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NICE issues guidance to cut ventilator pneumonia risk

NICE issues guidance to cut ventilator pneumonia risk

Ventilated ICU patients should be nursed with their upper body elevated to help reduce the risk of ventilator-associated pneumonia (VAP), according to latest NICE guidance.

The short guideline – issued last week in collaboration with the National Patient Safety Agency – also recommend that oral antiseptics should be used as part of the oral hygiene regimen for all patients who are intubated and receiving mechanical ventilation.

Professor Bruce Campbell, chairperson of the institute's patient safety advisory committee, said the two main measures outlined in the guidance should be simple to implement in clinical practice. 'Nursing patients with their upper body elevated is already very common practice, and use of oral antiseptics fits readily into the regular care of the upper airway,' he said.

He added that other measures which may contribute to reducing the risk of VAP, such as the use of systemic decontamination of the digestive tract, required further research before they were incorporated into guidance.


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Reader Response

Added: Thursday, 23 October 2008 06:14 BST
taher jamjoum, london, United Kingdom

All ITUs should develop their own local policy to reduce the risk of VAP using NICE guilines, local and national infection control policies and latest research.
ITUs should produce a document that explains the condition and the measures to be taken to prevent VAP.
The primary intervention to prevent any nosocomial infection is hand washing. Careful infection control practices related to respiratory care are also essential to preventing VAP. (Niederman & Craven, 2005; NICE, 2008)
To comply with NICE guidelines (2008) for the prevention of VAP all staff should use the following recommendations for all patients receiving mechanical ventilation:
1) To prevent bacterial colonization of the aerodigestive tract
2) To prevent aspiration of contaminated secretions
3)To reduce risk of VAP when suctioning a ventilated patient
Other key points to reduce the risk of VAP include (NICE, 2008):
• Avoid nasal intubation.
• Adequately secure endotracheal tube and take necessary measures to prevent accidental extubation.
• Avoid overuse of multiple antibiotics.
• Limit stress ulcer treatment if possible.
• Use daily chlorhexidine oral rinse.
• Provide immunizations (eg, influenza, pneumococcus, haemophilus B).


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