Janet Boehm EdD, MS, RRT
Director, Clinical Education
Youngstown State University
Youngstown, OH

Richard Branson, MS, RRT, FAARC
Associate Professor of Surgery
University of Cincinnati College of Medicine Cincinnati, OH

Richard Kallet, MSc RRT, FAARC
Clinical Projects Manager
University of California
Cardiovascular Research Institute
San Francisco, CA

Donna Hamel, RRT, FAARC
Clinical Research Coordinator
Duke University Health Systems
Raleigh-Durham, NC

Neil MacIntyre, MD, FAARC
Medical Director of Respiratory Services
Duke University Medical Center
Durham, NC

Tim Myers, BS, RRT-NPS
Pediatric Respiratory Care
Rainbow Babies and Children’s Hospital
Cleveland, OH

Tim Op’t Holt, EdD, RRT, AEC, FAARC
Professor, Department of Respiratory Care
and Cardiopulmonary Sciences
University of Southern Alabama
Mobile, AL

Ruth Krueger Parkinson, MS, RRT
Protocol/ PI Coordinator
Sioux Valley Hospital
Sioux Valley, SD

Helen Sorenson, MA, RRT, FAARC
Assistant Professor, Dept. of Respiratory Care
University of Texas Health Sciences Center
San Antonio, TX

Prevention of Ventilator-Associated Pneumonia
by Teresa A. Volsko, MHHS, RRT, FAARC

According to the Centers for Disease Control and Prevention (CDC), pneumonia accounts for approximately 15% of all hospital-associated infections, including 27% of all infections acquired in intensive-care units and 24% of those in coronary care units. Of the many risk factors for acquiring hospital-associated bacterial pneumonia, mechanical ventilation (and associated endotracheal intubation) is the most common.
The CDC’s National Nosocomial Infection Surveillance System (NNIS) reported that in 2002, the median rate of ventilator-associated pneumonia (VAP) in NNIS hospitals ranged from 2.2 per 1000 ventilator-days in pediatric ICUs to 14.7 per 1000 ventilator-days in trauma ICUs. Other investigators report that patients receiving continuous mechanical ventilation have 6 to 21 times the risk of developing hospital-associated pneumonia compared with patients who are not receiving mechanical ventilation.1 Because of this high risk, most of the research on hospital-associated pneumonia over the past 20 years has been focused on VAP.
The bacteria responsible for VAP are mostly Staphylococcus aureus, Pseudomonas aeruginosa, and Enterobacteriaceae, but infectious agents differ widely depending on the patients in the ICU, duration of hospital stay, and prior antimicrobial therapy. VAP is associated with a significant mortality risk. According to one review, the mortality rate for VAP, defined as pneumonia occurring more than 48 hours after endotracheal intubation and initiation of MV, ranges from 24% to 50% and can reach 76% in some settings or when lung infection is caused by high-risk pathogens.2 Although appropriate antimicrobial treatment of patients with VAP can significantly improve outcomes, the optimal strategy is to prevent infection in the first place, especially in an era of antibiotic-resistant bacteria.

Putting VAP Guidelines into Practice: Roundtable Discussion
Moderator: Dean Hess PhD, RRT, FAARC

Patient safety and quality of care have received increasing scrutiny in recent years. There is no dispute that patient care errors result in bad outcomes and increased costs. In the near future, such errors will likely impact reimbursement. Starting in 2009, Medicare will not cover the costs of preventable conditions, mistakes, and infections resulting from a hospital stay. From the perspective of the respiratory therapist, conditions such as nosocomial pneumonia -- specifically (VAP) -- likely will fall into the category of preventable conditions. Thus, it is imperative that the respiratory therapist implement practices to prevent VAP, as this will be increasingly scrutinized from the perspectives of quality, cost, and reimbursement. In this roundtable discussion, 3 respiratory therapists present their thoughts on implementation of VAP guidelines.

All CE Modules have been renewed for 2008