ZAP VAP | Guidelines

What the Guidelines Recommend

Clinical guidelines offer facilities a valuable evidence-based resource in the prevention of ventilator-associated pneumonia (VAP). Below is a summary of selected guidelines, recommendations, bundles and practice alerts for the reduction of VAP.

Guidelines included:

The American Thoracic Society (ATS)
Infectious Diseases Society of America (IDSA)
Centers for Disease Control (CDC)
Canadian Critical Care Society (CCCS)
Agency for Healthcare Research and Quality (AHRQ)
Institute for Healthcare Improvement (IHI)
American Association of Critical Care Nurses (AACN)
Safer Healthcare Now (SHN)

For the complete recommendations and supporting documentation from each organization, please refer to the published guideline or document.

= Included in organization’s recommended practices.
U = Unresolved
N = Not recommended

ATS, IDSA and CDC guideline categories are defined below.

Intervention	ATS & IDSA	CDC	CCCS	AHRQ	IHI	AACN	SHN
Staff education and involvement	I	IA
Appropriate hand disinfection	I	IA
Surveillance of ICU infections	II	IB
Avoid intubation and reintubation when possible	I	II
Noninvasive ventilation when possible	I	II
Oral vs. nasal intubation and gastric tube placement	II	IB
Continuous aspiration of subglottic secretions	I	II	*
Maintain endotracheal cuff pressures >20 cm H₂0	II
Prevent circuit condensate from entering ET tube or nebulizers	II	IB
Adequate staffing levels in ICU	II
Semirecumbent positioning	I	II
Enteral vs. parenteral nutrition	I	U
Routine use of selective digestive decontamination	N	U
Routine use of oral chlorhexidine	N	U
Daily interruption or lightening of sedation	II
Stress bleeding prophylaxis with either H₂ antagonists or sucralfate	Either	U	**	***
Change ventilator circuits only when visibly soiled; no regular changes		IA
Use of heat and moisture exchangers (HMEs)	U	U
Recommendation for closed suction or single-use open suction
Kinetic beds			*
Oral hygiene program for high-risk patients		II
Tight glycemic control	I
Deep vein thrombosis (DVT) prophylaxis

ATS/IDSA Evidence Levels

Level I (high): Evidence comes from well-conducted,
randomized controlled trials.
Level II (moderate): Evidence comes from well-designed, controlled trials without randomization or large case series with systematic analysis of disease patterns
and/or microbial etiology.
Level III (low): Evidence comes from case studies and expert opinion.

CDC Guidelines

Category IA: Strongly recommended for implementation and strongly supported by well-designed experimental, clinical or epidemiologic studies.
Category IB: Strongly recommended for implementation and supported by some clinical or epidemiologic studies and by strong theoretical rationale.
Category IC: Required for implementation, as mandated by federal or state regulation or standard.
Category II: Suggested for implementation and supported by suggestive clinical or epidemiologic studies or by strong theoretical rationale.
No Recommendation; Unresolved Issue (U): Practices for which insufficient evidence or no consensus exists about efficacy.

* Consider
** Sucralfate not recommended
*** H₂ antagonists

Request the full text for the ATS, IDSA and CCCS guidelines

Guidelines Summary (PDF)