This week is International Infection Prevention Week, the largest annual initiative to promote safe, hygienic hospital practices and stop Healthcare-Associated Infections (HAIs) before they happen.

Cancer patients using chemotherapy are especially vulnerable to contracting HAI’s.  Barbara Dunn with Kimberly-Clark Health Care kindly forwarded me the following info about healthcare-associated infections:

About Ventilator Associated Pneumonia
Although all HAIs can lead to dangerous outcomes, what you may not know is that Ventilator-Associated Pneumonia (VAP) is the HAI most likely to cause death.

A subset of HAP, Ventilator-Associated Pneumonia (VAP) refers to those cases that occur in patients who have been on ventilator support for at least 48 hours. The mechanisms for HAP and VAP infections are similar, although due to the fact that host defenses against pneumonia are so effectively bypassed by an endotracheal tube, the risk of pneumonia in ventilated patients is much higher.

Early-onset VAP is defined as hospital-acquired pneumonia that develops in patients who have been on a ventilator between 48 and 96 hours or less than four days. These patients may have had emergent, traumatic intubations or major chest, abdominal or neurosurgery. The usual pathogens associated with early onset VAP are most commonly the patient’s own normal, antibiotic-sensitive flora, such as methicillinsensitive Staphylococcus aureus (MSSA), Haemophilus influenza or Streptococcus pneumoniae.

Late-onset VAP is defined as hospital-acquired pneumonia that develops in patients who have been on a ventilator five days or longer. These patients often present with many pre-existing chronic conditions that predispose them to lung infections, such as chronic obstructive pulmonary disease (COPD) or cardiac-related pulmonary edema. The pathogens most commonly seen with late-onset VAP are the more resistant strains of bacteria such as methicillin-resistant Staphylococcus aureus (MRSA) or gram-negative bacteria such as Pseudomonas aeruginosa, Acinetobacter, Enterobacter, Klebsiella or Serratia.

Ventilated patients are especially susceptible to pneumonia as their normal host defenses are hampered, blocked or disabled during mechanical ventilation by the physical presence of the assisted-breathing device. The bacteria and other microorganisms, which are normally blocked or carried away from the respiratory tract, have the ability to bypass the normal body defenses and enter the lungs. In order to understand the vulnerabilities of the ventilated patient, a review of the normal reflexes and clearance mechanisms is helpful.

•Approximately 8-28% of critical care patients develop VAP
•Healthcare-associated pneumonia patients have a mortality rate of 20% to 33%
•VAP increases patient time in the ICU by 4 to 6 days
•Each incidence of VAP is estimated to generate an increased cost of $20,000 to $40,0001 –
 VAP accounts for 47% of all infections in ICU.
•Mortality rates for VAP are between 20% and 70%.
•VAP leads to increased hospitalization stays, costs, and mortality.
•Ventilator-associated pneumonia (VAP) is one of the most common health care-associated infections (HAIs) in critical care settings.
•Ventilator-associated pneumonia is defined as pneumonia occurring more than 48 hours after patients have been intubated and received mechanical ventilation.
•Prevention of VAP involves limiting exposure to resistant bacteria, discontinuing mechanical ventilation as soon as possible, and a variety of strategies to limit infection while intubated.
•Proper hand washing, sterile technique for invasive procedures, and isolation of individuals with known resistant organisms are all mandatory for effective Ventilator Associated Pneumonia control.
•To learn more about the impact of healthcare-associated infections for both medical professionals and patients, please visit haiwatch.com/VAP.

Handwashing
The practice of handwashing and the wearing of gowns and gloves are basic and quite possibly the most important actions taken for reducing colonization. Methicillin Resistant Staphylococcus aureus (MRSA) is commonly spread by caregivers’ hands.12 Gloves and gowns have been shown to be effective in preventing the nosocomial spread of antibiotic resistant bacteria including Vancomycin-resistant enterococci (VRE) as well as MRSA.

Oral Hygiene
The importance of patient oral and nasal hygiene is often overlooked, although it is one of the most basic of nursing interventions. Sole found that less than half of the 27 surveyed sites (48%) had written policies for oral care of intubated patients, and even fewer (37%) had oral suction policies.22 The use of closed suction systems (CSS) may contribute to the inattention paid to oral care in that oral suctioning is an integral part of traditional open suction procedures. Yet, it is widely recognized that the mouth is a virtual garden of normal bacterial flora and pathogenic organisms. Both Kollef7 and Kunis12 have advocated chlorhexidine oral rinse to reduce the oral bacterial load; however, its regular use may lead to chlorhexidine resistant organisms. Several studies have shown that oral decontamination is an effective method for reducing VAP.

VAP Risk Factors
The single largest VAP risk factor is the endotracheal tube. Because mechanical ventilator support cannot be performed without the endotracheal tube (or other artificial airway), it is a necessary evil. The endotracheal tube provides a direct passageway into the lungs, bypassing many “natural protection” mechanisms. The endotracheal tube increases the risk for VAP by:


•preventing cough (the patients natural defense)
•preventing upper airway filtering
•preventing upper airway humidification
•inhibiting epiglottic and upper airway reflexes
•inhibiting cilliary transport by the epithelium
•acting as a direct conduit into the lungs for airborne pathogens
•potentially acting as a reservoir for pathogens by providing a place for biofilm to form
•having a cuff which provides a place for secretions to “pool” in the hypoglottic area
•initiating a foreign body reaction, interfering with the local immune response


Host or patient risk factors include:
•age of 65 or more
•underlying chronic illness (e.g. Chronic Obstructive Pulmonary Disease (COPD), emphysema, asthma)
•immunosuppression
•depressed consciousness
•thoracic or abdominal surgery
•previous antibiotic therapy
•previous pneumonia or remote infection

We have all heard the old saying “If you want to get sick–check into the hospital!”  I’m glad groups like Barbara’s are working hard to help break that unfortunate cycle.

Feel good and keep smiling!  Pat

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