Ventilator-associated pneumonia

HAND HYGIENE

Meticulous hand hygiene before and after patient contact and handling respiratory equipment or condensate
- wear gloves and apron when handling ventilator condensate and other respiratory/oral secretions

Use a new, sterile ETT for each intubation attempt
- use sedation +/- video laryngoscopy for planned procedure to reduce need for multiple attempts
Ensure ETT does not contact environmental surfaces before insertion
Use a sterilised laryngoscope
Have ≥2 NICU staff members present for ETT retaping/repositioning

Clear secretions from the oropharynx before:
- ETT manipulation
- patient repositioning
- extubation
- re-intubation

Only when indicated
Do not use sodium chloride instillation routinely
For open suction, use ‘suction function’ on ventilator (if available) to prevent spray of condensate

Adjust enteral feeding (see Nutrition and enteral feeding guideline). Abdominal distension and vomiting increase risk of reflux and aspiration

Use colostrum/breast milk, or sterile water if no breast milk available (see Nutrition and enteral feeding guideline)
Carry out oral care:
- ≤24 hr after intubation
- every 3–4 hr
- before re-intubation as time allows
- before orogastric tube insertion

Use a separate suction catheter for oral and tracheal suction
Drain ventilator condensate away from baby every 2–4 hr and before repositioning
Avoid disconnection of ventilator circuit – only disconnect if:
- emergency use of Neopuff™ or ETT re-intubation
- change of circuit
- unable to remove condensate by manipulation of tubing
Do not routinely disconnect ventilator circuit when turning baby
Change ventilator circuit when visibly soiled or mechanically malfunctioning in addition to manufacturer’s instructions
Clean Neopuff™ connector with alcohol wipe after each manual contact with the ETT adapter
Use heated ventilator circuits

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