Page 534 - Clinical Application of Mechanical Ventilation
P. 534
500 Chapter 15
TABLE 15-7 methods to Prevent VAP in mechanically Ventilated Patients
Method Rationale
1. Exercise good hand hygiene (wash hands Reduce nosocomial infection
with soap and water or use alcohol gel
before and after patient contact; avoid
wearing rings during work)
2. Elevate head of bed at 30- to 45-degree Reduce incidence of aspiration
angle at all times
3. Change ventilator circuit when visibly Reduce incidence of contamination with
soiled or malfunctioned water condensate or secretions during
circuit change
4. Use noninvasive ventilation with face mask Avoid direct access of pathogens to lower
respiratory tract
5. Schedule sedation vacation for 6 to 8 hours Allow weaning assessment and early
daily extubation
6. Initiate early weaning from mechanical Reduce exposure of lower airway to patho-
ventilation gens and ventilator-induced lung injuries
7. Follow sterile techniques in suctioning and Reduce exposure of lower respiratory tract
prevent contamination of endotracheal or to pathogens
tracheostomy tube
8. Perform good oral care or decontaminate Reduce exposure of lower respiratory tract
oropharynx to pathogens
9. Use oral feeding tube Use of nasal feeding tube may cause
sinusitis, a condition associated with VAP
10. Use endotracheal tube with an ultrathin Reduce incidence of aspiration
and tapered-shape cuff membrane
11. Use endotracheal tube coated with silver Provide protection against some pathogens
or antimicrobial agents
12. Use endotracheal tube with a separate Reduce incidence of aspiration (routine use is
dorsal lumen above the cuff for subglottic not supported by reference Koenig et al.,
secretion drainage 2006)
© Cengage Learning 2014
Among the methods to prevent VAP, proper and frequent hand washing is by
far the simplest and most cost-effective way to reduce the incidence of VAP. While
research studies strongly support the elevation of head of bed, there are disagree-
ments on the degree of elevation. Darves (2005) emphasized that the angle of
elevation is not a critical issue and elevation should be done on mechanically venti-
lated patients unless the practice is contraindicated (e.g., postneurosurgical, severe
hypotension).
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