Incidence of ventilator-associated pneumonia at ICU - the effect of preventive measures in nursing care

Introduction: Pneumonia in patients on mechanical ventilation is the most frequently observed infectious complication in intensive care patients. The primary objective of the presented work was to evaluate compliance with procedures intended for the prevention of ventilator-associated pneumonia (VAP) in clinical practice at the Intensive Care Unit, University Hospital Ostrava (ICU UHO). The secondary objectives were to evaluate the incidence of VAP and the effect of a checklist introduced for prevention of VAP. Methods: The study group consisted of a total of 525 patients hospitalized at the ICU UHO between 2016 and 2017. The research was performed with analysis of data obtained from the introduced checklist of VAP. In patients who were mechanically ventilated and not admitted to the hospital with a primary diagnosis of pneumonia or already confirmed VAP. Results: In the overall assessment, compliance with only 2 of the 4 evaluated preventive measures against the onset of VAP was recorded in 58.10%. At one of the observed ICU, the incidence of VAP decreased by more than 50% after the introduction of the checklist. The results confirmed a statistically significant difference in the relation between positioning the patient in a semirecumbent position, maintaining pressure in the obturation cuff of the endotracheal tube within the recommended range, and the need to reintubate and the incidence of VAP. No statistically significant difference was observed in the relation between the performance of subglottic suctioning and the incidence of VAP. Conclusions: The results of the survey show that the implemented system of prevention and the newly elaborated checklist lead to a decreased incidence of VAP.