VAP BUNDLE COMPONENTS

Respiratory  Equipment  Management

Breathing  Circuits  with  Humidifiers

Change the circuit when it is visibly soiled or mechanically malfunctioning. Do not routinely change on the basis of duration of use of the breathing circuit (i.e. ventilator tubing and exhalation valve and the attached humidifier) that is in use on an individual patient.

Breathing  Circuit/Tubing  Condensation

Periodically drain and discard any condensation that collects in the tubing of mechanical ventilators, taking precautions not to allow condensation to drain toward the patient. Wear gloves to perform the procedure and/or when handling the fluid. Decontaminate hands with soap and water (if hands are visibly soiled) or with an alcohol-based hand solution before and after performing the procedure or handling the fluid.

Humidifiers

Use sterile (not distilled, nonsterile) water to fill bubbling humidifiers. Between the uses of reusable hand-powered resuscitation bags on different patients, sterilize or subject to high-level disinfection. Do not routinely sterilize or disinfect the internal machinery of anesthesia equipment. Between uses on different patients, clean reusable components of the breathing system or patient circuit (e.g., tracheal tube or face mask) inspiratory and expiratory breathing tubing, y-piece, reservoir bag, humidifier, and tubing, and then sterilize or subject them to high-level liquid chemical disinfection or pasteurization in accordance with the device manufacturers’ instructions for their reprocessing.

Keep all ventilators covered when not in use to reduce dust accumulation on devices.

Prevention  of  Person-to-Person  Transmission  of Bacteria 

Cohorting

Implement patient and staff cohorting whenever possible by using geographically distinct areas of care. In the deployed setting, this includes separating Host National from non-Host National patient due to differences in the microbiomes. Disinfect all patient care equipment after each patient transfer. Terminally clean rooms between patients and consider periodic (monthly) ICU/ICU subunit closure for thorough cleaning and disinfection. In deployed settings, this should be conducted as regularly as field conditions permit. 

Standard Precautions

Decontaminate hands by washing either with antimicrobial soap and water (if hands are visibly dirty or contaminated with blood or body fluids), or by using an alcohol-based waterless antiseptic agent if hands are not visibly soiled. Use personal protective equipment based on clinical circumstance.  

Contact precautions with gloves and gown for all patient contact for patients infected or suspected with epidemiologically significant pathogens, specifically MDR Acinetobacter spp., ESBL-producing Klebsiella spp. and Escherichia coli, carbapenem-resistant Enterobacteriaceae, vancomycin-resistant Enterococcus spp., and methicillin-resistant Staphylococcus aureus. Decontaminate hands before and after patient contact and use gloves as below.

Gloves

Wear gloves for handling secretions or objects contaminated with secretions of any patient. Change gloves and decontaminate hands as described previously between contacts with different patients. When anticipating becoming soiled from secretions, wear a gown and change it after soiling occurs and before providing care to another patient.

Care of patients with Tracheostomy

Perform tracheostomy care under aseptic conditions. When changing a tracheostomy tube, wear a gown and mask, use aseptic technique. Providers should familiarize themselves with manufacturers recommendations regarding the quality and frequency recommended for tracheostomy care. Additionally, the life expectancy of inner cannula is variable depending on the product used (e.g., 24h to 29 days). Tracheostomy care orders should be written specific to the product used.

Suctioning of respiratory tract secretions

Appropriate to use either the multiuse closed system suction (Ballard) catheter or the single-use open system suction catheter. Patients persistently on the ventilator should have a Ballard system in line, while those intermittently on or off the ventilator with a tracheostomy in place can have the open suction employed as appropriate. If the open-system suction is employed, use a sterile, single-use catheter and sterile technique when suctioning. Use only sterile fluid to remove secretions from the suction catheter if the catheter is to be used for re-entry into the patient’s lower respiratory tract.

Prevention  of  Mucus  Plugging  (Endotracheal Tube)

Prevention  of  Aspiration Related  Infection (Gastrointestinal)

Prevention  of  Postoperative  Pneumonia