Ventilator-associated pneumonia (VAP) is the leading cause of death among hospital-acquired infections. Hospital mortality of ventilated patients who developed VAP is 46% compared to 32% for ventilated patients who do not develop VAP.
VAP is associated with an increase of 7.6 days of ventilation, an increase of 8.7 days in intensive care, and an increase in total stay of 11.5 days. It also plays a role in 6–30% of additional deaths in these critically ill patients. A good number of these unfortunate outcomes are the result of system failures that could have been avoided.
Prevent VAP with VAP bundles, evidence-based practices that, when implemented together, should result in dramatic reductions in the incidence of VAP. Compliance with the VAP bundle has been most successful when all elements are executed together as an "all or none" strategy.
Five key components for the VAP bundle:
- Elevate the head of the bed to 45° when possible; otherwise, attempt to maintain the head of the bed at more than 30°
- Evaluate readiness for extubation daily
- Use endotracheal tubes with subglottic secretion drainage
- Conduct oral care and decontamination with chlorhexidine
- Initiate safe enteral nutrition within 24–48 hours of ICU admission
Pediatric VAP bundle:
- Elevate the head of the bed
- Properly position oral or nasal gastric tubes
- Perform oral care
- Eliminate the routine use of instil for suctioning
Additional evidence-based components of care:
- Hand hygiene
- Practices that promote patient mobility and autonomy
- Venous thromboembolism prophylaxis