In the clinical environment, it is critical to ensure sterility and pathogen safety for patients in order to prevent possible infections. This is necessary for the effectiveness of medical care because if these criteria are not met, the risk of harm to patient health increases. Ventilator-associated pneumonia (VAP) is one such example that occurs frequently. In general, VAP should be understood as a condition of pulmonary infection that develops in a patient while using ventilator-associated pneumonia. Thus, VAP should be classified as an unintentional clinical error and can be classified as a healthcare-associated infection. Obviously, the medical staff has no interest in the development of such pathogenesis because it not only complicates the course of treatment of the patient in critical condition on the ventilator but also has a destructive reputational potential for the clinic. In favor of this, preventive methodologies and techniques that can be used by clinical staff to reduce the likelihood of developing VAP need to be developed. The present research paper aims to discuss this pathologic condition in detail and review key techniques to minimize its development.
The Essence of VAP
One of the causes of increased mortality in intensive care units is ventilator-associated pneumonia. The ventilator plays a critical role for critically ill and vulnerable patients who are in a problematic condition and require artificial maintenance of lung function with pulmonary failure (Dumbre, 2019). Although the present procedure has many advantages in solving urgent clinical problems, using the ventilator entails some risks, among which special attention should be paid to the development of VAP. Infection of the lungs with pathogens occurs because of the intubated state of the patient, in which the airway disrupts the integrity of the mucous membranes, destroying the natural barriers to entry of infections.
Many sources suggest that VAP is the cause of increased mortality among ventilator patients (Dumbre, 2019; Chacko et al., 2017; Cooper, 2021). According to the CDC, more than 300,000 patients are exposed to ventilation each year, and mortality among VAP-infected patients ranges from 24% in young adults to 60% in patients over the age of 80 (NHSN, 2021). Thus, VAP is a severe threat to the clinical well-being of patients and impedes the entire credibility of the health care machine.
Diagnosis and Confirmations
Accurate diagnosis of VAP is complicated because of the unique features of this pathophysiological condition. In fact, the mere existence of such a problem seriously undermines the credibility of medical clinics since it is impossible to provide a one hundred percent guarantee that there is no chance of contracting VAP. In this context, an accurate diagnosis of this infection is a critical step since the earlier the infection is determined, the more opportunities there are for therapy. In this context, it is essential to note that, as a rule, critically ill patients connected to a ventilator cannot communicate effectively and talk about their condition, which means that any diagnosis is based only on objective examination data. There is evidence that the likelihood of VAP increases markedly in patients who have been on a ventilator for more than 48 hours which means that quality pulmonary monitoring is needed primarily in such patients (Cooper, 2021; Chacko et al., 2017). However, according to the CDC, lung radiographs do not provide reliable results because of the subjectivity and variability of the findings (NHSN, 2021). The most competent way to diagnose this pathogenesis is by a culture of a lower airway scrape and microscopic observation of the specimen. Only the use of reliable instruments of evidence-based medicine guarantees the reliability of the results obtained, so bronchoscopy, according to the described method, should be considered a competent solution in the diagnosis of VAP.
Based on the urgency of the problem, the academic medical community must take steps to find effective methodologies to combat VAP. By now, for this reason, a lot of useful information and views with a solid evidence base have been accumulated. One of the systemic recommendations is to constantly check the patient’s ability to breathe on their own in order to be able to disconnect them from the ventilator: in other words, the need to minimize the use of the machine, if permissible, is achieved. In addition, total sanitation and hygiene, whether disinfection of surfaces and used instruments or antiseptic treatment of hands are mandatory measures. An important preventive care area is treating the patient’s oral cavity (NHSN, 2021). Mechanical and pharmacologic oral cleansing is important in preventing VAP.
This includes the use of special gels and solutions for oral decontamination or a combination thereof (Cooper, 2021). In addition, some authors show the feasibility of engineered toothbrushes that are used once directly to prevent VAP (Chacko et al., 2017). At the same time, supramental pressure testing and secretion aspiration to prevent forced aspiration have been effective measures (Miranda da Cruz & da Silva Martins, 2019). The CDC also recommends keeping the patient’s bed headboard at an angle of 30 to 45 degrees to prevent spreading pathogens from the air (NHSN, 2021). Finally, it is impossible to achieve conditions of complete protection from infection in the absence of awareness of prevention methods. For example, only 56.7% of nurses in a survey study were fully informed about the essence of ventilator operation and the procedure’s features (Dumbre, 2019). Consequently, there is a gap between the prevention being developed and the degree of awareness of the problem, which means that staff needs to be trained effectively. Ultimately, all of the techniques described above can be useful with respect to minimizing the risk of VAP for ventilator patients.
One of the significant threats to the clinical well-being of critically ill patients with pulmonary failure is VAP. In general, using a ventilator is an excellent solution for critically ill patients. However, this procedure has side effects, among which pneumonia is very important. VAP should be considered a side effect of ventilator use, disrupting the airway mucosa’s protective integrity. Mortality from VAP varies greatly with patient age; in either case, it is a critical public health problem. This research paper also showed that VAP is difficult to diagnose with fluoroscopy, so bronchoscopy with culture is an effective method of investigation. Key measures to reduce the likelihood of infection include sanitation and hygiene, oral care, supramental pressure testing, and staff training. Ultimately, this will significantly reduce the risk of infection and thus prove to be a promising solution to the much-needed problem of pneumonia caused by the use of a ventilator.
Chacko, R., Rajan, A., Lionel, P., Thilagavathi, M., Yadav, B., & Premkumar, J. (2017). Oral decontamination techniques and ventilator-associated pneumonia. British Journal of Nursing, 26(11), 594-599. Web.
Cooper, A. S. (2021). Oral Hygiene care to prevent ventilator-associated pneumonia in critically ill patients. Critical Care Nurse, 41(4), 80-82. Web.
Dumbre, D. U. (2019). A study to assess the knowledge and compliance of critical care nurses regarding ventilator care bundle in the prevention of ventilator-associated pneumonia. Medico-Legal Update, 19(1), 176-178. Web.
Miranda da Cruz, J. R., & da Silva Martins, M. D. (2019). Pneumonia associated with invasive mechanical ventilation: nursing care. Revista de Enfermagem Referência, 4(20). Web.
NHSN. (2021). Ventilator-associated event (VAE). CDC. Web.