Technical patient safety solutions for ventilator-associated pneumonia in adults

1. Technical patient safety solutions for ventilator-associated pneumonia in adults Implementing the guidance 2008 NICE patient safety guidance 2

2. Definition of ventilator-associated pneumonia • Ventilator-associated pneumonia is often defined as pneumonia that develops 48 hours or more after intubation with an endotracheal or tracheostomy tube, and which was not present before intubation

3. Changing practice • The patient safety guidance is based on the best available evidence. • The Department of Health asks NHS organisations to implement national patient safety guidance.

4. Changing practice • Compliance with core standard C1(b) will be monitored by • the Healthcare Commission. • Compliance with standard 12b will be monitored by • the Healthcare Inspectorate Wales. • Health Act (2006) requires NHS organisations to audit • policies and procedures to prevent infection.

5. What this presentation covers • Background • Action • Other interventions evaluated • Costs and savings • Resources

6. Background:why these actions matter • Ventilator-associated pneumonia (VAP) is linked to higher morbidity, mortality and costs • VAP represents 31% of all ICU-acquired infections (USA) • Mortality rate of patients who have developed VAP is between 38% and 50% (USA).

7. Action • Mechanically ventilated patients who are intubated should be positioned with their upper body elevated (in a semi-recumbent or seated position) for as much of the time as possible. For some patients this will not be appropriate (for example, those with spinal injuries).

8. Action • Oral antiseptics (for example, chlorhexidine) should be included as part of the oral hygiene regimen for all patients who are intubated and receiving mechanical ventilation.

9. Other interventions evaluated • Selective decontamination of the digestive tract (SDD) • Antibiotics for SDD may reduce the incidence of VAP but bacterial resistance is of concern • Insufficient evidence to recommend any particular antibiotic regimen or define any patient subgroups who might benefit.

10. Other interventions evaluated • Kinetic bed therapy • poor quality evidence and a lack of patient and staff acceptability • Care bundles • insufficient evidence to recommend any particular care bundle

11. Costs and savings • Actions in the guidance are cost-effective interventions • Implementation of the actions is unlikely to result in a significant change in resource use in the NHS • The total annual cost to the NHS of implementing the action on antiseptics is expected to be less than £115,000 in England.

12. Related guidance • Clean hands help to save lives. NPSA patient safety alert 4 (2004) • High impact intervention no. 5: care bundle for ventilated patients. Department of Health (2007) • UK guidelines to address the management of hospital-acquired Pneumonia. British Society for Antimicrobial Chemotherapy (2008)

13. Related NICE guidance • Acutely ill patients in hospital. NICE clinical guideline 50 (2007) • Infection control. NICE clinical guideline 2 (2003)

14. Resources • Costing statement • Audit support • Shared learning database • www.nice.org.uk/PSG002

15. Access the guidance online • Patient safety guidance • ‘Understanding NICE guidance’ – a version for patients and carers • www.nice.org.uk/PSG002 • www.npsa.nhs.uk