1. Poster template by ResearchPosters.co.za Ventilator Associated Pneumonia rates in Intensive Care. Lori J. Delaney Assistant Professor: University of Canberra, PhD Scholar – Australian National University, Research Centre for Nursing & Midwifery Practice Contact: Email: lori.delaney@canberra.edu.au; Twitter; @LoriJDelaneylori.delaney@canberra.edu.au Introduction Ventilator Associated Pneumonia (VAP) is the primary nosocomial infection acquired by patients requiring mechanical ventilation 1. The principle risk factor for developing VAP is the presence of an artificial airway, as it inhibits the normal airway reflexes, and encourages the microaspiration of oropharngeal secretions. VAP imposes a considerable financial burden on Intensive Care Units (ICU), in terms of length of ICU stay and overall hospital stay 2. Further, it has been associated with an increase in mortality risk of approximately 30% 3. Patients who are admitted into Intensive care for more than 5 days have an overall infection rate of between 40-50%, with respiratory infections being the most prevalent 4. The primary nidus for the development of VAP is the microaspiration of contaminated subglottic respiratory secretions that accumulate around the endotracheal cuff 5. Aim ABAB Method A retrospective review of patient’s admitted to a 22 bed tertiary referral ICU, which provides clinical services inclusive of surgical, medical, trauma, neurosurgical and cardiothoracic was conducted over a 12 month period (January 1, 2012 to December 31 st 2012). A diagnosis of VAP was made based on the criteria previously published of; mechanical ventilation required for greater than 48 hours, chest radiographic features indicative of pneumonia, new or persistent infiltrates, plus two of the following criteria: 1. purulent tracheal secretions, 2.blood leucocytosis (>12×10 9 white blood cells/L) or leucopenia (<4×10 9 white blood cells/L), 3. or a temperature greater than 38.3°C 1. The primary end points for the study were; number of cases of ventilator-associated pneumonia, hours of ventilation support, length of ICU admission (days) and mortality. The study was approved by the ACT- Human Research and Ethics Committee (ACT-HREC). Results A total of 1563 clinical records were reviewed, with 452 patients identified as requiring mechanical ventilation for greater than 24 hours. A total of 28 (6.19%) patients admitted to ICU requiring mechanical ventilation for greater than 24 hours, and met the criteria for a diagnosis of VAP. The incidence rate of VAP was determined to be 11.2 VAP cases/1000days of mechanical ventilation. Figure 1. Demographic feature of patients diagnosed with Ventilator Associated Pneumonia. Conclusion The incidence rate of VAP within the ICU is comparable to international rates. The lower number of individual VAP cases may be attributed to the decreased duration of mechanical ventilation amongst our patient cohort. The development of VAP as an acquired infection during the course of admission was associated with increased length of stay, need to tracheostomy to facilitate liberation from mechanical support and increased mortality. The findings indicate that there is a need to frequently assess and evaluate patients for the presence of VAP, and develop additional strategies that build upon current clinical care bundles to reduce incidences. Implications for practice References Acknowledgements Figure 2. The ventilatory support and outcomes of patients with Ventilator Associated Pneumonia 1.Valencia, M. & Torres, A. (2009). Ventilator associated pneumonia. Current Opinion in Critical Care.15:30-35. 2. Deem, S. & Treggiari, M.M.(2010). New endotracheal tubes designed to prevent ventilator associated pneumonia: Do they make a difference. Respiratory Care.55(8); 1046-1055. 3. Papazian, L., Bregeon, F., Thirion, X., Gregoire, R., Sauz, P., Denis, J.P. et al (1996). Effect of ventilator-associated pneumonia on mortality and morbidity. American Journal of Respiratory and Critical Care Medicine. 154(1);91-97. 4. Pneumatikos, I.A., Dragoumanis, C.K., Bouros, D.E.(2009) Ventilator associated pneumonia or endotracheal tube associated pneumonia. Anethesiology.110(3); 673- 680. 5. Blunt, M.C., Young, P.J., Patil, A. & Haddock, A. (2001). Gel lubrication of the tracheal tube cuff reduces pulmonary aspiration. Anesthesiology.95(2);216-219. The author would like acknowledge the generous support of the: Office of Nursing and Midwifery for their generous support via the Professional Development Scholarship program, and the Intensive Care Research Office (ACT Health) for their assistance with data collection. Th The aim of the study was to: Ascertain the incidences VAP in the Canberra Hospital Intensive Care Unit, and to Report the impact that VAP has on mechanical ventilation days, and hospital length of stay. Demographic ETT (n=28) Sex: Male/Female (%)64.3/35.7 Age: yr. (mean±SD)59.64 (19.74) APACHE II score (mean±SD) 19.27 (7.05) Diagnostic group (%) Trauma 14.3 Sepsis 10.7 Metabolic disorders 3.6 Neurological 14.3 Respiratory 25 Non-surg cardovasc 7.1 Neuromuscular dis. 7.1 Resp (post op) 7.1 Neuro surg 3.6 Other7.2 Ventilation requirements N= 28 Reintubation (%)21.43 Tracheostomy insertion (%)35.71 Duration of Tracheostomy, days (mean± SD) 54.66 (52.28) Duration of MV, hrs. (mean ± SD) 252.6 (176.54) ICU stay, days (mean±SD)29.04 (38.19) HLOS, day (mean±SD)67.75 (65.74) Status at discharge, alive/deceased (%) 75/25 VAP is considered to be a hospital acquired infection and a nurse sensitive indicator of clinical performance in the ICU. The development of VAP has adverse implications for patient outcomes including increased duration of mechanical ventilation, failure to liberate from mechanical ventilation, need for tracheotomy and increased patient mortality. There is a need to consider additional strategies to reduce the incidences of VAP amongst ICU patients such as Subglottic Endotracheal Tubes. Patients who were found to have developed VAP failed initial attempts to extubate 21.43% of the time, and was associated with a prolonged need for tracheostomy support. A diagnosis of VAP was associated with a mortality rate of 25%, with the majority of these patients dying in ICU (n=6).