Week 12 - Topic 4: Ventilator-Associated Pneumonia Flashcards
What are 2 measures to prevent aspiration?
1) Encourage use of noninvasive ventilation (ex: CPAP or BiPAP)
2) Encourage use of orotracheal tube vs nasotracheal
Why are CPAP and BiPAP non invasive?
They push air into the lungs through the outside rather than through an inside tube
Why would we prefer orotracheal tube rather than nasotracheal?
To diminish risk sinusitis and aspiration pneumonia
How is mechanical ventilation done (2 methods)?
1) Positive pressure (artificial airway): air pushed into the lungs through an endotracheal tube providing oxygen
2) Negative pressure (no artificial airway): mimics ventilation by externally pushing the lungs –> iron lung
What are complications with intubation related to the stomach?
Stress ulcers and GI hemorrhage (rare 1%)
Why do we discourage using prophylactic agents that could reduce stress ulcers?
Increases risk of C dif
How can you prevent VAP?
Extubate when no longer needed
Where does a nasogatric tube end up in?
Esophagus
Where does and endotracheal tube (entry: mouth) end up in?
Trachea
What is at the end of an endotracheal tube once its in the trachea?
A cuff that is inflated to make sure tube stays in place
What is dangerous about the inflated cuff?
Secretions filled with organisms can pool at the top of the cough and go down into the lungs when the cuff is deflated or the tube moves
What are the 4 areas of oropharyngeal colonization?
1) Lips and gums
2) Tongue
3) Teeth
4) Mucous membranes secretions
What is dangerous about oropharyngeal areas with regards VAP? What must you do?
They can create a biofilm onto the tube and go down into the tubes
Clean the mouth with 0.5% chlorhexidine to reduce mouth flora
What is dangerous about suctioning with regards to VAP?
When you suction, you instill normal saline to wash down the trachea. The water and microorganisms can go down into the lungs
A person with green sputum is most likely to be infected with which bacteria?
Pseudomonas colonizing the oropharynx
What are 7 hospital-acquired bacteria causing VAP?
Gram -:
1) Pseudomonas aeruginosa
2) Serratia marcescens
3) Klebsiella spp
4) Acetinobacter spp
Gram +:
5) Staph areus
6) Strep pneumoniae
7) MRSA
According to a study, 50% of patients develop pneumonia from what type of colonization?
Oropharyngeal colonization
Name 6-7 risk factors for VAP
- Intubation (nasal or oral)
- Immobility
- Lying flat in bed
- Gastric distension
- Nasogastric tubes
- Inadequate P in the cuff = easy self-extubation
- Frequent manipulation of ventilator circuits
- Suctioning/instillation of normal saline
- Prolonged ventilator support
- Health conditions (asthma, COPD, emphysema)
Name 6-7 ways to prevent VAP
- Inspect skin and oral mucosa for skin breakdown and flora buildup
- Change tube ties when wet or every 24h
- Rotate oral tube from one end of the mouth to the other
- Lubricate lips to prevent drying
- Mouth care**: oral chlorhexidine 0.5% as mouth rinse every 2-4h and as needed
- Ensure cuff P is measured and recorded on a regular basis
- Take measures to prevent accidental extubation (ensure adequate sedation)
- HOB at 30-45° or reverse Trendelenburg
- Hand hygiene prior to touching NG or suction
- Use dominant hand + sterile glove for hand exposed to secretions
When do you use reverse trendelenburg position as opposed to HOB at 45°?
- Low BP, unstable VS
- Agitated and at risk of falling out of bed
- Compromised circulation from femoral lines
- Spinal cord injury
When do you use high level disinfection vs low level?
High level: for internal surfaces that touch mucous membranes
Low level: for external surfaces
How and when do you clean the external ventilator machine?
Low level disinfection
Clean frequently touched surfaces every shift
How and when do you clean and change circuit/tubing?
High level disinfection
Do not change routinely to avoid manipulation and dislodging fluid, policies vary from 3-7 days.
Change the circuit when it is visibly soiled or malfunctioning.
How and when do you clean humidifiers and nebulizers?
Cleaned and then High level disinfection
Fill humidifiers with sterile water
