Prevention of hospital-associated pneumonia and ventilator-associated pneumonia

Objective: To synthesize the available clinical data for the prevention of hospital-associated pneumonia (HAP) and ventilator-associated pneumonia (VAP) into a practical guideline for clinicians. Data Source: A Medline database and references from identified articles were used to perform a literature search relating to the prevention of HAPNAP. Conclusions: There is convincing evidence to suggest that specific interventions can be employed to prevent HAPNAP. The evidence-based interventions focus on the prevention of aerodigestive tract colonization (avoidance of unnecessary antibiotics and stress ulcer prophylaxis, use of sucralfate for care unit staffing, avoidance of tracheal intubation with the use of mask ventilation, application of weaning protocols and optimal use of sedation to shorten the duration of mechanical ventilation, semirecumbent positioning, minimization of gastric distension, subglottic suctioning, avoidance of ventilator circuit changes/ manipulation, routine drainage of ventilator circuit condensate). Clinicians caring for patients at risk for HAPNAP should promote the development and application of local programs encompassing these interventions based on local resource availability, occurrence rates of HAPNAP, and the prevalence of infection due to antibiotic-resistant bacteria (Pseudomonas aeruginosa, Acinetobacter species, and methicillin-resistant Staphylococcus aureus).