pBox 9-5
Evidence based practice guidelines for the
prevention of ventilator associated
pneumonia (VAP)
GASTRIC REFLUX PREVENTION
1. All mechanically ventilated patients, as
well as those at high risk for respiration
(e.g., decreased level of consciousness,
enteral tube in place), should have the
head of the bed elevated at an angle of
30 to 45 degress unless medically
contraindicated.
2. Routinely verify appropriate placement
of the feeding tube.
AIRWAY MANAGEMENT
1. If feasible, use an endotracheal tube
with a dorsal lumen above the
endotracheal cuff to allow drainage (by
continuous or intermittent suctioning)
of tracheal secretions that accumulate
in the patient’s subglottic area.
2. Unless contraindicated by the patient’s
condition, perform orotracheal rather
than nasotracheal intubation.
3. Endotracheal tube (ETT) cuff
management: before deflating the cuff
of an ETT in preparation for tube
removal, or before moving the tube,
ensure taht secretions are cleared from
above the tube cuff.
4. Use only sterile fluid to remove
sceretions from the suction catheher is
to be used for reentry into the patient’s
lower respiratory tract.
5. Perform tracheostomy under asptic
conditions.
ORAL CARE
1. Develop and implement a Periodically drain or discard any
comprehensive hygiene program.
2. Use an oral chlorhexidine glucconate
(0,12%) rinse during the perioperative
period on patients who undergo
cardiac surgery.
CROSS-CONTAMINATION
1. Hand washing : decontaminate hands
with soap and water or a waterless
antiseptic agent after contact with
mucous membranes, repiratory
secretions, or objects contaminated
with respiratory secretions, whether or
not gloves are worn.
2. Decontaminate hands with soap and
water or a waterless antiseptic agent
before and after contact with a patient
who has an endotracheal or
tracheostomy tube, and before and after
contact with any respiratory device that
is used on the patient, whether or not
gloves are worn.
3. Wear gloves for handling respiratory
secretions or objects contaminated with
respiratory secretions of any patient.
4. When soiling with respiratory
secretions is anticipated, wear a gown
and change it after soiling and before
providing care to another patient.
5. Room-air humidifiers: do not use large-
volume , room-air humidifiers that
create aerosols (nebulizers) unless they
can be strelized or subjected to high
level disinfection at least daily and
filled only with sterile water.
MOBILIZATION
1. Ambulate as soon as medically
indecated in the postoperative period.
EQUIPMENT CHANGES
1. Do not change routinely, on the basisi
of duration of use, the patinet’s
ventilator circuit. Change the circuit
when it is visibly soiled or
mechanically malfuntioning.
candensate that colects in the tubbing.
Do not allow condensate to drain that
toward the patients.
2. Between use on different patients,
sterilize or subject to high-level
disinfection all manual resuscitation
bags.