Critically ill patients who are unconscious or sedated in Critical Care units often require mechanical ventilation, which places them at increased risk of developing Ventilator-Associated Pneumonia (VAP).

VAP is defined as a new-onset pneumonia occurring in patients who have been mechanically ventilated for more than 48 hours via an endotracheal (ET) tube or tracheostomy. 

In contrast, Hospital-Acquired Pneumonia (HAP) is an acute lower respiratory tract infection that develops 48 hours or more after hospital admission and was not incubating at the time of admission. Patients with HAP are not mechanically ventilated and typically present with another underlying condition.

Both VAP and HAP are associated with significant increases in mortality and morbidity. Complications include prolonged duration of mechanical ventilation, extended Intensive Care Unit stays, increased overall hospital length of stay, and higher healthcare costs.

Evidence suggests that approximately 20-25% of ventilated patients develop VAP, making it one of the most common and serious nosocomial infections in Critical Care . VAP can increase ICU length of stay by an average of six days and generate additional costs. Diagnosis is typically based on a combination of clinical history, signs and symptoms, chest radiographic findings, and microbiological results.

Numerous studies have demonstrated that the implementation of evidence-based interventions, such as elevating the head of the bed, undertaking daily sedation holds and providing effective oral hygiene, can significantly reduce the incidence of Ventilator-Associated Pneumonia.

These findings prompted the National Institute for Health and Care Excellence (NICE), the National Patient Safety Agency (NPSA), and the UK Department of Health to publish guidance on high-impact interventions aimed at reducing VAP rates within UK Critical Care Units.

Evidence supporting these interventions has also led to the widespread adoption of the Ventilator Care Bundle, which includes the following interventions:

• Elevation of the head of the bed to 30–45 degrees
• Daily sedation interruption with assessment of readiness for extubation
• Use of subglottic secretion drainage
• Provision of effective oral hygiene
• Avoidance of routine ventilator circuit changes

The evidence-based consensus paper for Oral Care within Adult Critical Care Units by the BACCN  focuses specifically on the oral care interventions required to reduce the risk of developing Ventilator-Associated Pneumonia.