VENTILATOR-ASSOCIATED

PNEUMONIA
I. COLLABORATIVE PRACTICES
1. Multidisciplinary Team Communication.
Collaboration among healthcare providers, along with the consistent implementation of evidence-based
practices and infection control measures, is essential in preventing VAP.
2. Ensure adequate staffing.
Adequate nurse staffing in the ICU provides nurses with the time, opportunity, and resources to implement
care practices that reduce risk and early identification of VAP.

II. BASIC MANDATORY MEASURES

1. Education and training of nurses about airway management (aspiration of
bronchial secretions).
Regular training, education, and feedback can help ensure that the preventive measures, interventions,
and strategies are effectively employed.
2. Strict hand hygiene with alcohol solutions before airway management.
Hand-washing before and after patient contact and the use of gloves is a proven measure for the
prevention of VAP and other nosocomial infections.
3. Oral hygiene with chlorhexidine.
Adequate oral care can reduce bacterial overgrowth and reduce the risk of infection.
4. Control and maintenance of cuff pressure.
A cuff pressure level below 20 cm H2O is associated with an increased risk of VAP in patients not
receiving systemic antibiotics.
5. Semi-recumbent positioning. Avoidance of 0° supine positioning.
It may help spontaneous ventilation and reduce aspiration of contaminated gastric content.
6. Peptic Ulcer Disease Prophylaxis.
Administering medications for peptic ulcer disease prophylaxis to reduce the risk of gastric aspiration.
7. Promoting procedures and protocols that safely avoid or reduce the duration
of mechanical ventilation.
Shortening the duration of mechanical ventilation, lowers the risk of VAP.
8. Avoidance of elective changes of ventilator circuits, humidifiers, and
endotracheal tubes.
Planned ventilator circuit changes may increase cost and the risk of VAP and should not be performed.
9. Daily Sedation Holds and Assessment of Readiness to Wean.
Reducing the use of sedation and performing daily assessments of a patient's readiness to wean from
mechanical ventilation can shorten the duration of mechanical ventilation, lowering the risk of VAP.
10. Minimize ventilator exposure.
The most important evidence-based practice for lowering VAP risk is minimizing a patient’s exposure to
mechanical ventilation.

III. HIGHLY RECOMMENDED MEASURES

1. Selective Decontamination of the Digestive Tract (SDD) or Selective
Oropharyngeal Decontamination (SOD).
This intervention aims at the reduction of endogenous infections by preventing or eradicating the aero-
digestive carrier state with potentially pathogenic flora.
2. Continuous aspiration of subglottic secretions (CASS).
Aspiration of secretions that accumulate around the endotracheal tube of mechanically ventilated patients
can lead to VAP. The use of endotracheal tubes or tracheostomy tubes with subglottic suction ports helps
in the removal of secretions above the cuff, reducing the risk of aspiration.
3. Short course (2–3 days) of systemic antibiotic therapy.
Fostering a culture of safety and infection prevention within the healthcare facility to encourage all staff to
take ownership of VAP prevention. Intravenous antibiotics have shown to be protective and are therefore
recommended for prevention and treatment of infection.

IV. REFERENCES
Boltey, E., Yakusheva, O., & Costa, D. K. (2017). 5 Nursing strategies to prevent ventilator-associated pneumonia. American Nurse Today, 12(6), 42–43.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5706660/
Coppadoro, A., Bellani, G., and Foti, G. (2019). Non-Pharmacological Interventions to Prevent Ventilator-Associated Pneumonia: A Literature Review. Respiratory Care December 2019, 64 (12) 1586-1595; DOI:
https://doi.org/10.4187/respcare.07127
F. Álvarez Lermaa, M. Sánchez Garcíab, L. Lorentec, F. Gordod, J.M. Añóne, J. Álvarezf, M. Palomarg, R. Garcíah, S. Ariasi, M. Vázquez-Calatayudj, and R. Jamk (2014). Guidelines for the prevention of
ventilator-associated pneumonia and their implementation. The Spanish “Zero-VAP” bundle. Medisina Intensiva, Volume 38, Issue 4, Pg. 226-236 (May 2014). DOI: 10.1016/j.medine.2013.12.001