Posts tagged: ventilator-associated pneumonia

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.

The Underreporting of Pneumonia Infections In Hospitals

Ventilator-Associated Pneumonia (VAP) is a type of lung infection that occurs in individuals receiving mechanical intubation. In intensive-care units, VAP is one of the leading causes of healthcare-associated infections, however there is currently no reliable definition of a VAP patient. Preventing VAP continues to be a priority, as it is associated with increased healthcare costs, longer hospital stays, and increased mortality and morbidity.

Defining a VAP infection is based on subjective elements and will need further standardization. A new system that is currently scheduled for implementation in 2013 will categorize VAP into 4 levels:

  1. Ventilator-associated condition (VAC)
  2. Infection-related complications (IVAC)
  3. Possible VAP
  4. Probable VAP

Like other healthcare-associated infections, the underreporting of infection rates continues to be a general trend. With healthcare-associated infections being the most common type of hospital-related complication, this fact is even more alarming. In a recent review of over 100 hospitals in California concluded that approximately 1/3 of all healthcare-associated infections go unreported. Read more »

Study Shows That 1 In 3 Healthcare-Associated Infections Go Unreported

In a recent study conducted by the California Public Health Authorities, it was concluded that approximately one-third of the infections that should have been reported under California law were in fact not reported. This study, which was conducted in 2011, reviewed one-hundred hospitals in the state.

Several states have passed laws requiring the mandatory reporting of infection statistics from hospitals and other healthcare facilities. I personally had the honor of testifying at the Rhode Island State House in 2009 on behalf of such a bill, which was eventually made law. Public reporting of healthcare-associated infection statistics from hospitals and other applicable healthcare facilities is important for several reasons, including the fact that such statistics provide the public with tangible evidence that can help public health officials and other professionals better gauge the problem at hand. Yet as this study proves, more progress in this area is still needed in order to curb the unnecessary deaths due to healthcare-associated infections.

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Ondine’s Photodisinfection Technology Being Developed To Treat Chronic Sinusitis

Photodisinfection is a highly effective antimicrobial therapy involving non-thermal light and a topically placed photosensitizer. It is currently being used for the treatment of oral infections and nasal decolonization of MRSA and S. aureus. Photodisinfection is also being currently used for the treatment of endotracheal tube biofilms to prevent ventilator associated pneumonia. One of the areas of medical need identified for photodisinfection is for the treatment of chronic sinusitis that has failed surgical and medical therapies. It is estimated that there are more than 500,000 of these people suffering in the US alone, and this number grows by 10% annually.

Polymicrobial biofilms, many of them antibiotic resistant, have been significantly implicated in the etiology of this chronic indolent disease process and its associated inflammatory processes.  Preclinical studies we have conducted demonstrate the effectiveness of photodisinfection to selectively photoeradicate a broad spectrum of biofilm micoorganisms, including antibiotic resistant S. aureus, P. aerugenosa and fungal species, without causing injury to tissue or mucosa.

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Ondine Study Shows Reduction of Endotracheal Tube Biofilm Using Photodisinfection

Ventilator-associated pneumonia is one of the most common and deadliest forms of healthcare-associated infections.  In the U.S alone, more than one million patients in healthcare facilities require mechanical ventilation every year. Up to 1 in 4 of these patients are reported to develop ventilator-associated pneumonia and up to half of them will die.1

Antimicrobial photodynamic therapy (aPDT), commonly known as Photodisinfection, is a non-invasive technique that used to study the reduction of biofilm in the lumen of an endotracheal tube. When patients undergo mechanical ventilation, an endotracheal tube is inserted into their throat to assist with breathing. This tube has long been recognized as a major factor in a patient’s risk for developing biofilm infections. For patients that require mechanical ventilation, such as those in ICUs, the biofilm can dislodge from the endotracheal tube and enter the lungs directly, often resulting in difficult-to-treat pneumonia.

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Ondine To Launch Ventilator-Associated Pneumonia (VAP) Photodisinfection Clinical Study

We are thrilled to announce that the FDA has approved a human clinical study to investigate the use of photodisinfection to prevent ventilator-associated pneumonia (VAP). VAP occurs when a lung infection develops in a patient ventilated with an endotracheal tube and continues to be the #1 cause of healthcare-associated infections in intensive care units. In the U.S alone, more than 1.3 million patients are mechanically ventilated every year. Of these patients, 10%-20% will develop ventilator-associated pneumonia, and up to half of them will die.

“A successful VAP study would represent a key step towards the commercialization of this new application of photodisinfection which utilizes Ondine’s patented technology and products…(our technology) has been proven to be highly effective at eliminating biofilms in ex vivo models, it is therefore ideally suited for the elimination of endotracheal tube biofilms resulting in the prevention of VAP” says Carolyn Cross, Chairman & CEO of Ondine.

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Top healthcare-associated infections: UTI, VAP, SSI

Urinary tract infections, ventilator associated pneumonia and surgical site infections are three of the top HAIs

Healthcare-associated infections cost the US healthcare system a shocking $35-$45 billion each year1. There are many different types of HAIs that contribute to this disturbingly high number. Let’s focus on three of the top HAIs that are demanding immediate public attention:

  1. Urinary tract infections
  2. Ventilator associated pneumonia
  3. Surgical site infections Read more »
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