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
...Rec...
...Recommendati...
...Essen...
...tion and prevent reintubation if possible...
...tion. Minimize sedation of ventil...
3. Maintain and improve physical conditi...
...the head of the bed to 30–45ºa. (L...
...Provide oral care with toothbrushing but wit...
6. Provide early enteral rather than par...
...ventilator circuit only if visibly soiled or...
...Additional Appr...
...der using selective decontamination of the or...
...Additional App...
...der utilizing endotracheal tubes with subglottic...
.... Consider early tracheostomy. (Moderate)2737437...
...der post-pyloric feeding tube placement in patie...
...Approaches th...
1. Oral care with chlorhexidine. (Moderate)273743...
...iotics. (Moderate)2737...
...polyurethane endotracheal tube cuffs. (...
...ered endotracheal tube cuffs. (Moderate)2737437...
...ntrol of endotracheal tube cuff pressures. (Moder...
...uent cuff pressure monitoring. (Mod...
...endotracheal tubes. (Moderate)2737437...
...inetic beds. (Moderate)27...
...tioning.a (Moderate)2737437...
...0. Chlorhexidine bathing.a (Moderate)27...
...Stress ulcer prophylaxis. (Moderate)273...
...ng residual gastric volumes. (Moderate)273743...
...ly parenteral nutrition. (Moderat...
...Unresolved Issues...
Closed/in-line endotracheal suct...
...ated for reasons other than VAP prevent...
...Recommendations to...
...Essential Pract...
...on-invasive positive pressure ventilatio...
.... Minimize the duration of mechanical ventil...
...readiness to extubate daily. (Low)2...
...ients without sedation whenever pos...
...Avoid unplanned extubation. (Low)2737437...
...Avoid reintubation by using nasal continu...
...ular oral care with sterile water. (Low)273...
.... Minimize breaks in the ventilator cir...
...e ventilator circuit only if visibly soiled or ma...
...feine therapy to facilitate extubation....
Addition...
...Lateral recumbent positioning. (Low)273743...
...elenberg positioning. (Low)2737437...
...d/in-line suctioning systems. (Low)2737437...
...l care with maternal colostrum. (Moderate)273743...
...Appr...
...gular oral care with antiseptics. (Low)2737...
...tamine-2 receptor antagonists. (Moderate...
3. Prophylactic broad-spectrum antib...
...pontaneous breathing trials. (Low)27...
...Daily sedative interruptions. (Low)...
...phylactic probiotics or synbiotics. (Low)2737437...
...Unresolved Issues...
...tubes with subglottic secretion drainage p...
...ated endotracheal tubes. (NA)2737437...
...Recommendat...
...Essential Practice...
...tion. Use noninvasive positive pressu...
...diness to extubate daily using spontaneou...
...minimize unplanned extubations and reintubation...
...overload. (Moderate)2737437...
...ular oral care (i.e., toothbrushing or gauze if n...
...ate the head of the bed unless medically contrain...
...tilator circuits only when visibly soiled or malfu...
...Remove condensate from the ventilator circuit...
...Use cuffed endotracheal tubes....
...cuff pressure and volume at the minimal...
...ction oral secretions before each posit...
...Additional Approaches: mi...
...inimize sedation. (Moderate)2737437...
...e endotracheal tubes with subglottic...
...rly tracheotomy. (Low)2737437...
...Approache...
...nged systemic antimicrobial therapy fo...
...ropharyngeal or digestive decontamination...
...iotic prophylaxis. (Low)2737437...
...l care with antiseptics such as chl...
...s ulcer prophylaxis. (Low)273...
...coated endotracheal tubes. (Low)2737437...
...Unresolved Issues...
...ed/in-line suctioning. ()2737437
...Practices Supported b...
...ide regular oral care. Diagnose and...