1. Ming Li

2.  Strong linkage to patient mortality!  Nosocomial infections in 10% of ICU patients  2008 – Medicare reimbursement measures

3.  PNA after 48 hrs of intubation  Leading cause of M&M in ventilated pts  Incidence 10-25%  Mortality rate 5-27%  VAP = $40,000 additional cost

4.  Gastric pH  Positioning  Subglottic aspiration

5.  H2 Blockers  Proton Pump Inhibitors  Sucralfate (misoprostol) – may be preferable

7. Conclusion  Promising but more research needs to be done

8.  5 million CVCs inserted per year  >15% of patients have complications ◦ 5-26% have infectious complications  Mortality rate 12-25% for CRBSIs

9.  Sterile Technique  Duration  Ultrasound guidance  Antibiotic-impregnated catheters

14.  VAP ◦ Gastric pH ◦ Positioning ◦ Subglottic aspiration?  Central venous catheter infections ◦ Sterile technique ◦ Duration ◦ Ultrasound guidance ◦ Antibiotic-impregnated catheters