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

...mmendations...

...ns to Prevent VAP in Adult Patients (Tab...

...Practices: interventions with little risk...

...tubation and prevent reintubation if possi...

...Minimize sedation. Minimize sedation...

...aintain and improve physical condit...

...Elevate the head of the bed to 30–45ºa....

...oral care with toothbrushing but wit...

...ide early enteral rather than pare...

7. Change the ventilator circuit only if vi...

...al Approaches: may decrease duration...

...using selective decontamination o...

...Approaches: may lower VAP rates, but curr...

...ilizing endotracheal tubes with subglottic sec...

...nsider early tracheostomy. (Moderate)27374...

...st-pyloric feeding tube placement in patients w...

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

.... Oral care with chlorhexidine. (Moderate)2737...

.... Probiotics. (Moderate)2737...

...athin polyurethane endotracheal tube cuf...

...Tapered endotracheal tube cuffs. (Moderate)2737...

...mated control of endotracheal tube cuff pressu...

...f pressure monitoring. (Moderate)2737437...

...coated endotracheal tubes. (Modera...

...Kinetic beds. (Moderate)27374...

...positioning.a (Moderate)2737437...

.... Chlorhexidine bathing.a (Moderate)273743...

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

12. Monitoring residual gastric volum...

13. Early parenteral nutrition. (Modera...

...esolved Issues

...ine endotracheal suctioning. ()2737437...

...indicated for reasons other than VAP prevention....


...commendations to Prevent VAP in Prete...

...ractices: confer minimal risk of harm and...

...e non-invasive positive pressure ventilation in...

...inimize the duration of mechanical ventilation. (H...

...ssess readiness to extubate daily. (Low)2737437...

...nage patients without sedation whenever pos...

...d unplanned extubation. (Low)2737437...

...reintubation by using nasal continuous...

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

...inimize breaks in the ventilator circuit. (Low)...

...ntilator circuit only if visibly soiled or...

...affeine therapy to facilitate extubation. (High)27...

...pproaches: minimal risks of harm, but impact o...

...ateral recumbent positioning. (Low)2737437...

...Reverse Trendelenberg positioning. (Low)2737437...

...line suctioning systems. (Low)2737...

...care with maternal colostrum. (Moderate)27374...

...that Should Not be Considered a Rou...

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

...Histamine-2 receptor antagonists. (Moderate)27374...

...phylactic broad-spectrum antibiotic...

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

...ly sedative interruptions. (Low)2737437...

...actic probiotics or synbiotics. (Lo...

...esolved Issues...

...Endotracheal tubes with subglottic secretion...

...ed endotracheal tubes. (NA)2737437...


...ons to Prevent VAP in Pediatric Patients...

...ential Practices: confer minimal risk of...

...intubation. Use noninvasive pos...

...Assess readiness to extubate daily using s...

...steps to minimize unplanned extubations and reintu...

...oid fluid overload. (Moderate...

...Provide regular oral care (i.e., tooth...

...the head of the bed unless medically contraindi...

...ventilator circuits only when visibly soi...

...condensate from the ventilator circuit f...

...d endotracheal tubes. (Low)2737437...

...n cuff pressure and volume at the minimal occlusi...

...l secretions before each position change....

...l Approaches: minimal risks of harm and some...

...Minimize sedation. (Moderate)273...

...Use endotracheal tubes with subglottic secr...

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

...hat Should Not be Considered a Routine Part of VA...

...onged systemic antimicrobial therapy for ventilat...

...oropharyngeal or digestive decontamina...

...obiotic prophylaxis. (Low)2737437...

...care with antiseptics such as chl...

...er prophylaxis. (Low)2737437...

6. Silver-coated endotracheal tubes. (Low)2737...

...resolved Iss...

Closed/in-line suctioning. ()273743...


...s Supported by Interventional Studies Sugge...

...ovide regular oral care. Diagnose and...