Role of Respiratory Therapist in the Prevention of Ventilator-Associated Pneumonia in Patients Admitted in Intensive Care Units at Tertiary Care Hospitals Peshawar

Abstract

Background: Ventilator-associated pneumonia (VAP) is one of the most common nosocomial infections among mechanically ventilated patients and is associated with increased morbidity, mortality, prolonged ICU stay, and healthcare costs. Respiratory therapists (RTs) play an important role in preventing VAP through effective airway management, oral care, infection control practices, and ventilator management. Objective: To identify the role of respiratory therapists in the prevention of VAP and to determine the most effective patient position and oral care solution for mechanically ventilated patients. Methodology: A descriptive cross-sectional study was conducted from June to November 2022 in the ICUs of Lady Reading Hospital, Khyber Teaching Hospital, and Hayatabad Medical Complex. A total of 105 mechanically ventilated patients and respiratory therapists were included using non-probability convenience sampling. Data were collected through self-interviews and a modified questionnaire and analyzed using SPSS version 22. Results:
The study showed that 89.5% of RTs used proper PPE during suctioning, while 93.3% maintained cuff pressure between 20–30 cmH₂O. Semi-recumbent position was maintained in 61.9% of patients and was found to be the most effective position in reducing VAP incidence. Chlorhexidine was the most commonly used oral care solution (64.8%) and showed better preventive effects against VAP compared to normal saline and hydrogen peroxide. Most patients were intubated with cuffed endotracheal tubes, and appropriate infection prevention measures such as regular suctioning, use of separate washing fluid, and changing ventilator circuits after weaning were commonly practiced. Overall, VAP was detected in 28.6% of patients, while 71.4% did not develop VAP. Statistical analysis showed a significant association between body positioning, oral care practices, and prevention of VAP. Conclusion: The study concluded that semi-recumbent positioning and chlorhexidine oral care are effective strategies for reducing the occurrence of ventilator-associated pneumonia in mechanically ventilated patients. Proper infection control practices and ventilator care provided by respiratory therapists also play a significant role in the prevention of VAP.

Keywords: Ventilator-associated pneumonia (VAP), Respiratory therapists, Mechanical ventilation, Oral care, Chlorhexidine, Semi-recumbent position, Intensive care unit (ICU), Endotracheal tube, Infection control, Mechanical ventilator.