This article reviews the top five evidence-based nursing practices for reducing VAP risk in critically ill adults. Minimize ventilator exposure. Provide excellent oral hygiene care. Coordinate care for subglottic suctioning. Maintain optimal positioning and encourage mobility. Ensure adequate staffing.
What is the VAP prevention bundle?
The VAP prevention bundle includes: head of bed elevation to 30 to 45 degrees, oral care with Chlorhexidine 0.12%, peptic ulcer prophylaxis, deep vein thrombosis (DVT) prophylaxis, and spontaneous awakening trials and breathing trials. This guide presents evidence-based practices to promote VAP reduction.
How can we prevent ventilator associated events?
Potential strategies include avoiding intubation, minimizing sedation, paired daily spontaneous awakening and breathing trials, early exercise and mobility, low tidal volume ventilation, conservative fluid management, and conservative blood transfusion thresholds.
What is VAP protocol?
Dressler points out that Emory’s VAP-prevention protocol also includes oral care procedures, aspiration precautions, hand hygiene, and spontaneous breathing trial, when appropriate.) 2. Sedation vacation and weaning assessment.
Why is prevention of VAP important?
VAP prevention: Infection control in the ICU The goal of infection control is to prevent cross transmission of pathogens, which has been shown to play an important role in the development of nosocomial infections including VAP.
How do you manage VAP?
The major goals of VAP management are early, appropriate antibiotics in adequate doses followed by de-escalation based on microbiological culture results and the clinical response of the patient.
What is the ventilator bundle?
“Ventilator bundle “is a package of evidence -based interventions that include: (1) Elevation of patient’s head of bed to 30- 45 degrees; (2) Daily sedation vacation and daily assessment of readiness to extubation; (3) Peptic ulcer prophylaxis; (4) Deep vein thrombosis (DVT) prophylaxis.
How do you prevent VAEs?
There are three major approaches to prevent VAEs: (1) avoid intubation, (2) minimize duration of mechanical ventilation, and (3) target the specific conditions that most frequently trigger VAEs. In practice, these approaches are often highly congruent.
What are the most common conditions that trigger ventilator-associated events?
Four common conditions that are often associated with ventilator-associated events are pneumonia, atelectasis, fluid overload and acute respiratory distress syndrome.
How do you diagnose VAP?
VAP is most accurately diagnosed by quantitative culture and microscopic examination of lower respiratory tract secretions, which are best obtained by bronchoscopically directed techniques such as the protected specimen brush and bronchoalveolar lavage.
What bacteria causes VAP?
Common causative pathogens of VAP include Gramnegative bacteria such as Pseudomonas aeruginosa, Escherichia coli, Klebsiella pneumoniae, and Acinetobacter species, and Gram-positive bacteria such as Staphylococcus aureus9-14.
How is VAP spread?
It is thought by many, that VAP primarily occurs because the endotracheal or tracheostomy tube allows free passage of bacteria into the lower segments of the lung in a person who often has underlying lung or immune problems. Bacteria travel in small droplets both through the endotracheal tube and around the cuff.
How common is VAP?
Eighty-six percent of nosocomial pneumonias are associated with mechanical ventilation and are termed ventilator-associated pneumonia (VAP). Between 250,000 and 300,000 cases per year occur in the United States alone, which is an incidence rate of 5 to 10 cases per 1,000 hospital admissions (134, 170).
What are the two types of medical ventilation?
Positive-pressure ventilation: pushes the air into the lungs. Negative-pressure ventilation: sucks the air into the lungs by making the chest expand and contract.
What are some interventions to prevent ventilator-associated pneumonia VAP )?
Top Recommendations for VAP Prevention Practice Good Hand Hygiene. Always clean your hands with soap and water or an alcohol-based rub before touching the patient or the ventilator. Maintain the Patient’s Oral Hygiene. Maintain the Patient in a Semirecumbent Position.
What is VAP infection?
Ventilator-associated pneumonia is a lung infection that develops in a person who is on a ventilator. A ventilator is a machine that is used to help a patient breathe by giving oxygen through a tube placed in a patient’s mouth or nose, or through a hole in the front of the neck.
Can VAP occur after extubation?
The presence of an endotracheal tube is the main cause for developing ventilator associated pneumonia (VAP), but pneumonia can still develop in hospitalized patients after endotracheal tube removal (Post-Extubation Pneumonia, PEP).
Why does intubation cause pneumonia?
Indirectly, intubation can result in an enhanced capacity of tracheobronchial cells to bind gram-negative bacteria, an effect that favors airway colonization and pneumonia.
What is included in the ventilator bundle?
Recent findings: The Ventilator Bundle contains four components, elevation of the head of the bed to 30-45 degrees, daily ‘sedation vacation’ and daily assessment of readiness to extubate, peptic ulcer disease prophylaxis, and deep venous thrombosis prophylaxis, aimed to improve outcome in mechanically ventilated.
What are the care bundles?
A ‘care bundle’ is a collection of interventions that may be applied to the management of a particular condition. It is distinct in several ways from just any checklist about patients’ care. A care bundle aims to tie them together into a cohesive unit that must be adhered to for every patient, every time.
What medications and treatments are included in a ventilator bundle?
Ventilator bundle treatments included the head of a bed up 30 degrees to 45 degrees, awaken and extubation appraisal, daily use of proton pump inhibitors for peptic ulcer prevention, prevention of deep vein thrombosis (DVT), chlorhexidine mouth nursing, and removal of sputum by suction from subglottic area.
Who is at risk for VAP?
Chronic diseases might be a risk factor for VAP, including coronary disease, diabetes, respiratory diseases, chronic renal failure, and Hashimoto’s thyroiditis (But et al., 2017; Chang et al., 2017; Jimenez-Trujillo et al., 2017).
What are ventilator-associated events?
The new term, ventilator-associated event (VAE), groups all the conditions that result in a significant and sustained deterioration in oxygenation, defined as a greater than 20% increase in the daily minimum fraction of inspired oxygen or an increase of at least 3 cm H2O in the daily minimum positive end-expiratory Jan 1, 2014.
Which humidification strategy reduces the incidence of VAP?
Conclusion: Our results showed that the rate of VAP could be significantly reduced by changing the strategy from active to passive humidification devices, especially concerning patients requiring long-term respirator therapy.