Centers for Disease Control and Prevention

Ventilator-Associated Pneumonia Still a Concern, Study Says

mask holds oxygen mask to face


Contrary to data published by the Centers for Disease Control and Prevention, ventilator-associated pneumonia rates in hospital intensive care units have not declined significantly since 2005, according to a new study out of the UConn School of Medicine.

The study, published in the Journal of the American Medical Association, found that about 10 percent of critically ill patients placed on a ventilator develop ventilator-associated pneumonia (VAP). The finding is based on reviews of charts from hospitals across the country from 2005-2013.

“VAP is not going away; it still affects approximately one in 10 ventilated patients,” says the study’s lead author, Dr. Mark L. Metersky of UConn Health’s Division of Pulmonary and Critical Care Medicine. “Our findings are in stark contrast to the CDC’s report of a marked decline in VAP rates that had some believing it may no longer be an important problem.”

Researchers reviewed data compiled by the Medicare Patient Safety Monitoring System from a representative sampling of 1,856 critically ill Medicare patients, ages 65 and older, who needed two or more days of mechanical ventilation.

While the VAP rates were stable throughout that time, the rates did not correlate with the CDC’s National Healthcare Safety Network reported rates, which suggest declining rates between 2006 and 2012 in both medical and surgical ICUs. The rate of VAP is one of the metrics for patient safety and health care delivery quality that many hospitals are scored on nationally.

VAP is not going away … Our findings are in stark contrast to the CDC’s report of a marked decline in VAP rates that had some believing it may no longer be an important problem.

Patients in need of mechanical ventilation are often the most critically ill in a medical or surgical ICU hospital setting. Research has shown that up to 15 percent of patients who get it may die from VAP.
The study authors examined the prevalence of VAP in patients on a ventilator following a heart attack,
heart failure, pneumonia, or major surgery. These types of patients are at higher risk for developing pneumonia, a bacterial infection, due to the need for a tube extending down their throat and into their lungs to help them breathe.

“We have not beaten this,” says Metersky. “Current hospital interventions that are used in an attempt to prevent VAP are not working. VAP is still a significant issue, and needs more examination into how we survey its occurrence and report it, along with more research into how best to prevent this type of pneumonia in vulnerable patient populations.”

The higher-than-expected VAP rates may be leading patients to experience complications or death from their lung infection or spend more time on a ventilator or in the ICU, slowing recovery. It may also increase use of antibiotics, leading to potential resistance, and increase health care costs due to longer hospital stays.

Metersky collaborated on the study with colleagues at Qualidigm, Harvard Medical School, and Harvard School of Public Health. It was supported by the Agency for Healthcare Research and Quality of the U.S. Department of Health and Human Services.

America’s Opioid Epidemic: What Doctors Need to Know

Q&A with Dr. Surita Rao, UConn Health assistant professor of psychiatry

Q

Can you characterize the U.S. opioid epidemic?

Our country’s opioid epidemic has been going on for several years. The U.S. is the biggest global consumer of prescription opioids. In 1997, 76 million prescriptions were written, more than doubling by 2013 to 207 million. Americans consume nearly 100 percent of the world’s hydrocodone (Vicodin) and 81 percent of its oxycodone. The majority of those physically addicted or overdosing are getting opioid prescriptions from their doctors’ offices.


Q

What are the dangers of opioids?

These strong pain pills are very physically addictive and it’s often hard for patients to live without them, even after their pain subsides. The biggest dangers of opioids are overdose and death. After doctors stop prescribing them, some patients turn to the street to illegally get their pills, while some may even switch to heroin. When mixed with heroin, anxiety medications, or alcohol, opioids are even more likely to lead to overdose.


Q

What do the new Centers for Disease Control and Prevention guidelines call for?

In March the CDC called on primary care doctors to more carefully assess each individual patient’s risk of taking an opioid and to take extreme caution when prescribing it for longer than seven days for acute pain, unless for terminal cancer or palliative care. The lowest-effective dose of non-slow-release pain pills should always be used, and patient use needs to be continuously reevaluated. Guidelines stress the critical need for increased education and communication about opioid risks including constipation, drowsiness, stopping breathing, drug and alcohol interaction, addiction, overdose, and death.


Q

What should medical providers keep top-of-mind?

For patients, physicians should always consider first NSAIDS (such as acetaminophen and ibuprofen), routine exercise, physical therapy, hot and cold compresses, and possibly steroidal injections. If opioids are necessary, beware that long-term opioid use can lead to physical dependence and intense withdrawal. Patients should be slowly weaned off. Patients who have developed an addiction to opioids that goes beyond a physical dependence will need to undergo medical detox, or take agonist maintenance medication to curb their brain-receptor cravings. Psychotherapy specifically targeted for substance abuse disorders, including individual counseling and group therapy, is always needed for successful recovery from an addictive illness. Patients should be encouraged to proactively lower their daily pain risk factors, not abuse or share opioids, and seek medical attention if they start to experience withdrawal symptoms or addiction.