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
...commendatio...
...to Prevent VAP in Adult Patients (Table 1)...
...ces: interventions with little risk of harm and t...
...intubation and prevent reintubation i...
...ize sedation. Minimize sedation of ve...
...in and improve physical conditioning....
...te the head of the bed to 30–45ºa. (Low)27374...
...oral care with toothbrushing but wi...
...vide early enteral rather than parenteral nu...
...e the ventilator circuit only if v...
...Approaches: may decrease duration...
...ing selective decontamination of the orop...
...oaches: may lower VAP rates, but current data...
...Consider utilizing endotracheal tube...
...early tracheostomy. (Moderate)2737437...
...ost-pyloric feeding tube placement in...
...that Should Not be Considered a Routi...
...ith chlorhexidine. (Moderate)2737437...
...obiotics. (Moderate)27374...
3. Ultrathin polyurethane endotracheal tube c...
...otracheal tube cuffs. (Moderate)2737437...
...trol of endotracheal tube cuff pressure...
...requent cuff pressure monitoring. (Moderate)...
...coated endotracheal tubes. (Moderate)2737437...
...Kinetic beds. (Moderate)2737...
...positioning.a (Moderate)2737437...
...0. Chlorhexidine bathing.a (Mode...
...tress ulcer prophylaxis. (Moderate)2737437...
...oring residual gastric volumes. (Moderate)27374...
...parenteral nutrition. (Moderate)2737437...
...solved Issues
...d/in-line endotracheal suctioning. ()2...
...May be indicated for reasons other than V...
...endations to Prevent VAP in Preterm Ne...
...ntial Practices: confer minimal risk of harm and m...
...vasive positive pressure ventilation in se...
...mize the duration of mechanical ventil...
...ssess readiness to extubate daily. (Low)27374...
...ients without sedation whenever possible. (Low)2...
.... Avoid unplanned extubation. (Low)273743...
...id reintubation by using nasal continuous...
...gular oral care with sterile water. (Low)273...
...reaks in the ventilator circuit. (Low)...
...he ventilator circuit only if visibly soiled or...
...ine therapy to facilitate extubatio...
...pproaches: minimal risks of harm, but impact on V...
...eral recumbent positioning. (Low)273...
...endelenberg positioning. (Low)2737...
.... Closed/in-line suctioning systems. (Low)2737437
...ral care with maternal colostrum. (M...
...aches that Should Not be Considered...
.... Regular oral care with antiseptics. (Low)...
...eceptor antagonists. (Moderate)2737437...
...ic broad-spectrum antibiotics. (Moderate)2737437...
.... Daily spontaneous breathing trials. (Low...
...sedative interruptions. (Low)2737437...
...Prophylactic probiotics or synbiotics. (Lo...
...solved Issues...
...Endotracheal tubes with subglottic secreti...
...-coated endotracheal tubes. (NA)2737437...
...ions to Prevent VAP in Pediatric Patients (T...
...ntial Practices: confer minimal risk of har...
...tubation. Use noninvasive positive press...
...ness to extubate daily using spontaneous...
...to minimize unplanned extubations and...
...void fluid overload. (Moderate)...
...de regular oral care (i.e., toothbrushing or gauz...
...ate the head of the bed unless medically contr...
...ventilator circuits only when visibly soiled or m...
...ondensate from the ventilator circuit fr...
...uffed endotracheal tubes. (Low)2737437...
...ff pressure and volume at the minimal occlus...
...on oral secretions before each position cha...
...roaches: minimal risks of harm and...
.... Minimize sedation. (Moderate)273...
...dotracheal tubes with subglottic sec...
...arly tracheotomy. (Low)2737437...
...that Should Not be Considered a R...
...ged systemic antimicrobial therapy for ventil...
...ctive oropharyngeal or digestive decontamina...
...c prophylaxis. (Low)2737437
...with antiseptics such as chlorhexidine. (Moderate...
...ss ulcer prophylaxis. (Low)2737437...
...coated endotracheal tubes. (Low)2737437...
...olved Issues...
...Closed/in-line suctioning. ()2737437...
...pported by Interventional Studies Suggesting Lowe...
...ovide regular oral care. Diagnose and manage dy...