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The National Institute for Health and Clinical Excellence (NICE) in collaboration with the National Patient Safety Agency (NPSA) has today issued guidance to improve the safety of patients in the NHS in England and Wales by reducing the risk of pneumonia in patients aged 16 years and older who are on a ventilator.

Pneumonia is an inflammatory condition of the lungs caused by bacterial, viral or fungal infection. Ventilator-associated pneumonia (VAP) can occur as a complication of mechanical ventilation, particularly when ventilation is required for a prolonged period of time and in patients who are critically ill. VAP is a significant problem - data from the USA suggests that it represents 31% of all intensive care unit (ICU)-acquired infections, and that it occurs in 9–27% of all intubated patients. Patients who develop VAP are at risk of serious complications (for example, acute respiratory distress syndrome) and have a significantly longer stay on ventilator machines and in ICU.

NICE/NPSA have recommended that for patients who are on a ventilator and have a tube placed into their mouth, nose or through the neck and down into their windpipe, healthcare professionals should:

• position patients with their upper body elevated (in a semi-recumbent or seated position) for as much of the time as possible. For some patients this will not be appropriate (for example, those with spinal injuries).
• Include oral antiseptics (for example, chlorhexidine) as part of the oral hygiene regimen for all patients who are intubated and receiving mechanical ventilation.

Professor Bruce Campbell, Chairman, Patient Safety Advisory Committee said: “This guidance recommends two particular measures which help to prevent ventilator
associated pneumonia, and which are simple to implement. Nursing patients with their upper body elevated is already very common practice, and use of oral antiseptics fits readily into the regular care of the upper airway.

It is important to emphasize that this was not intended to be a comprehensive guideline – there are many other measures which may contribute to reducing the risk of VAP. For example, there was evidence to support the use of systemic decontamination of the digestive tract (SDD), but many specialists in the UK have concerns about the possibility of more infections by multi-resistant bacteria if this were used routinely. The guidance gives specific recommendations for further research to increase our knowledge of SDD in the context of UK practice.”

Kevin Cleary, Medical Director, National Patient Safety Agency said: "Evidence suggests that Ventilator Associated Pneumonia is a significant patient safety problem and can lead to further serious complications. This important guidance recommends actions that will help improve the situation and help reduce the risk of pneumonia in patients who are on a ventilator."

Notes to Editors

About NICE

1. The National Institute for Health and Clinical Excellence (NICE) is the independent organisation responsible for providing national guidance on the promotion of good health and the prevention and treatment of ill health.

2. NICE produces guidance in three areas of health:

• public health – guidance on the promotion of good health and the prevention of ill health for those working in the NHS, local authorities and the wider public and voluntary sector
• health technologies – guidance on the use of new and existing medicines, treatments and procedures within the NHS
• clinical practice – guidance on the appropriate treatment and care of people with specific diseases and conditions within the NHS.

About the NPSA

3. The National Patient Safety Agency encompasses the National Research Ethics Service, Patient Safety Division and the National Clinical Assessment Service. Our vision is to lead and contribute to improved, safe patient care by informing, supporting and influencing healthcare individuals and organisations. Each division works within its sphere of expertise to improve patient outcomes. For more information visit: www.npsa.nhs.uk

About the patient safety pilot

4. As a result of the review of patient safety commissioned by the Chief Medical Officer1, the National Institute for Health and Clinical Excellence (NICE) and the National Patient Safety Agency (NPSA) were asked to develop and evaluate a pilot project for the production of a technical solution to address patient safety problems, which will form guidance for the NHS. NICE’s core principles of guidance development will be applied to the project.

These principles include:

• A comprehensive evidence base
• Independent advisory committees
• Clinical and patient expert input
• Transparent process and decision making
• Genuine consultation
• Effective dissemination and implementation
• Regular review.

5. Guidance on the technical patient safety solutions for prevention of ventilator-associated pneumonia in adults can be found on the NICE website at http://www.nice.org.uk/PatientSafetyPilot