Quality of Care

Ventilator-Associated Pneumonia

Highland Hospital has established protocols for the prevention of ventilator-associated pneumonia based on the guidelines from the Infectious Diseases Society of America (IDSA) and/or the American Thoracic Society (ATS). Your physician may recommend different treatments to meet your individual needs.

Respiratory failure is the primary reason for mechanical ventilation (also called ventilator, respirator, or breathing machine). Patients who are on a ventilator are at risk for ventilator-associated pneumonia, and those with weakened immune systems have the greatest risk.

Ventilator-associated pneumonia (VAP) is an infection that develops 48 hours or more after being on a ventilator (breathing machine that performs the work of moving gases into and out of the lungs). Community-acquired pneumonia (CAP) is more common and generally less severe than ventilator-associated pneumonia (VAP). The bacteria that cause VAP may be resistant to antibiotics and therefore more difficult to effectively treat. VAP requires vigilant preventive efforts by intensive care staff members who care for patients on ventilators.

The following list contains guidelines for the prevention of VAP from the Infectious Diseases Society of America and the American Thoracic Society.

  • Intubation (insertion of a breathing tube into the windpipe to connect to a mechanical ventilator) is avoided when possible.
  • Non-invasive ventilation (pressurized face mask oxygenation) is used when possible.
  • Orotracheal (mouth to windpipe) breathing tubes and orogastric (mouth to stomach) feeding tubes are chosen over breathing and feeding tubes that are inserted into the nose for patients who are on a mechanical ventilator when possible.
  • Continuous aspiration of subglottic (below tongue) secretion (CASS) tubes are used when possible to remove secretions where harmful bacteria can grow.
  • Condensation from oxygen tubing is removed routinely to prevent growth of harmful bacteria and accidental pouring of condensed water and bacteria into the patient's airway.
  • Effort is made to maintain blood sugar levels between 80-110 mg/dl to reduce infection risk when appropriate.
  • The head of the bed is elevated 30 to 45 degrees when possible.
  • Protocols for getting patients off of the ventilator as soon as possible (early weaning) are used to reduce time on the ventilator when possible.
  • Routine oral care is provided to prevent the growth of harmful bacteria in the mouth, which could further infect the lungs.
  • Effort is made to maintain adequate staffing levels in order to promote an optimal environment for patient care.