Ventilator-associated Pneumonia in the Intensive Care Unit of the Institute of Oncology Ljubljana in 2021 and the Role of Nurses in its Prevention

Abstract

BACKGROUND: Ventilator-associated pneumonia (VAP) is the most common infection in critically ill patients and has the highest mortality. It prolongs ventilation time and length of stay, increases antibiotic consumption, increases the likelihood of death, increases the cost of treatment, and is difficult to diagnose. AIM: At the intensive care unit (ICU) of the Institute of Oncology, Ljubljana, we prospectively monitor risk factors for VAP and its incidence. It is a mixed surgical/internal ICU. METHODS: A centers of disease control and prevention VAP diagnosis criteria and strategies to prevent VAP were used. Registered nurses recorded risk factors in all intubated patients in all three shifts, and the diagnosis protocol was completed by the physician in case of antibiotic administration in suspected VAP. RESULTS: The expected incidence of VAP is around 18/1,000 ventilated days. In 2021, 67 patients were mechanically ventilated in our ICU (patients who completed ventilation in that year). The total time spent on ventilation was 17,143 h or 714.3 days. As the criteria for ventilator-assisted pneumonia (VAP) is >48 h of ventilation, we excluded 19 patients who had been ventilated for 48 h or less. Among 48 patients who were ventilated for > 48 h, the total ventilation was 16,765 h or 698.5 days. We recorded 8 VAP in 714 days, which is 1 VAP per 89 days of ventilation or 11.2/1,000 ventilation days. Healthcare staff, especially registered nurses, play a major role in VAP prevention, providing care every day, all days of the week. Most  prevention interventions and strategies are part of routine nursing care. Lack of knowledge about infection prevention and appropriate nursing care among nurses can become a barrier to adherence to evidence-based guidelines for the prevention of VAP. CONCLUSION: This study will help nurses to learn about VAP and its prevention in detail so that they can apply the knowledge in clinical practice. Understanding the pathophysiology of VAP, its risk factors and the nursing care bundle is essential for appropriate prevention and treatment of VAP. Specific protocols, strategies, and active control should be available in each ICU regarding the care bundle.