WS/T 863-2025 in English

Standard Development Background and Technological Evolution

WS/T 863-2025, "Standard for the Prevention and Control of Ventilator-Associated Pneumonia," is a professional standard developed by the National Health Commission to address the critical issue of nosocomial infections in critical care settings. Ventilator-associated pneumonia (VAP) is one of the most common hospital-acquired infections in critically ill patients, and its incidence is directly related to patient prognosis and the quality of medical care. This standard, building on previous infection control experience and integrating the latest evidence-based medicine, systematically updates relevant guidelines established since 2012.

The standard's development process referenced the latest consensus from the Infectious Diseases Society of America (IDSA), the American Thoracic Society (ATS), and the European Respiratory Society (ERS), and incorporated the specificities of Chinese medical practice to create a more operational technical specification. Key technological advancements include the explicit recommendation of a bundled prevention and control strategy, the standardized use of subglottic aspiration, and strengthened requirements for the management of multidrug-resistant bacteria. The standard precisely defines key terms, providing unified standards for clinical practice. Ventilator-associated pneumonia (VAP) is defined as pneumonia occurring 48 hours after the establishment of an artificial airway and mechanical ventilation. This timeframe is based on extensive clinical research evidence and effectively distinguishes community-acquired from hospital-acquired pneumonia. The definition of a subglottic secretion suction endotracheal tube, a key technical device, emphasizes the structural characteristics and drainage function of the opening above the cuff. Clinical studies have shown that proper use of a SSD catheter can reduce the incidence of VAP by more than 50%. The definition of a heat and moisture exchanger (artificial nose) highlights its dual functions of heat and moisture retention and bacterial filtration. Chapter 4 of the standard establishes a comprehensive VAP prevention and control system from the organizational and management perspective. Clinical departments are required to incorporate VAP prevention into medical quality management, and a collaborative supervision mechanism among multiple departments such as hospital infection management, medical affairs, and nursing is clarified. Special emphasis is placed on the importance of verification of compliance with evidence-based measures, and specific checklists are required to be developed and supervised for implementation.

In terms of training system construction, the standard requires the development of a systematic training plan and regular updating of training content. All medical personnel using ventilators must receive professional training, including ventilator operation skills and infection prevention and control knowledge. Hand hygiene and isolation technology are basic prevention and control measures, and the relevant provisions of WS/T 313 and WS/T 311 must be strictly implemented.

Technical Key Points for Preventive Measures

Chapter 5: Preventive Measures embodies the concept of controlling VAP at its source. Strictly understanding the indications for endotracheal intubation is the primary principle. Non-invasive ventilation is recommended as the first choice, and orotracheal intubation is preferred over nasotracheal intubation. Daily assessment of the need for weaning from the ventilator embodies the core strategy of "early weaning from the ventilator."

Posture management requires the head of the bed to be elevated 30° to 45°. This measure reduces the risk of reflux and aspiration of gastric contents through gravity. Oral hygiene is required every 6–8 hours, based on the close association between oral bacterial colonization and the development of VAP. Enteral nutrition management emphasizes aspiration risk assessment, and nasogastric tubes are recommended for high-risk patients.

Antimicrobial use guidelines clearly stipulate the avoidance of systemic or topical prophylaxis, embodying the principle of rational antimicrobial use. Sedative management requires daily assessment to avoid ventilator dependence due to excessive sedation. The recommended bundle strategy represents the latest concept in VAP prevention and control.

Key Techniques for Airway Management

Chapter 6 provides specific technical operating specifications for airway management. Airway cuff pressure monitoring should be maintained between 25 and 30 cmH2O. This pressure range effectively seals the airway while preventing ischemic damage to the tracheal mucosa. For patients who are expected to be indwelling for more than 72 hours, the use of a subglottic secretion suction endotracheal tube is recommended.

Ventilator circuit management emphasizes that it should not be routinely replaced frequently, and should be replaced promptly in case of contamination or failure. This requirement is based on the evidence-based basis that "unnecessary intervention may increase the risk of infection." Condensate management requires that the water collection cup be at the lowest position of the pipeline, and the pipeline must be kept closed during cleaning to prevent the spread of bacterial aerosols.

The humidification device selection provides two options: heated humidifier and heat and moisture exchanger. It is clearly not recommended to continuously pump in humidification fluid with a micropump. Humidification water requires sterile water, and the replacement cycle of the heat and moisture exchanger is 5 to 7 days. It should be replaced promptly when contaminated or when airway resistance increases.

Detailed Explanation of Disinfection and Sterilization Specifications

Chapter 7: Disinfection and Sterilization Requirements embody the concept of tiered management. Reusable ventilator external tubing and accessories should be centrally handled by the CSSD, following the principle of one-per-use, one-disinfection. Long-term users should replace them weekly. This requirement ensures standardized disinfection quality and traceability.

Ventilator mainframe cleaning requirements require at least two wipes and disinfection daily, with prompt disinfection in the event of contamination, and terminal disinfection after each patient. The increased frequency of multidrug-resistant bacterial infections or nosocomial infection outbreaks reflects the principle of risk-based management. Environmental surface cleaning emphasizes the management of frequently touched surfaces, aligning with the "cleanliness first" infection control principle. Bed curtain management requires prompt replacement of contaminated beds and regular cleaning and disinfection. This detailed requirement addresses a previous blind spot in environmental management. All disinfection and sterilization procedures must reference foundational standards such as WS/T 367 and WS 310.1 to ensure uniformity of technical specifications. Chapter 8, Monitoring Requirements, establishes a comprehensive quality monitoring system. Targeted VAP monitoring is a core component, requiring regular analysis of monitoring data and timely feedback. Monitoring of preventive measure compliance evaluates prevention and control effectiveness through process indicators, reflecting the principle of forward-looking quality management. Monitoring of ventilator cleaning and disinfection effectiveness requires compliance with WS 392 to ensure equipment safety. Analysis and feedback of monitoring data should form a closed-loop management system to provide a basis for continuous quality improvement. It is recommended that medical institutions establish a baseline for VAP incidence and set reasonable improvement targets.

Expected Benefits of Standard Implementation

The full implementation of WS/T 863-2025 is expected to significantly improve healthcare quality. Through standardized prevention and control measures, the incidence of VAP is expected to decrease by 30%-50%, leading to corresponding reductions in patient hospitalization time and medical expenses. More importantly, the implementation of the standard will promote the improvement of infection control systems in medical institutions and enhance overall medical safety. The standard will officially take effect on February 1, 2026. Medical institutions are advised to prepare in advance, including staff training, system revisions, and equipment configuration, to ensure a smooth transition. During the implementation of the standard, emphasis should be placed on data collection and experience summary to accumulate practical evidence for subsequent revisions.