Pathogens Associated with the Intensive Care Unit Environment – Considerations for the Respiratory Therapist

The August 1 2010 Article Review is by John Davies, MA RRT FAARC

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This program has been approved for 2.0 contact hours by the AARC

Ventilator-associated pneumonia (VAP) is the most common nosocomial pulmonary infection and accounts for a significant proportion of the 1.7 million infections and 99,000 associated deaths each year in American hospitals. Methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococcus (VRE) are of growing concern due to their ease of transmission via medical devices and hospital personnel. Other pathogens causing VAP include Staphylococcus aureus, Streptococcus pneumonia and Hemophilus influenzae, Pseudomonas aeruginosam, Acinetobacter species and Enterobacter species. A clear diagnosis of VAP requires a combination of findings from clinical signs, chest X-ray, and analysis of bronchial alveolar lavage. Although there are several natural defense systems against infection, these are often breached through the use of indwelling devices, such as catheters, and inadequately sterilized mechanical ventilation equipment, such as endotracheal tubes, ventilator circuits, humidifiers, medication nebulizers and suction catheters. Methods to prevent VAP include effective handwashing with antimicrobial preparations, education of hospital staff, thorough sterilization of equipment, and implementation of protocols such as the VAP bundle. Modified equipment is now available to limit the likelihood of infection.