Challenge 2D HAI

Ventilator-Associated Pneumonia (VAP)

Executive Summary Checklist

In order to implement a program to reduce ventilator-associated pneumonia (VAP) the following implementation plan will require these actionable steps. The following checklist was adapted from the prevention strategies recommended by the California Department of Public Health (CDPH).1

  • Monitor ventilated patients for: positive cultures, temperature chart/log, pharmacy reports of antimicrobial use, and change in respiratory secretions:
    • When complications exist, raise them on top of the patient’s EHR problem list.
  • Measure adherence to VAP prevention practices and consider monitoring compliance:
    • Hand hygiene.
    • Daily sedation vacation/interruption and assessment of readiness to wean.
    • Regular antiseptic oral care.
    • Semi-recumbent position of all eligible patients.
  • Prevent exposure to contaminated equipment:
    • Use sterile water to rinse reusable respiratory equipment.
    • Remove condensation from ventilator circuits.
    • Change ventilator circuit only when malfunctioning or visibly soiled.
    • Store and disinfect respiratory equipment effectively.
  • Reduce colonization of aero-digestive tract:
    • Use non-invasive ventilation methods when possible (i.e. CPAP, BiPap).
    • Use oro-tracheal over naso-tracheal intubation.
    • Use cuffed Endotracheal Tube (ETT) with inline or subglottic suctioning.
    • Perform regular oral care with an antiseptic agent.
    • Reduce opportunities to introduce pathogens into the airway.
  • Reduce duration of ventilation:
    • Conduct “sedation vacations”.
    • Assess readiness to wean from ventilator daily.
    • Conduct spontaneous breathing trials.
  • Prevent aspiration of secretions:
    • Maintain elevation of head of bed (HOB) (30-45 degrees).
    • Avoid gastric over-distention.
    • Avoid unplanned extubation and re-intubation.
    • Use cuffed endotracheal tube with in-line or subglottic suctioning.
    • Encourage early mobilization of patients with physical/occupational therapy.
  • Implement evidence-based guidelines to prevent the occurrence of VAP:
    • Commitment from hospital leadership to support a program to eliminate VAP.
  • Develop an education plan for attendings, residents and nurses to cover key curriculum pertaining to the prevention of VAP.
  • Encourage continuous process improvement through the implementation of quality process measures and metrics and a monthly display through a dashboard.

Between the 2017 World Patient Safety, Science & Technology Summit and the 2017 Midyear Planning Meeting a workgroup comprised of experts representing administrators, clinicians, technologists and patient advocates will meet to update this APSS. If you are interested in joining this workgroup, please email us.

References
  1. California Department of Public Health (CAPH). VAP Prevention. https://www.cdph.ca.gov/programs/hai/Documents/Slide-Set-9-VAP-Prevention.pdf

Parent Challenge

  1. Challenge 2: Healthcare-associated Infections (HAIs)