| 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) |
