Posts tagged: Hospital acquired infection

Ventilator Acquired Pneumonia: A Large Problem for Hospitals

Although hospitals are centers of refuge for those who need care, an unfortunate reality is that the number of people coming in and leaving these facilities inevitably results with the spread of disease and infections between patients, doctors, and other health care workers. These unintentionally transmitted diseases, born in hospital settings, are collectively known as Hospital Acquired Infections (nosocomial infections in medical literature). This class of disease results in over  99,000 deaths each year in the United States alone.

One significant form of nosocomial infection is Ventilator Acquired Pneumonia (VAP) which, as the name suggests, is pneumonia (an inflammatory condition of the lung) transmitted to patients while they are on mechanical ventilator breathing support. The incidence of this disease is between 8% and 20%, and mortality rates are between 20% and 50%. As a result, VAP has a critical impact on morbidity, length of stay, and cost of ICU care.

A significant contributor to such high rates of incidence and morbidity is the fact that patients on mechanical ventilation systems are often sedated and are rarely able to communicate or cough up the biofilm that grows in the tubes and drains down into the lungs. Typical symptoms of pneumonia may be absent or unobservable, leading to delays in detection and therefore treatment.  Under these conditions, the medical signs that a patient has acquired pneumonia are increased number of white blood cells on blood testing and new shadows (infiltrates) on chest x-rays. Other important signs are fever, low body temperature, purulent sputum, and hypoxemia (decreasing amount of oxygen in the blood).

If any of these symptoms are suspected by care takers, two conventional methods of diagnosis are deployed. The first is to collect cultures from the trachea while also scanning the chest with an x-ray to detect new or enlarging infiltrates. The other method is more invasive and involves a bronchoalveolar (where fluid is squired out small areas of the lung and recollected for examination), as well as a chest x ray.

Treatment regimens depend on the specific bacteria causing the inflammation, although a widely used first step is the prescription of empiric therapy (broad spectrum antibiotics) until the particular bacterium and its sensitivities are determined. Once the specific microorganisms implicated in generating pneumonia are known, more antibiotics are prescribed. The use of antibiotics raises the issue of resistance from the bacteria, and the related decrease of efficacy of the antibiotic in the years to come.

Photodisinfection is a non antibiotic approach under development by the research and development teams at Ondine Biomedical Inc., for the decolonization of the tubes of long term intubated patients. Pre-clinical studies have demonstrated proven effects of Photodisinfection directed toward the inner surface of the endotracheal tubes. The Exelume™ Photodisinfection system is currently being tested in NIH funded clinical trials in the US. Other Photodisinfection applications under development by Ondine include:  periodontitis, chronic sinusitis, burns & wounds, UTI, vertical transmission of HIV, nasal decolonization to reduce SSI, GI infection protection, etc.

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