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
...mmendations...
...ations to Prevent VAP in Adult Patients (Table 1)...
...l Practices: interventions with little risk of...
...intubation and prevent reintubation if possib...
...nimize sedation. Minimize sedat...
...improve physical conditioning. Pro...
...Elevate the head of the bed to 30–45ºa. (Low)2...
...oral care with toothbrushing but without chlorh...
...ovide early enteral rather than parenteral n...
...Change the ventilator circuit only if visib...
...ional Approaches: may decrease duratio...
...ing selective decontamination of the oropharynx an...
...dditional Approaches: may lower VAP rates...
...sider utilizing endotracheal tubes with s...
...y tracheostomy. (Moderate)2737437...
.... Consider post-pyloric feeding tube placement in...
...t Should Not be Considered a Routine P...
...ith chlorhexidine. (Moderate)273743...
...ics. (Moderate)2737437...
...rathin polyurethane endotracheal tube...
...otracheal tube cuffs. (Moderate)2737437...
...control of endotracheal tube cuff pr...
...Frequent cuff pressure monitoring. (...
...ver coated endotracheal tubes. (Moderate)273743...
...etic beds. (Moderate)2737437
...Prone positioning.a (Moderate)273...
...hlorhexidine bathing.a (Moderate)2737...
11. Stress ulcer prophylaxis. (Moderate)2737...
...residual gastric volumes. (Moderate)2737437...
...Early parenteral nutrition. (Moderate)2737437...
...solved Issues...
...Closed/in-line endotracheal suctioni...
...May be indicated for reasons other than VAP p...
...mmendations to Prevent VAP in Preterm Neonate...
...ntial Practices: confer minimal risk of har...
...-invasive positive pressure ventilation in select...
...mize the duration of mechanical ventilation....
...Assess readiness to extubate daily. (Low)2737...
...anage patients without sedation whenever possible...
...oid unplanned extubation. (Low)27...
...ubation by using nasal continuous positive a...
.... Provide regular oral care with sterile...
...nimize breaks in the ventilator circuit. (Low)273...
...Change the ventilator circuit only if v...
...e caffeine therapy to facilitate extubati...
...oaches: minimal risks of harm, but i...
...Lateral recumbent positioning....
...ndelenberg positioning. (Low)2737437...
...osed/in-line suctioning systems. (Low)2737437...
...h maternal colostrum. (Moderate)2737437...
...Should Not be Considered a Routine P...
...ar oral care with antiseptics. (Low...
...eceptor antagonists. (Moderate)2737437...
.... Prophylactic broad-spectrum antibiotics. (Mode...
4. Daily spontaneous breathing tria...
...Daily sedative interruptions....
.... Prophylactic probiotics or synbiotics. (Low)27...
...nresolved Iss...
...cheal tubes with subglottic secretion drainage...
...r-coated endotracheal tubes. (NA)2737437...
...ions to Prevent VAP in Pediatric Patients (Tabl...
...tices: confer minimal risk of harm and some d...
...ation. Use noninvasive positive pressure v...
...Assess readiness to extubate daily usin...
...minimize unplanned extubations and re...
...oid fluid overload. (Moderate)27...
...ovide regular oral care (i.e., toothbr...
...head of the bed unless medically contraindicate...
...Change ventilator circuits only when visibly soi...
...ensate from the ventilator circuit...
...uffed endotracheal tubes. (Low)...
...Maintain cuff pressure and volume at the m...
...ion oral secretions before each position chan...
...dditional Approaches: minimal risks of harm a...
...inimize sedation. (Moderate)2737437...
...eal tubes with subglottic secretion dr...
...Consider early tracheotomy. (Low)2737...
...proaches that Should Not be Considered a...
.... Prolonged systemic antimicrobial th...
.... Selective oropharyngeal or digestive decont...
3. Probiotic prophylaxis. (Low)273...
...care with antiseptics such as chlo...
...ulcer prophylaxis. (Low)2737...
...endotracheal tubes. (Low)2737437...
...olved Issues
...sed/in-line suctioning. (...
...Supported by Interventional Studies Suggesting...
...ovide regular oral care. Diagnose and...