Table 4 Suggested measures for prevention of ventilator-associated pneumonia (VAP) [41], [42], [49]

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)