Strategies to Prevent Ventilator-Associated Pneumonia, Ventilator-Associated Events, and Nonventilator Hospital-Acquired Pneumonia in Acute-Care Hospitals
Recommendations
Recommendations to Prevent VAP in Adult Patients (Table 1)
Essential Practices: interventions with little risk of harm and that are associated with decreases in duration of mechanical ventilation, length of stay, mortality, antibiotic utilization, and/or costs
- Use high flow nasal oxygen or non-invasive positive pressure ventilation (NIPPV) whenever safe and feasible.
- Minimize sedation of ventilated patients whenever possible.
- Preferentially use multimodal strategies and medications other than benzodiazepines to manage agitation.
- Utilize a protocol to minimize sedation.
- Implement a ventilator liberation protocol.
Additional Approaches: may decrease duration of mechanical ventilation, length of stay, and/or mortality in some populations but not in others, and may confer some risk of harm in some populations.
Additional Approaches: may lower VAP rates, but current data are insufficient to determine their impact on duration of mechanical ventilation, length of stay, and mortality.
Approaches that Should Not be Considered a Routine Part of VAP Prevention
Unresolved Issues
- Closed/in-line endotracheal suctioning.
Recommendations to Prevent VAP in Preterm Neonates (Table 2)
Essential Practices: confer minimal risk of harm and may lower VAP and/or PedVAE rates
Additional Approaches: minimal risks of harm, but impact on VAP and VAE rates is unknown
Approaches that Should Not be Considered a Routine Part of VAP Prevention
Unresolved Issues
- Endotracheal tubes with subglottic secretion drainage ports.
- Silver-coated endotracheal tubes.
Recommendations to Prevent VAP in Pediatric Patients (Table 3)
Essential Practices: confer minimal risk of harm and some data suggest that they may lower VAP rates, PedVAE rates, and/or duration of mechanical ventilation.
- Use noninvasive positive pressure ventilation (NIPPV) or high-flow oxygen by nasal cannula whenever safe and feasible.
- Assess readiness to extubate daily using spontaneous breathing trials in patients without contraindications.
- Take steps to minimize unplanned extubations and reintubations.
- Avoid fluid overload.
- Change ventilator circuits only when visibly soiled or malfunctioning (or per manufacturer’s instructions).
- Remove condensate from the ventilator circuit frequently and avoid draining the condensate toward the patient.
- Use cuffed endotracheal tubes.
- Maintain cuff pressure and volume at the minimal occlusive settings to prevent clinically significant air leaks around the endotracheal tube, typically 20–25 cm H2O. This “minimal leak” approach is associated with lower rates of postextubation stridor.
- Suction oral secretions before each position change.
Additional Approaches: minimal risks of harm and some evidence of benefit in adult patients but data in pediatric populations are limited.
Approaches that Should Not be Considered a Routine Part of VAP Prevention
Unresolved Issues
- Closed/in-line suctioning.
Recommendation Grading
Disclaimer
Overview
Title
Strategies to Prevent Ventilator-Associated Pneumonia, Ventilator-Associated Events, and Nonventilator Hospital-Acquired Pneumonia in Acute-Care Hospitals
Authoring Organizations
Infectious Diseases Society of America
Society for Healthcare Epidemiology of America
Publication Month/Year
May 19, 2022
Last Updated Month/Year
October 9, 2024
Supplemental Implementation Tools
Document Type
Guideline
Country of Publication
US
Document Objectives
The purpose of this document is to highlight practical recommendations to assist acute care hospitals to prioritize and implement strategies to prevent ventilator-associated pneumonia (VAP), ventilator-associated events (VAE), and non-ventilator hospital-acquired pneumonia (NV-HAP) in adults, children, and neonates. This document updates the Strategies to Prevent Ventilator-Associated Pneumonia in Acute Care Hospitals published in 2014.
Target Patient Population
Adults, children, and neonates in hospitals
Target Provider Population
Acute-care hospitals
Inclusion Criteria
Male, Female, Adolescent, Adult, Child, Older adult
Health Care Settings
Emergency care, Hospital, Operating and recovery room
Intended Users
Epidemiology infection prevention, nurse, nurse practitioner, physician, physician assistant
Scope
Management, Prevention
Diseases/Conditions (MeSH)
D053717 - Pneumonia, Ventilator-Associated, D000077299 - Healthcare-Associated Pneumonia
Keywords
hospital-acquired pneumonia, ventilator-associated pneumonia, HAP, VAP
Source Citation
Klompas M, Branson R, Cawcutt K, Crist M, Eichenwald EC, Greene LR, Lee G, Maragakis LL, Powell K, Priebe GP, Speck K, Yokoe DS, Berenholtz SM. Strategies to prevent ventilator-associated pneumonia, ventilator-associated events, and nonventilator hospital-acquired pneumonia in acute-care hospitals: 2022 Update. Infect Control Hosp Epidemiol. 2022 May 20:1-27. doi: 10.1017/ice.2022.88. Epub ahead of print. PMID: 35589091.