A group of evidence-based practices called a ‘ventilator bundle’ are followed for all patients placed on mechanical ventilation. The components of the bundle are listed below and when implemented together, result in a dramatic reduction in the incidence of VAP:
Keeping the head of the bed elevated between 30 and 45 degrees for the majority of the day
Providing daily “sedation vacation” and daily assessment of readiness to extubate, a process in which patient sedation is interrupted until the patient follows commands and are then assessed for discontinuation of mechanical ventilation
Providing peptic ulcer disease (PUD) prophylaxis which helps prevent reflux of gastric contents and secretions because critically ill intubated patients are more susceptible to aspiration
Providing venous thrombosis (DVT) prophylaxis (unless contraindicated) to prevent the formation of blood clots in the major veins of the legs, pelvis or lungs
A special tube known as an EVAC endotracheal tube is used on all patients who are on a ventilator greater than 48 hours. This tube has been shown to reduce VAP in long term ventilated patients.
Oral care is provided every four hours to reduce the bacteria in the mouth.
A team of doctors, nurses and Infection Preventionists reviews every patient on a ventilator, every day to ensure the bundle components are in place and identify any opportunity for improvement in care.