Ventilator-associated pneumonia is the most common healthcare-associated infection in mechanically ventilated patients. Despite this, accurate diagnosis of ventilator-associated pneumonia is difficult owing to the variety of criteria that exist. In this prospective national audit, we aim to quantify the existence of patients with suspected ventilator-associated pneumonia that would not be detected by our standard healthcare-associated infection screening process. Furthermore, we aim to assess the impact of tracheostomy insertion, subglottic drainage endotracheal tubes and chlorhexidine gel on ventilator-associated pneumonia rate. Of the 227 patients recruited, suspected ventilator-associated pneumonia occurred in 32 of these patients. Using the HELICS definition, 13/32 (40.6%) patients were diagnosed with ventilator-associated pneumonia (H-posVAP). Suspected ventilator-associated pneumonia rate was increased in our tracheostomy population, decreased in the subglottic drainage endotracheal tube group and unchanged in the chlorhexidine group. The diagnosis of ventilator-associated pneumonia remains a contentious issue. The formalisation of the HELICS criteria by the European CDC should allow standardised data collection throughout Europe, which will enable more consistent data collection and meaningful data comparison in the future. Our data add weight to the argument against routine oral chlorhexidine. The use of subglottic drainage endotracheal tubes in preventing ventilator-associated pneumonia is interesting and requires further investigation.
Keywords: Ventilator-associated pneumonia; chlorhexidine; healthcare-associated infection surveillance; subglottic endotracheal tubes; tracheostomy.
© The Intensive Care Society 2019.