Prevention of Ventilator-Associated Pneumonia, Ventilator-Associated Events, and Nonventilator Hospital-Acquired Pneumonia in Acute Care Hospitals

Publication Date: May 20, 2022

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

...ecommendation...

...mendations to Prevent VAP in Adult Patie...

...l Practices: interventions with little risk of h...

.... Avoid intubation and prevent reintubation if pos...

...mize sedation. Minimize sedation of ventilat...

...tain and improve physical conditioning. Provide e...

...head of the bed to 30–45ºa. (Low...

.... Provide oral care with toothbrush...

...rly enteral rather than parenteral nutrition. (Hi...

...ventilator circuit only if visibly soiled or mal...

...pproaches: may decrease duration of mechanical...

...g selective decontamination of the orophar...

...onal Approaches: may lower VAP rates, but curren...

...ider utilizing endotracheal tubes with subgl...

...sider early tracheostomy. (Moderate)2737...

...ider post-pyloric feeding tube placement in...

...Should Not be Considered a Routine Part o...

.... Oral care with chlorhexidine. (Modera...

...ics. (Moderate)2737437...

...n polyurethane endotracheal tube cuffs. (Mo...

...racheal tube cuffs. (Moderate)2737437...

...Automated control of endotracheal tube...

.... Frequent cuff pressure monitoring. (M...

...Silver coated endotracheal tubes. (Moderat...

...inetic beds. (Moderate)2737437...

...ne positioning.a (Moderate)27374...

...dine bathing.a (Moderate)2737437...

...Stress ulcer prophylaxis. (Moderate)2737437...

.... Monitoring residual gastric volumes....

...y parenteral nutrition. (Moderate)...

...esolved Issues...

...sed/in-line endotracheal suctioning....

...ndicated for reasons other than VAP prev...


...ions to Prevent VAP in Preterm Neonates (Table...

...l Practices: confer minimal risk of harm...

...non-invasive positive pressure ventilation...

...ize the duration of mechanical ventilation....

...ess readiness to extubate daily. (Low)273...

.... Manage patients without sedation whe...

...Avoid unplanned extubation. (Low)...

...id reintubation by using nasal continuous positiv...

7. Provide regular oral care with sterile water. (...

...ze breaks in the ventilator circui...

...he ventilator circuit only if visibly so...

...ine therapy to facilitate extubation. (High)27374...

...dditional Approaches: minimal risks of harm,...

...recumbent positioning. (Low)27374...

...Trendelenberg positioning. (Low)27374...

...losed/in-line suctioning systems. (Low)2737437...

...care with maternal colostrum. (Moderate)2737...

...Should Not be Considered a Routine...

...care with antiseptics. (Low)2737437...

...receptor antagonists. (Moderate)2737437...

.... Prophylactic broad-spectrum antibioti...

...neous breathing trials. (Low)2737437...

.... Daily sedative interruptions. (Low)2737...

...c probiotics or synbiotics. (Low)2737437...

...nresolved Issue...

...dotracheal tubes with subglottic s...

...er-coated endotracheal tubes. (NA)2737437...


...ommendations to Prevent VAP in Pediatric Patien...

...Practices: confer minimal risk of harm...

...void intubation. Use noninvasive positive p...

...Assess readiness to extubate dail...

...steps to minimize unplanned extubations and r...

...d overload. (Moderate)2737437...

...e regular oral care (i.e., toothbrushing or g...

.... Elevate the head of the bed unless medic...

...Change ventilator circuits only when visibly...

...Remove condensate from the ventilator cir...

...fed endotracheal tubes. (Low)273743...

...Maintain cuff pressure and volume at the mi...

...Suction oral secretions before each position ch...

...proaches: minimal risks of harm and som...

...imize sedation. (Moderate)2...

...e endotracheal tubes with subglottic secret...

...onsider early tracheotomy. (Low)27374...

...Should Not be Considered a Routine Part of VAP P...

...Prolonged systemic antimicrobial therapy for...

.... Selective oropharyngeal or diges...

...iotic prophylaxis. (Low)2737437...

...ral care with antiseptics such as chlorhexidine...

...ulcer prophylaxis. (Low)2737437...

...lver-coated endotracheal tubes. (Low)2737437...

...solved Issues...

...-line suctioning. ()2737437


Practices Supported by Interventional St...

...Provide regular oral care. Diagnose a...