The risk of death by patients in the intensive care unit (ICU) stems not only from their critical illness but also from nasocomial infection. Among the critically ill patients, pneumonia is one of the most common nasocomial infections, affecting 27% of the patients (Cai, 2011). Hospital-acquired pneumonia (HAP) or ventilator-associated pneumonia (VAP) as it is commonly referred occur 48 hours or more after admission and endotracheal intubation (mechanical ventilation) of the patient (Drakulovic, 1999). The frequency of nasocomial pneumonia varies among the types of ICUs with high incidences of VAP mortality reported in children’s pediatric intensive care unit (PICU) than in adults’ (Cai, 2011). This mostly is due to the increased use of mechanical ventilation and immune deficiency. Studies show that almost 90% of patients in the ICU diagnosed with VAP were mechanically ventilated patients with the rate of infection at between five and 15 recorded incidences for every 1,000 hospital admissions in United State (U.S).
Mechanically ventilated patients experience the accumulation of secretions when coughing and mucociliary clearance are impaired by the endotracheal tubes. The secretions are eliminated by use of endotracheal suctioning of the tracheal tube of the patient to promote good ventilation and oxygenation. Until recently suction has been performed using the aseptic technique, where the patient must be first disconnected from the ventilator (Zeitoun, 2003). However the new tracheal suction system has the advantage of ensuring that the patient is not disconnected from the ventilation system during suction thus maintaining the cardiovascular parameters. Since there is a consensus that the main vehicle of transmission is staff hands, use of glasses, gloves, masks during suction reduces the chances of environmental cross-contamination. However, it is worth noting that, in clinical researches conducted on the open and closed tracheal suction system, there was no significant decrease in the development of VAP when closed tracheal suction was used. To reduce the high mortality and morbidity associated with VAP, preventive measures must be employed such as semi-recumbent patient positioning achieved by elevating the head of the bed by 300 to 450(Cai, 2011). To reduce the oropharynx colonization by bacteria, use of nasotracheal and nasogastric tubes is highly discouraged in favor of oral endotracheal intubation and orogastric tubes. However, despite all the preventive measures, studies show no change in mortality rates. The unreliable and inaccurate number of VAP cases reported, experts argue, is the cause of no reported change in the mortality stemming from VAP. It is partly due to a lack of standardized criteria of diagnosis.
References
CAI, X., Sun, J., Ba, L., & Li, W. (2011). Distribution and antibiotic resistance of pathogens isolated from ventilator-associated pneumonia patients in pediatric intensive care unit. World Journal of Emergency Medicine, 2(2), 117.
Drakulovic, M. B., Torres, A., Bauer, T. T., Nicolas, J. M., Nogué, S., & Ferrer, M. (1999). Supine body position as a risk factor for nosocomial pneumonia in mechanically ventilated patients: a randomised trial. The Lancet, 354(9193), 1851-1858.
Zeitoun, S. S., Botura Leite De Barros, A. L., & Diccini, S. (2003). A Prospective, Randomized Study Of Ventilator-associated Pneumonia In Patients Using A Closed Vs. Open Suction System. Journal of Clinical Nursing, 12(4), 484-489.
