With the exception of VAP, there is very little data and evidence regarding HAP. The grade of the evidence in many cases is low due to methodology, questions about generalizability from other settings or patient populations and other issues. In some instances, evidence may be upgraded based on low cost and feasibility of the intervention. The following suggestions are therefore evidence-informed practices.
Routine Precautions – All patients
Routine Practices and Additional Precautions for Preventing the Transmission of Infection in Healthcare Settings (Public Health Agency of Canada, 2012).
(Tablan et al., 2003; Davis, 2012);
- Staff education and involvement in infection prevention.
- Infection and microbiologic surveillance with data on local drug resistant pathogens.
- Appropriate cleaning, sterilization or disinfection and maintenance of equipment, devices and environment.
- Vaccinate staff and high risk patients (i.e. Flu shots).
- Deep breathing exercises and ambulation.
- Isolate infected patients as indicated.
- Rapid screening with isolation as indicated.
- Limit symptomatic staff and visitors.
- Maintain intact, moist, and healthy oral lining and mucosa.
- †Monitoring and early removal of invasive devices.
†Anti-microbial stewardship program.
- ‡Swallow screens.
‡Serum glucose in target range.
- See prevention strategies for Aspiration Pneumonia.
(Safer Healthcare Now! 2012)
- Elevation of the head of the bed to 45° when possible, otherwise attempt to maintain the head of the bed greater than 30° should be considered.
- Daily evaluation of readiness for extubation.
- The utilization of endotracheal tubes with subglottic secretion drainage.
- Oral care and decontamination with Chlorhexidine.
- Initiation of safe enteral nutrition within 24-48h of ICU admission.
† Rotstein et al. 2008
‡ Quinn et al. 2014