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
...ons to Prevent VAP in Adult Patients (Table 1)...
...al Practices: interventions with little...
...Avoid intubation and prevent reintubation...
...sedation. Minimize sedation of v...
3. Maintain and improve physical conditionin...
4. Elevate the head of the bed to 30–45ºa....
...ide oral care with toothbrushing but without chl...
...e early enteral rather than parenteral nu...
...the ventilator circuit only if visibl...
...Approaches: may decrease duration of...
...nsider using selective decontamination of the or...
...ional Approaches: may lower VAP rates,...
...ider utilizing endotracheal tubes with subglo...
...arly tracheostomy. (Moderate)2737437...
...nsider post-pyloric feeding tube placeme...
...ches that Should Not be Considered a...
...are with chlorhexidine. (Moderate)273743...
...robiotics. (Moderate)2737437...
...olyurethane endotracheal tube cuffs. (Moderate)...
...racheal tube cuffs. (Moderate)2737437...
...control of endotracheal tube cuff pressure...
...Frequent cuff pressure monitoring. (...
...d endotracheal tubes. (Moderate)273743...
...tic beds. (Moderate)273...
...tioning.a (Moderate)2737437...
...exidine bathing.a (Moderate)2737437...
...r prophylaxis. (Moderate)2737437...
...ing residual gastric volumes. (Mod...
13. Early parenteral nutrition. (Moderat...
...esolved Issues...
.../in-line endotracheal suctioning. ()27374...
...ed for reasons other than VAP preventi...
...dations to Prevent VAP in Preterm Neonate...
...ices: confer minimal risk of harm an...
...non-invasive positive pressure ventil...
...duration of mechanical ventilation. (Hig...
...ess to extubate daily. (Low)2737437...
...ients without sedation whenever poss...
...nned extubation. (Low)2737437...
...oid reintubation by using nasal continuous...
...ar oral care with sterile water. (Low)27374...
...inimize breaks in the ventilator circuit. (L...
...ge the ventilator circuit only if visibly soiled...
.... Use caffeine therapy to facilitate extubati...
...nal Approaches: minimal risks of harm, but impact...
...ateral recumbent positioning. (Low)2...
...Reverse Trendelenberg positioning. (Low)27374...
...Closed/in-line suctioning systems...
...care with maternal colostrum. (Moderate)2737437...
...Should Not be Considered a Routine Part of VAP...
...oral care with antiseptics. (Low)2737437...
...receptor antagonists. (Moderate)2...
...actic broad-spectrum antibiotics....
.... Daily spontaneous breathing trials. (Low)273...
...dative interruptions. (Low)2737437
...rophylactic probiotics or synbiotics. (Low)2...
Unresolved Issue...
...racheal tubes with subglottic secretion drai...
...er-coated endotracheal tubes. (NA)27...
...mendations to Prevent VAP in Pediatric Pati...
...ctices: confer minimal risk of harm and some da...
...bation. Use noninvasive positive pressure...
...readiness to extubate daily using spontaneous...
...teps to minimize unplanned extubations and re...
...id overload. (Moderate)2737437...
...regular oral care (i.e., toothbrushing or...
...he head of the bed unless medically cont...
...nge ventilator circuits only when visibl...
...e condensate from the ventilator circuit...
...Use cuffed endotracheal tubes. (Low)2737437
...ntain cuff pressure and volume at the minim...
...tion oral secretions before each position change...
...itional Approaches: minimal risks of harm and som...
...sedation. (Moderate)2737437...
...tracheal tubes with subglottic secretion draina...
...rly tracheotomy. (Low)2737437...
...t Should Not be Considered a Routine Pa...
...stemic antimicrobial therapy for ventilator-ass...
...oropharyngeal or digestive decontamination. (...
3. Probiotic prophylaxis. (Low)27...
...are with antiseptics such as chlorhexidine....
...er prophylaxis. (Low)2737437...
6. Silver-coated endotracheal tubes. (L...
...solved Issues...
...-line suctioning. ()2737437...
...Supported by Interventional Studies Suggesting Lo...
...regular oral care. Diagnose and mana...