Nicolo Andrei A.

Añonuevo, PhD NA, RN

International Ambassador, Society for Healthcare Epidemiology of America
References:
References:
Toolkit for Preventing Health Care-Associated
Infections (JCI), 2010
WHO Guidelines on Hand Hygiene in Healthcare, 2009
Chicago Journals: Strategies to Prevent Ventilator-
Assisted Pneumonia in Acute Care Hospitals, 2008
Infection Control and Hospital Epidemiology, 2008
 Ventilator Associated Pneumonia (VAP)

Occurs for approximately 15%

of all HCAIs, making it the second
most common HCAI after UTI.

Toolkit for Preventing Health-Care Associated Infections, Joint Commission Resources, 2010
  Intubation for more than 48 hours (the main risk factor
is the presence of the device)
 Immunocompromised patients
 Aspiration of contaminated secretions
 Colonization of aerodigestive tract
 Contaminated respiratory equipment and supplies
 Enteral feeding
 Comorbid illness or impaired functional status
 Compromised respiratory system
 Older than 60 years of age
 Male gender

Toolkit for Preventing Health-Care Associated Infections, Joint Commission Resources, 2010
 A “bundle” is a group of interventions
related to a disease process that, when
executed together, result in better outcomes
than when implemented individually.

Toolkit for Preventing Health-Care Associated Infections, Joint Commission Resources, 2010
Follow hand hygiene protocol
0.12% chlorhexidine gluconate for oral care

 The spectrum of antimicrobial activity of chlorhexidine

includes gram negative and gram positive bacteria.

Among it’s most important attributes is

its persistence; it remains chemically
active on tissue for 6 hours.

Recommended frequency of performing

oral care is up to 4x a day.
 Testing daily for possible extubation
 This can be accomplished during the daily sedation
interruption and daily rounds where the patient’s
neurological status can be assessed.
 Avoid unplanned extubation and reintubation.
 Patients should be removed from mechanical
ventilation as soon as possible.
 Stress ulcer prophylaxis

Either H2 blocker/PPI/Sulcralfate

Reducing the level of acidity in the gastric tract

reduces the level of stress ulceration and protects the
respiratory tract from acidic contents.
 Deep vein thrombosis prophylaxis

 Although the relationship between

deep vein thrombosis prophylaxis
and the prevention of pneumonia
is unclear, when this intervention
is applied as part of the ventilator
bundle, the rate of VAP is
significantly decreased.
 Head Elevation of bed 30°- 45°

 Maintain patients in a semi recumbent position (30°-45°

elevation of the head of bed) unless there are
complications.

There is a 67% decline in the incidence of VAP when

a semi recumbent position is used during the first 24
hours.
Elevate head of bed 30°- 45°