Prevention strategies of Ventilator-associated pneumonia and NV-HAP released by SHEA/IDSA/APIC

Recent guidance document provides practical advice to aid acute-care hospitals in prioritising and implementing methods to reduce ventilator-associated pneumonia (VAP), ventilator-associated events (VAEs), and nonventilator hospital-acquired pneumonia (NV-HAP) in adults, children, and neonates.

The Society for Healthcare Epidemiology (SHEA) sponsored this expert guideline paper, which is the result of a joint effort headed by SHEA, the Infectious Diseases Society of America, the Association for Professionals in Infection Control and Epidemiology, the American Hospital Association, and The Joint Commission, with significant contributions from members of a number of organisations and societies with topic expertise.

Recommendations are divided into two categories: "basic practises" that should be implemented by all acute-care hospitals, and "additional methods" that may be explored for use in specific areas and/or populations within hospitals if essential practises do not reduce HAIs.

Essential practices

To avoid intubation, shorten the period of intubation, and eliminate reintubations, a recommendation for high-flow nasal oxygen or noninvasive positive pressure breathing was included.

A suggestion for spontaneous waking trials or sedation protocols as effective ways for reducing sedation in adults was included.

Endotracheal tubes with subglottic secretion drainage were reclassified from an Essential Practice to an Additional Approach, and a daily toothbrushing guideline was added.

Caffeine treatment was included as a suggestion for facilitating extubation in preterm newborns.

Additional approaches

Endotracheal tubes with subglottic secretion drainage have been reclassified as an optional rather than mandatory procedure for adults and older children.

In patients at high risk for aspiration, a suggestion to seek early tracheostomy was included, as well as a recommendation to explore postpyloric rather than stomach feeding.

Not recommended

Probiotics

oral care with chlorhexidine

Endotracheal tube cuffs made of ultra-thin polyurethane

Cuffs for endotracheal tubes that are tapered

Endotracheal cuff pressures automatically controlled.

Endotracheal cuff pressure monitoring on a regular basis.

Recommendations to prevent NV-HAP

Interventions that may lower NV-HAP rates with little risk of harm

Maintain regular oral hygiene - Oral hygiene is the most well researched therapy for preventing NV-HAP.

NV-HAP may be avoided if dysphagia is diagnosed and treated early, particularly in neurologically compromised post-stroke patients.

Assist with early mobilisation

Implement multimodal interventions to prevent viral infections - Symptom screening of patients and healthcare workers, surveillance testing of all admitted patients, transmission-based precautions for patients with suspected and confirmed respiratory viral infections, universal masking when respiratory virus transmission rates are high in the hospital or community, assuring adequate ventilation are all possible strategies to prevent nosocomial viral transmission.

Approaches not generally recommended for routine NV-HAP prevention

Systemic antibiotic prophylaxis - Prophylactic antibiotics have had no effect on pneumonia incidence, functional prognosis, or death in acute stroke patients in randomised studies.

Reference -

Klompas, M., Branson, R., Cawcutt, K., Crist, M., Eichenwald, E., Greene, L., . . . Berenholtz, S. (2022). Strategies to prevent ventilator-associated pneumonia, ventilator-associated events, and nonventilator hospital-acquired pneumonia in acute-care hospitals: 2022 Update. Infection Control & Hospital Epidemiology, 1-27. doi:10.1017/ice.2022.88