Both the CDC and the Institute for Healthcare Improvement have established evidence-based care bundles to prevent VAP. The general elements of the bundle include hand hygiene compliance, elevation of the head of the bed to 30 o to 45 unless medically contraindicated, daily sedation vacations and assessment of readiness to extubate, continuous suctioning of subglottic secretions, daily oral care with chlorhexidine, peptic ulcer dis ease prophylaxis, deep venous thrombosis prophylaxis, and not routinely changing, on the basis of duration of use, the patient's ventilator circuit.