ÎEnsure that all ICU beds used for patients undergoing ventilation have a built-in tool to provide continuous monitoring of the angle of incline (B-III).
Approaches that should NOT be considered a routine part of VAP prevention
ÎDo NOT routinely administer intravenous immunoglobulin, white-cell- stimulating factors (filgrastim or sargramostim), enteral glutamine, or chest physiotherapy (A-III).
ÎDo NOT routinely use rotational therapy with kinetic or continuous lateral rotational therapy beds (B-II).
ÎDo NOT routinely administer prophylactic aerosolized or systemic antimicrobials (B-III).
Prevention of Catheter-Associated Urinary Tract Infection (CAUTI) Basic practices for prevention and monitoring of CAUTI*
ÎAppropriate infrastructure for preventing CAUTI
> Provide and implement written guidelines for catheter use, insertion, and maintenance (A-II).
> Ensure that only trained, dedicated personnel insert urinary catheters (B-III). > Ensure that supplies necessary for aseptic-technique catheter insertion are available (A-III).
> Implement a system for documenting the following information in the patient record: indications for catheter insertion, date and time of catheter insertion, individual who inserted catheter, and date and time of catheter removal (A-III).
ÎEducation and training
> Educate healthcare personnel involved in the insertion, care, and maintenance of urinary catheters about CAUTI prevention, including alternatives to indwelling catheters and procedures for catheter insertion, management, and removal (A-III).
ÎAppropriate technique for catheter insertion
> Insert urinary catheters only when necessary for patient care and leave them in place only as long as indications persist (A-II).
> Consider other methods for management, including condom catheters or in-and-out catheterization, when appropriate (A-I).
> Ensure that there are sufficient trained personnel and technology resources to support surveillance of catheter use and outcomes (A-III).
> Practice hand hygiene (based on Centers for Disease Control and Prevention or World Health Organization guidelines) immediately before insertion of the catheter and before and after any manipulation of the catheter site or apparatus (A-III).
> Insert catheters using aseptic technique and sterile equipment (A-III). > Use gloves, drapes, and sponges; a sterile or antiseptic solution for cleaning the urethral meatus; and a single-use packet of sterile lubricant jelly for insertion (A-III).
> Use as small a catheter as possible that is consistent with proper drainage, to minimize urethral trauma (B-III).
