VAP Bundles/Guidelines

[NICURN29]

We are in the process of forming a multidisciplinary committee to investigate VAP and revise our ventilator procedures and VAP bundle. I was wondering if anyone would be willing to share any information on what you do in your unit to prevent VAP. We are a 20+ bed level III NICU, and we utilize conventional mechanical ventilation, HFOV, and HFJV.

[NicuGal, MSN, RN]

We gathered a lot of our info from http://www.ihi.org

Somethings we do:

Inline suction only unless specifically ordered.

Separate suction for oral and ETT/trach suction

All ambu bags must be capped when at the bedside and not stowed in the bed

Mouth care with each hands on care

HOB up 30%

Suction mouth first then ETT

No saline down tubes unless the secretions are so thick you can't suction them up, remember, RDS is usually a non-secretion producing entity. Using saline damages the cilia and dislodges colonized bugs.

If you need to disconnect the vent tubing from the ETT for any reason, do not lay it on the bed, suspend it from the holder or place on a sterile item (we use an opened 2x2)

Change suction tubing with the inline

Change containers per hospital protocol, but we change our with our inline/tubing changes.

We have very few VAP's now since we instituted this 4 years ago. The kids that get them are usually the ones the do require saline for suctioning and what they grow are micro-organisms that like water.

[NICURN29]

Thanks for the quick reply! I have one more question...how often do you change your inline suction? Do you do it every 24 hours, or do you change as needed? I am hearing from some people who work in the "big people" world that they are no longer changing inlines every 24 hours, which has cut down on the number of times you have to break the circuit, obviously. How do y'all handle that?

[NicuGal, MSN, RN]

The link we change every 3 days, the suction cath itself is changed every day, it doesn't really break the circuit as the catheter is outside of the port. We used to change the cath every 3 days but we were finding people don't rinse them...we figured this out when we did a blind audit and our VAP number had risen a bit.