Strategies to Prevent Ventilator-Associated Pneumonia in Acute Care Hospitals: 2014 Update

Abstract

Previously published guidelines are available that provide comprehensive recommendations for detecting and preventing healthcare-associated infections (HAIs). The intent of this document is to highlight practical recommendations in a concise format to assist acute care hospitals in implementing and prioritizing strategies to prevent ventilator-associated pneumonia (VAP) and other ventilator-associated events (VAEs) and to improve outcomes for mechanically ventilated adults, children, and neonates. This document updates “Strategies to Prevent Ventilator-Associated Pneumonia in Acute Care Hospitals,” published in 2008. This expert guidance document is sponsored by the Society for Healthcare Epidemiology of America (SHEA) and is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America (IDSA), the American Hospital Association (AHA), the Association for Professionals in Infection Control and Epidemiology (APIC), and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise. The list of endorsing and supporting organizations is presented in the introduction to the 2014 updates.

A Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals: 2014 Updates

“…The major aim of the original documents published in 2008 and the 2014 Compendium updates [15][16][17][18][19][20][21] is to provide acute care hospitals with up-to-date, practical, relatively concise expert guidance to assist in prioritizing and implementing HAI prevention efforts. These articles are the products of a highly collaborative effort led by the Society for Healthcare Epidemiology of America (SHEA), the Infectious Diseases Society of America (IDSA), the American Hospital Association (AHA), the Association for Professionals in Infection Control and Epidemiology (APIC), and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise, including the CDC, the Institute for Healthcare Improvement (IHI), the Pediatric Infectious Diseases Society (PIDS), the Society for Critical Care Medicine (SCCM), the Society for Hospital Medicine (SHM), and the Surgical Infection Society (SIS).…”

Potential Cost-effectiveness of Early Identification of Hospital-acquired Infection in Critically Ill Patients

“…Table 1 summarizes the model parameters and their corresponding values applied in the base-case analysis and the values tested in sensitivity analysis. Probabilities corresponding to the development of various types of infections were derived using the midpoint (10%) of the rates of VAP among ventilated patients recently reported by Klompas and colleagues (17) along with North American data reported from the large Extended Prevalence of Infection in Intensive Care (EPIC II) study (18). Estimates of the probability of receiving delayed antibiotic treatment with standard care (28.7%) and the increased risk of mortality with delayed versus timely ORIGINAL RESEARCH therapy (odds ratio, 3.4) were based on a large U.S.-based cohort study by VazquezGuillamet and colleagues (19).…”

Ventilator-associated pneumonia prevention: one good turn does not always deserve another

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Ventilator-associated pneumonia (VAP) is a frequent complication of patients undergoing invasive mechanical ventilation and its occurrence is associated with considerable morbidity and mortality [1][2][3]. The key factor in the pathogenesis of VAP is the endotracheal tube (ETT) [4].

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“…Its presence compromises the natural anatomical barriers (larynx) and functional mechanisms (mucus clearance and cough), and it expedites the formation of biofilm as well as macro-and microaspiration of oropharyngeal secretions. As a result, several strategies have been successfully implemented, namely subglottic secretion drainage or cuff pressure control [3,4].One of the current recommendations for VAP prevention is elevation of the head of bed to 30-45° to prevent the reflux of colonized gastric contents that has a potential role in VAP pathogenesis. This strategy has been evaluated in three randomized controlled trials (RCT) enrolling 337 patients, one positive and two negatives [5][6][7], and in a meta-analysis pooling these three studies that found a significant impact on prevention [8].…”

“…This strategy has been evaluated in three randomized controlled trials (RCT) enrolling 337 patients, one positive and two negatives [5][6][7], and in a meta-analysis pooling these three studies that found a significant impact on prevention [8]. However, the quality of evidence is low, being considered a basic practice because of its simplicity, ubiquity, low cost, and potential benefit [3].Simultaneously, we can conceive that in a patient with an ETT, any position above horizontal increases the gravitational forces exerted by subglottic secretions above the cuff and, consequently, the risk of aspiration [9]. The results of several experimental studies challenged the recommendation of the semirecumbent position in VAP prevention.…”