Federal Ministry of Health
VOLUME 2: SECTION 2
CHAPTER 4 : HEALTH CARE ASSOCIATED PNEUMONIA
(INCLUDING VENTILATOR ASSOCIATED PNEUMONIA)
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Chapter Outline
• Chapter contents
• PPP 1.1:Overview
• PPP 1.2:Risk factors for hospital-acquired pneumonia
• PPP 1.3:Strategies for preventing health care associated pneumonia (including VAP).
• PPP 1.4: Monitoring, surveillance of health care associated pneumonia (including VAP)
• PPP 1.5: Summary
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Chapter contents:
• Overview
• Risk factors for hospital-acquired pneumonia
• Strategies for preventing health care associated pneumonia (including VAP).
• Monitoring, surveillance of health care associated pneumonia (including VA).
• Summary
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Chapter Objective
At the end of this module, participants will be able to:
• Understand Epidemiology and mechanisms of hospital-acquired pneumonia
• Identify Risk factors for hospital-acquired pneumonia
• Identify Strategies for preventing ventilator-associated pneumonia and other hospital-acquired
pneumonias in adults, children, and infants
• Understand Monitoring and surveillance of ventilator-associated pneumonia
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Overview
• Health care associated pneumonia accounts for 15% of all HAIs
• VAP accounts for 32% of all infections acquired in intensive
care units
• The majority of non-ventilator-associated pneumonia and VAP
is caused by bacteria
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The major risk factors for HAP
• Surgery
• Intubation and mechanical ventilation.
• Aspiration of stomach or oropharyngeal fluids contaminated with colonizing organisms
• Enteral feeding in a supine body position
• Subglottic pooling of secretions
• Oropharyngeal colonization
• Stress ulcer prophylaxis.
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Strategies For Preventing Health Care Associated
Pneumonia
Reducing the Risk of Pneumonia among All Patients
The following procedures should be followed to prevent transmission of pathogens:
• Perform hand hygiene including after contact with body secretions.
• Wear clean gloves when handling respiratory secretions or objects contaminated with
respiratory secretions.
• Wear a gown when contact with respiratory secretions from a patient is anticipated and
change it after soiling occurs and before providing care to another patient .
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Cont…
• Use single-use respiratory care items where possible
• Teach patients to cough or sneeze into a tissue.
• Avoid crowding patients in wards or outpatient treatment areas
• Space beds 1 meter (3 feet) or more from other beds
• Place only one person in a bed
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Cont..
• Consider placing patients in a head-to-foot position to increase the distance
between the patients’ faces if the beds are pushed close together
• Ensure proper air ventilation in the room
• Provide airborne infection isolation rooms or single, well-ventilated rooms.
• Clean hard surfaces that are frequently touched
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Prevention of Ventilator-Associated Pneumonia in Patients of All
Ages
Ensure the following IPC practices for all patients on a ventilator.
• Perform hand hygiene.
• Use aseptic technique for intubation and other procedures that involve manipulation of
the endotracheal tube and the ventilator circuit
• Use single-use respiratory care items where possible;
• Maintain aseptic technique when suctioning mucus via an endotracheal tube
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Monitoring And Surveillance Of Infections Related To Health Care-
Associated Pneumonia (Including VAP)
Steps in the HAP Surveillance Process
• Decide which procedures to monitor
• Define the numerator and denominator: for VAP surveillance, the numerator is
the number of cases of VAP, and the denominator is the number of ventilator-
days during the same time period.
• Establish the definition to be used to identify cases
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Cont..
• Develop a process to identify cases
• Perform surveillance systematically
• Collate data and prepare reports
• Initiate quality improvement activities as necessary
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Summary
The use of mechanical ventilators is increasing among newborn, pediatric, and adult
patients in low- and middle-income countries. VAP is one of the most common HAIs,
resulting in increased health care costs as well as increased mortality among intubated
patients on mechanical ventilators. Applying specific prevention measures
recommended in this chapter, including proper compliance with recommended IPC
practices, will help reduce the risk of VAP
