TY - JOUR T1 - The Role of the Intensive Care Unit Environment in the Pathogenesis and Prevention of Ventilator-Associated Pneumonia JF - Respiratory Care SP - 813 LP - 838 VL - 50 IS - 6 AU - Christopher J Crnich AU - Nasia Safdar AU - Dennis G Maki Y1 - 2005/06/01 UR - http://rc.rcjournal.com/content/50/6/813.abstract N2 - Ventilator-associated pneumonia is preceded by lower-respiratory-tract colonization by pathogenic microorganisms that derive from endogenous or exogenous sources. Most ventilator-associated pneumonias are the result of exogenous nosocomial colonization, especially, pneumonias caused by resistant bacteria, such as methicillin-resistant Staphylococcus aureus and multi-resistant Acinetobacter baumannii and Pseudomonas aeruginosa, or by Legionella species or filamentous fungi, such as Aspergillus. Exogenous colonization originates from a very wide variety of animate and inanimate sources in the intensive care unit environment. As a result, a strategic approach that combines measures to prevent cross-colonization with those that focus on oral hygiene and prevention of microaspiration of colonized oropharyngeal secretions should bring the greatest reduction in the risk of ventilator-associated pneumonia. This review examines strategies to prevent transmission of environmental pathogens to the vulnerable mechanically-ventilated patient. ER -