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Ventilator-Associated Pneumonia

Ventilator-associated pneumonia (VAP) occurs when germs multiply in the lungs of patients using a ventilator to help them breathe. This causes fevers, chills, difficulty breathing, increased sputum and other pneumonia symptoms.

These infections can lead to serious complications, even death, especially for critically ill patients.

What is a ventilator?

A ventilator is a life-saving machine that helps a person breathe when they cannot breathe well on their own. Often, a person is connected to a ventilator in surgery or when recovering from serious illness. A ventilator is connected to a tube, an endotracheal or "ET" tube, placed in the patient's lungs. The tube is inserted through the mouth, nose or throat.

Patients connected to a ventilator at UCSF Medical Center are always in an intensive care unit or in surgery. A ventilator may be used for several weeks.

How does UCSF monitor ventilator-associated pneumonia?

UCSF measures VAP rates according to the methods of the National Healthcare Safety Network (NHSN) of the Center for Disease Control and Prevention's (CDC). The rate is expressed as the number of infections per 1,000 ventilator days, or the total number of days patients use a ventilated. If a patient is on a mechanical ventilator for five days, that would count as 5 ventilator days.

What is the rate of ventilator-associated pneumonia at UCSF?

Lower is better when comparing ventilator-associated pneumonia rates. UCSF's goal is to be below 1.5 VAP per 1,000 ventilator days. Individual units compare against NHSN data. In the fiscal year 2013, the rate was 1.4. Efforts continue to reduce the rate.

Ventilator-associated pneumonia chart

What does UCSF do to prevent ventilator-associated pneumonia?

Here is what we're doing to prevent VAP:

  • We keep the head of the bed elevated to 30 degrees or higher to prevent stomach acids from entering the lungs.
  • We clean the patient’s mouth at least six times each day to reduce the risk of mouth germs getting into the lungs.
  • We clean our hands before touching patients and ventilators.
  • We remove the ventilator and tube as soon as patients can safely breathe on their own.
  • We clean the ventilator at least twice each day.
  • We give medications to keep the patient comfortable and at the least risk for getting VAP.
  • We audit the procedures to confirm our employees follow procedures properly.
  • A committee of Infection Control staff, nurses and doctors meets frequently to review our VAP rates and examine the care we give. If a VAP occurs, this committee evaluates what, if anything, went wrong.

What can you do?

Talk to your health-care team members. Do they follow the UCSF care and maintenance standards when caring for a patient with a ventilator? Find out when the ventilator can be safely removed. If you don't see them clean their hands, ask them to do so before touching you, the patient or the ventilator.

 

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