What is VAP protocol?

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.

What is a VAP care bundle?

7, 8 The VAP bundle, which is derived from the IHI bundle, is composed of the following five major interventions: (1) head-of-bed elevation between 30° and 45°; (2) a daily “sedation vacation” and a readiness-to-wean assessment; (3) peptic ulcer disease prophylaxis; (4) deep vein thrombosis prophylaxis; and (5) daily …

What is the difference between VAP and VAE?

This explains why the relative mortality rate for VAE is higher than traditionally defined VAP. By definition, a VAP that does not meet VAE criteria is one in which there is no significant increase in ventilator support following a period of stability or improvement.

Why is VAP bundle important?

Ventilator-associated pneumonia (VAP) in a critically ill patient significantly increases risk of mortality and, at a minimum, increases ventilator time, length of stay, and cost of care. It is a complex condition not only to diagnose but also to treat, thus prevention is extremely important.

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 do you identify VAP?

Reasonable clinical criteria for the suspicion of VAP include a new and persistent (>48-h) or progressive radiographic infiltrate plus two of the following: temperature of >38°C or <36°C, blood leukocyte count of >10,000 cells/ml or <5,000 cells/ml, purulent tracheal secretions, and gas exchange degradation (5, 103).

How do you avoid VAP?

To reduce risk for VAP, the following nurse-led evidence-based practices are recommended: reduce exposure to mechanical ventilation, provide excellent oral care and subglottic suctioning, promote early mobility, and advocate for adequate nurse staffing and a healthy work environment.

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.

What is the minimum period of time the patient has to be on a ventilator for VAP to be diagnosed?

NOTE: Patients must be mechanically ventilated for at least 4 calendar days to fulfill VAE criteria (where the day of intubation and initiation of mechanical ventilation is day 1). The earliest date of event for VAE (the date of onset of worsening oxygenation) is day 3 of mechanical ventilation.

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).

How effective is the VAP bundle?

Strong significant negative correlation between compliance of VAP bundle and VAP rate was found, p < 0.0001, VAP bundle compliance ranged from 94% to 100%.

How is VAP treated?

A new approach in VAP treatment is the use of nebulized antibiotics. Its main appeal is that allows achieving high local concentration of antibiotics, with fast clearance, which reduces risk for development of resistance, and with minimal absorption that translates into less toxicity.

What are the best recommendations for VAP prevention?

Top Recommendations for VAP Prevention Three of the core recommendations for VAP prevention are autonomous nursing interventions, which you can practice every day in the ICU. 1. Practice Good Hand Hygiene

How to prevent VAP in a ventilator patient?

Top Recommendations for VAP Prevention 1 Practice Good Hand Hygiene Always clean your hands with soap and water or an alcohol-based rub before touching the patient or the ventilator. 2 Maintain the Patient’s Oral Hygiene This can help to prevent bacterial colonization of the endotracheal tube. 3 Maintain the Patient in a Semirecumbent Position

Which is more fatal Central line infection or VAP?

It is the most fatal of the hospital acquired infections, with higher mortality rates than either central line infections or sepsis. Ventilated patients who develop VAP have mortality rates of 45 percent, compared to 28 percent for ventilated patients who do not develop VAP.

Can a proton pump inhibitor increase the risk of VAP?

VAP Prevention Strategies. Some studies suggest that proton pump inhibitors (Prevacid, Prilosec), which are commonly prescribed to prevent stress ulcers and gastritis in ICU patients, may increase the risk of VAP, by changing the acidity of the aerodigestive tract and making it more susceptible to bacterial colonization.