Table 2.

Measures to prevent ventilator-associated pneumonia

Nonpharmacologic

Avoidance of endotracheal intubation (noninvasive ventilation)

Early weaning of mechanical ventilation

Appropriate staffing levels in the intensive care units

Subglottic suctioning

Avoidance of unnecessary changes in the ventilator circuit

Draining ventilator circuit and using heat and moisture exchangers

Semi-erect positioning

Prevention of gastric distension and checking gastric volumes and residual feeds

Biofilm prevention on endotracheal tube and oral tissue surfaces

Following rigorous hand washing and disinfection procedures

Pharmacologic

Use of chlorhexidine or other methods for oral care

Antibiotic cycling (changing appropriate antibiotic regimen for specific organisms)

Limiting use of antibiotic prophylaxis

Using shorter courses of empirical antibiotic therapy when possible

Following stringent protocols for blood transfusions

Table adapted from Kollef (39).