ICU focused measures | Institution focused measures |
---|---|
Alcohol-based hand washing policy | Surveillance program for pathogen profiling and creation of “antibiogram” |
Early discontinuation of invasive devices | Frequent educational programs to reduce unnecessary antibiotic prescription |
Reduce reintubation rates | Propagate use of non-invasive positive pressure ventilation (NIPPV) |
Use of oropharyngeal vs. nasopharyngeal feeding tubes | Endotracheal tubes (ETTs) with potential benefit: |
Polyurethane-cuffed ETT | |
Silver/antibiotic coated ETT | |
Aspiration of subglottic secretions (HI-LO ETT) | |
Semi-recumbent patient positioning (30-45°) | Maintain policy for oral decontamination |
Selective digestive decontamination (SDD) | |
Endotracheal tube cuff pressure ~ 20 cm H2O | Early weaning and extubation |
Early tracheostomy | Daily sedation holds |
Small bowel feeding instead of gastric feeding | Preference on using heat-moisture exchangers over heater humidifiers |
Prophylactic probiotics | Mechanical removal of the biofilm (e. g., the mucus shaver) |