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What’s New in the
Patient Safety World
June 2022
Guideline Update: Preventing
Hospital-Acquired Pneumonia
The 2022 update of “Strategies to prevent ventilator-associated pneumonia, ventilator-associated events, and nonventilator hospital-acquired pneumonia in acute-care hospitals” has just been published (Klompas 2022). This is the first update since 2014 and is the collaborative work of the Society for Healthcare Epidemiology (SHEA), the Infectious Diseases Society of America (IDSA), the American Hospital Association, the Association for Professionals in Infection Control and Epidemiology, and The Joint Commission. Representatives from multiple other organizations and societies also contributed.
The major changes are summarized below:
- Added a recommendation for high flow nasal oxygen or noninvasive
positive pressure ventilation as options to avoid intubation, minimize
duration of intubation, and prevent reintubations
- Added a recommendation for spontaneous awakening trials or sedation
protocols as effective strategies to minimize sedation in adults
- Reclassified endotracheal tubes with subglottic secretion drainage
from an Essential Practice to an Additional Approach
- Added a recommendation for daily toothbrushing
- Added a recommendation to use caffeine therapy to facilitate extubation in preterm neonates
- Reclassified endotracheal tubes with subglottic secretion drainage
as an additional approach rather than an essential practice for adults and
older children
- Added a recommendation to consider early tracheostomy
- Added a recommendation to consider postpyloric rather than gastric feeding in patients at high risk for aspiration
Importantly, several practices are “Not Recommended”:
- Oral care with chlorhexidine
- Probiotics
- Ultrathin polyurethane endotracheal tube cuffs
- Tapered endotracheal tube cuffs
- Automated control of endotracheal cuff pressures
- Frequent endotracheal cuff pressure monitoring
There is also a new section on prevention of nonventilator hospital-acquired pneumonia (NV-HAP). This section emphasizes oral care, recognizing and managing dysphagia, early mobilization, and implementing multimodal approaches to prevent viral infections. It also notes there is insufficient evidence regarding any recommendations about bed positioning or stress-ulcer prophylaxis and it states that systemic antibiotic prophylaxis is not generally recommended.
The guideline update is comprehensive and provides the rationales for each of the recommendations and has almost 400 references.
Some of our prior columns on HAI’s (hospital-acquired infections):
December 28, 2010 “HAI’s: Looking In All The Wrong Places”
October 2013 “HAI’s: Costs, WHO Hand Hygiene, etc.”
February 2015 “17% Fewer HAC’s: Progress or Propaganda?”
April 2016 “HAI’s:
Gaming the System?”
September 2016 “More
on Preventing HAI’s”
November 2018 “Privacy
Curtains Shared Rooms and HAI’s”
December 2018 “HAI
Rates Drop”
January 2019 “Oral
Decontamination Strategy Fails”
February 2019 “Infection
Prevention for Anesthesiologists”
March 2019 “Does
Surgical Gowning Technique Matter?”
May 2019 “Focus
on Prophylactic Antibiotic Duration”
July 2019 “HAI’s and Nurse Staffing”
February 2020 “NICU: Decolonize the Parents”
June 16, 2020 “Tracking Technologies”
August 2020 “Surgical Site Infections and Laparoscopy”
December 2020 “Do You Have These Infection Control Vulnerabilities?”
May 2021 “CLABSI’s Up in the COVID-19 Era”
August 2021 “Updated Guidelines on C. diff”
October 2021 “HAI’s Increase During COVID-19 Pandemic”
References:
Klompas M, Branson R, Cawcutt K, et al.. Strategies to prevent ventilator-associated pneumonia, ventilator-associated events, and nonventilator hospital-acquired pneumonia in acute-care hospitals: 2022 Update. Infect Control Hosp Epidemiol 2022; 20: 1-27
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