The role of the intensive care unit environment in the pathogenesis and prevention of ventilator-associated pneumonia.
Ventilator-associated pneumonia is preceded by lower-respiratory-tract colonization by pathogenic microorganisms that derive from endogenous or exogenous sources. Most ventilator-associated pneumonias are the result of exogenous nosocomial colonization, especially, pneumonias caused by resistant bacteria, such as methicillin-resistant Staphylococcus aureus and multi-resistant Acinetobacter baumannii and Pseudomonas aeruginosa, or by Legionella species or filamentous fungi, such as Aspergillus. Exogenous colonization originates from a very wide variety of animate and inanimate sources in the intensive care unit environment. As a result, a strategic approach that combines measures to prevent cross-colonization with those that focus on oral hygiene and prevention of microaspiration of colonized oropharyngeal secretions should bring the greatest reduction in the risk of ventilator-associated pneumonia. This review examines strategies to prevent transmission of environmental pathogens to the vulnerable mechanically-ventilated patient.
Crnich
Christopher J
CJ
Section of Infectious Diseases, Department of Medicine, University of Wisconsin Medical School, University of Wisconsin Center for Health Sciences, Madison WI, USA.
Safdar
Nasia
N
Maki
Dennis G
DG
D003428:Cross Infection / Q000188:drug therapy* / Q000382:microbiology / Q000517:prevention & control*; D004866:Equipment Contamination; D006801:Humans; D007362:Intensive Care Units; D011014:Pneumonia / Q000188:drug therapy* / Q000382:microbiology / Q000517:prevention & control*; D012122:Ventilators, Mechanical / Q000009:adverse effects*