Prevention of Ventilator-Associated Pneumonia, Ventilator-Associated Events, and Nonventilator Hospital-Acquired Pneumonia in Acute Care Hospitals
Key Points
Key Points
- Hospital-acquired pneumonia (HAP) is the most common nosocomial infection.
- Patients on mechanical ventilation are at risk for multiple serious complications.
- CDC’s ventilator-associated events (VAE) framework is designed to detect the breadth of these events when severe enough to lead to sustained increases in ventilator settings.
- Despite reports of dramatic decreases in ventilator-associated pneumonia (VAP) rates over the past two decades, 5–10% of ventilated patients continue to be treated for VAP and/or VAE.
- This pocket guide highlights practical recommendations to assist acute care hospitals in implementing and prioritizing efforts to prevent VAP, VAE, and non-ventilator hospital acquired pneumonia (NV-HAP) in adults, children, and neonates.
- It is based on a synthesis of evidence, theoretical rationale, current practices, practical considerations, author consensus, and consideration of potential harm, where applicable.
- No guideline or expert guidance document can anticipate all clinical situations. This pocket guide is not meant to be a substitute for individual clinical judgment by qualified professionals.
Recommendations
...ommendations
...to Prevent VAP in Adult Patients (...
...ctices: interventions with little risk of harm...
...ion and prevent reintubation if possib...
...ze sedation. Minimize sedation of ventilat...
...improve physical conditioning. Provide early e...
...e head of the bed to 30–45ºa. (Low)273...
...Provide oral care with toothbrushing but without...
...early enteral rather than parenteral nutr...
7. Change the ventilator circuit only if...
...pproaches: may decrease duration of m...
...g selective decontamination of the or...
...ditional Approaches: may lower VAP rates, bu...
...r utilizing endotracheal tubes with subglottic se...
...ider early tracheostomy. (Moderate)2737437...
...ider post-pyloric feeding tube placement i...
...es that Should Not be Considered a...
...ral care with chlorhexidine. (Moderate)2737437...
...Probiotics. (Moderate)2...
...trathin polyurethane endotracheal tube cuffs. (M...
...endotracheal tube cuffs. (Moderate)2737437...
...Automated control of endotracheal tube cuff p...
...uent cuff pressure monitoring. (Moderate)27...
...coated endotracheal tubes. (Moderate)...
...etic beds. (Moderate)2737437...
...one positioning.a (Moderate)273...
...hexidine bathing.a (Moderate)2737437
...1. Stress ulcer prophylaxis. (Modera...
...ing residual gastric volumes. (Moder...
...ly parenteral nutrition. (Moderate)27374...
...nresolved Issues
...losed/in-line endotracheal suctioning. ()2...
...cated for reasons other than VAP prev...
...endations to Prevent VAP in Preterm Neonates (...
...sential Practices: confer minimal ri...
1. Use non-invasive positive pressure venti...
...nimize the duration of mechanical ventil...
...ess to extubate daily. (Low)2737437...
...ients without sedation whenever possible. (Low)27...
...oid unplanned extubation. (Low)2737437...
...intubation by using nasal continuou...
...vide regular oral care with sterile water....
...Minimize breaks in the ventilator ci...
...hange the ventilator circuit only if visibly...
...Use caffeine therapy to facilitate extubation. (Hi...
...Approaches: minimal risks of harm, but...
...al recumbent positioning. (Low)27374...
...Trendelenberg positioning. (Low)273...
...osed/in-line suctioning systems. (Low)2737437...
...with maternal colostrum. (Moderate...
...that Should Not be Considered a Routine Par...
...gular oral care with antiseptics. (Low)273743...
...eceptor antagonists. (Moderate)2737...
...ic broad-spectrum antibiotics. (Moderate...
...spontaneous breathing trials. (Low)2737...
...ily sedative interruptions. (Low)2737437...
...probiotics or synbiotics. (Low)2737...
...solved Issues...
...tracheal tubes with subglottic secretio...
...coated endotracheal tubes. (NA)2737437...
...ommendations to Prevent VAP in Pediatric P...
...ntial Practices: confer minimal risk of...
...void intubation. Use noninvasive p...
...ess to extubate daily using spontaneo...
Take steps to minimize unplanne...
...id overload. (Moderate)2737437
...ovide regular oral care (i.e., toothbrushin...
...e head of the bed unless medically contra...
...Change ventilator circuits only when visibly so...
...densate from the ventilator circuit...
...Use cuffed endotracheal tubes. (Low...
...ntain cuff pressure and volume at th...
...uction oral secretions before each position chan...
...nal Approaches: minimal risks of harm and some evi...
...sedation. (Moderate)2737437...
...acheal tubes with subglottic secretion draina...
.... Consider early tracheotomy....
...aches that Should Not be Considered a...
...longed systemic antimicrobial therapy for ventila...
...pharyngeal or digestive decontamination. (L...
...Probiotic prophylaxis. (Low)27374...
...with antiseptics such as chlorhexidine. (Modera...
...Stress ulcer prophylaxis. (Low)2737437...
.... Silver-coated endotracheal tubes. (Low)27...
...olved Issues...
...sed/in-line suctioning. ()273...
...upported by Interventional Studies...
...ovide regular oral care. Diagnose and m...