[Prevention of ventilator-associated pneumonia: review of national and international guidelines].
Both in the USA and in Europe the most frequent hospital-acquired infection in intensive care units is the ventilator-associated pneumonia. Particularly, patients with artificial respiration are at risk. Their risk to acquire a nosocomial pneumonia is six to twenty-one times higher than for patients breathing without artificial help. Established risk factors are, amongst others, old age, tracheotomy or reintubation, defective immune functions, already existing pulmonary infections and lifestyle-dependent factors like smoking. Recent scientific results indicate that endogenous infections are the most important reason for the development of a ventilator-associated pneumonia. Infections are initiated by microaspiration of bacteria from the oropharynx. Bacterial colonisation of the mouth is often favoured by an increased gastric pH-value, a secondary effect of the accompanying medicinal therapy. On a national as well as an international level there are evidence-based guidelines for the prevention of ventilator-associated pneumonia available. A comparison of guidelines of the US-American "Centers for Disease Control and Prevention" (CDC) with those of the German "Robert Koch-Institut" reveals deviating recommendations. Differences concern especially the changing of respiratory tubes, the use of filters and of closed humidifying systems. Additionally there are not yet recommendations for every aspect of infection prevention. However, recent studies show that regular surveillance of infections, further training of staff members and critically considering the invasive use of medical devices are able to reduce the rate of nosocomial infections and especially ventilator-associated pneumonia.
Panknin
Hardy-Thorsten
HT
ht.panknin@worldonline.de
D001424:Bacterial Infections / Q000451:nursing* / Q000517:prevention & control / Q000635:transmission; D003428:Cross Infection / Q000451:nursing* / Q000517:prevention & control / Q000635:transmission; D019317:Evidence-Based Medicine; D005858:Germany; D006801:Humans; D007362:Intensive Care Units; D017410:Practice Guidelines as Topic; D012121:Respiration, Artificial / Q000451:nursing*; D012307:Risk Factors; D014481:United States