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
...ecommendations...
...dations to Prevent VAP in Adult Patients (T...
...ices: interventions with little risk of harm...
...ntubation and prevent reintubation i...
...Minimize sedation. Minimize sedation of ve...
...ntain and improve physical conditioning....
...te the head of the bed to 30–45ºa. (L...
...ide oral care with toothbrushing but without chlo...
...rovide early enteral rather than parenteral...
...the ventilator circuit only if visibly s...
...proaches: may decrease duration of mechanical ven...
...sider using selective decontamination of the orop...
...roaches: may lower VAP rates, but current data...
...tilizing endotracheal tubes with subglottic...
...sider early tracheostomy. (Moderate...
...Consider post-pyloric feeding tube pl...
...hat Should Not be Considered a Routine Part of VAP...
.... Oral care with chlorhexidine. (Mode...
...ics. (Moderate)2737437...
...yurethane endotracheal tube cuffs. (Moderate)2737...
...racheal tube cuffs. (Moderate)2737437...
...ted control of endotracheal tube cuff p...
...Frequent cuff pressure monitoring. (Mode...
...coated endotracheal tubes. (Moderate)2...
...tic beds. (Moderate)2737437...
...e positioning.a (Moderate)2737...
...Chlorhexidine bathing.a (Modera...
...ess ulcer prophylaxis. (Moderate)2737...
...esidual gastric volumes. (Moderate)2737437...
...nteral nutrition. (Moderate)2737437...
...olved Issues...
.../in-line endotracheal suctioning. ()2...
...May be indicated for reasons other than VAP p...
...mmendations to Prevent VAP in Prete...
...ntial Practices: confer minimal risk of harm an...
...se non-invasive positive pressure ventilation in s...
2. Minimize the duration of mechanical venti...
...s readiness to extubate daily. (Low)27...
...Manage patients without sedation whenever...
...nplanned extubation. (Low)2737437...
6. Avoid reintubation by using nasa...
...egular oral care with sterile water. (Low)273...
...imize breaks in the ventilator circuit. (Lo...
9. Change the ventilator circuit only if visibly s...
...ine therapy to facilitate extubation. (High)273...
...l Approaches: minimal risks of harm, but impact...
...recumbent positioning. (Low)2737437...
.... Reverse Trendelenberg positionin...
...d/in-line suctioning systems. (Low)2737437...
.... Oral care with maternal colostrum. (Moderate)273...
...Should Not be Considered a Routine P...
.... Regular oral care with antiseptics. (Low)2737437...
...stamine-2 receptor antagonists. (Moderate)2737...
...Prophylactic broad-spectrum antibiotics. (Moderat...
...neous breathing trials. (Low)27374...
...ly sedative interruptions. (Low)2737437...
...actic probiotics or synbiotics. (L...
...resolved Issues
...eal tubes with subglottic secretion drain...
...ted endotracheal tubes. (NA)2737437...
...commendations to Prevent VAP in Ped...
...ractices: confer minimal risk of harm and so...
...tubation. Use noninvasive positive press...
...ssess readiness to extubate daily using spontaneou...
...to minimize unplanned extubations and r...
...fluid overload. (Moderate)2737437...
...ar oral care (i.e., toothbrushing or...
...e the head of the bed unless medica...
Change ventilator circuits only when visi...
...ve condensate from the ventilator circuit fr...
...ed endotracheal tubes. (Low)2737437...
...uff pressure and volume at the minimal occlusi...
...Suction oral secretions before eac...
...Approaches: minimal risks of harm and some evi...
...imize sedation. (Moderate)2737437...
...otracheal tubes with subglottic secretion draina...
...rly tracheotomy. (Low)2737437...
...that Should Not be Considered a Routi...
...ed systemic antimicrobial therapy for ventilator...
...oropharyngeal or digestive decontam...
...obiotic prophylaxis. (Low)2737437...
...Oral care with antiseptics such as chlorhex...
5. Stress ulcer prophylaxis. (Low)27...
...lver-coated endotracheal tubes. (Low)...
...solved Issues...
...n-line suctioning. ()2737437...
...ractices Supported by Interventional Studies Sug...
...lar oral care. Diagnose and manage dysphagi...