario.ca/en/eRepository/PIDAC-IPC_Annex_B_Prevention_Transmission_ARI_2013.pdf

PIDAC. (2014). Best practices for hand hygiene in all health care settings, (4th ed.). Retrieved from Public Health Ontario website: www.publichealthontario.ca/en/eRepository/2010-12%20BP%20Hand%20Hygiene.pdf

PIDAC. (2015a). Best practices for prevention, surveillance and infection control management of novel respiratory infections in all health care settings. Retrieved from Public Health Ontariowebsite: www.publichealthontario.ca/en/eRepository/Best_Practices_Novel_Respiratory_Infections.pdf

PIDAC. (2015b). Infection prevention and control for clinical office practice. Retrieved from Public Health Ontario website: www.publichealthontario.ca/en/eRepository/IPAC_Clinical_Office_Practice_2013.pdf

PIDAC. (2016). Tools for preparedness: Triage, screening and patient management for Middle East Respiratory Syndrome Coronavirus (MERS-CoV) infections in acute care settings. Retrieved from Public Health Ontario website: www.publichealthontario.ca/en/eRepository/PIDAC-IPC_Preparedness_Tools_MERS_CoV_2013.pdf

Public Health Agency of Canada. (2013). Canadian immunization guide. Retrieved from Public Health Agency of Canada website: http://phac-aspc.gc.ca/publicat/cig-gci/p03-work-travail-eng.php#a1

Public Health Agency of Canada. (2014). Canadian Tuberculosis Standards (7th ed.). Retrieved from http://www.phac-aspc.gc.ca/tbpc-latb/pubs/tb-canada-7/assets/pdf/tb-standards-tb-normes-prefeng.pdf

Public Health Agency of Canada. (2016). Summary of assessment of public health risk to Canada associated with Middle East Respiratory Syndrome Coronavirus (MERS-CoV). Retrieved from Public Health Agency of Canada website: www.phac-aspc.gc.ca/eri-ire/coronavirus/risk_assessment-evaluation_risque-eng.php

Public Health Ontario. (n.d.a). Chain of transmission and risk assessment: Glossary of terms. Retrieved from Public Health Ontario website: www.publichealthontario.ca/en/LearningAndDevelopment/OnlineLearning/InfectiousDiseases/IPACCore/Documents/CORE_Trainers_COT_and_RA_Module_Glossary_April _2014.pdf

Public Health Ontario. (n.d.b). Risk Algorithm to Guide PPE Use. Retrieved from Public Health Ontario website: www.publichealthontario.ca/en/eRepository/IPAC_Clinical_Office_Practice_Risk_Algorithm_PPE_2013.pdf

World Health Organization. (2015). Middle East respiratory syndrome coronavirus (MERS-CoV). Retrieved from World Health Organization website: www.who.int/mediacentre/factsheets/mers-cov/en/