Proposed strategies to prevent pulmonary nosocomial infections
| Strategy | Relative importance | Comments |
|---|---|---|
| Preventing colonisation | ||
| Hygiene | +++ | Anti-microbial soaps may be more effective than non-medicated (prospective multiple crossover trial) |
| Heat and moisture exchangers | ++ | Reduced incidence of nosocomial pneumonia (randomised trial, meta-analysis) but caution as increased endotracheal secretions (randomised trial) |
| Selective digestive decontamination | ++ (especially in trauma patients) | Reduced respiratory tract infections (meta-analysis) but risk of bacterial resistance remains a problem (prospective survey) |
| Subglottic drainage | ++ | Reduced incidence of nosocomial pneumonia (randomised trial, meta-analysis) |
| Semi-recumbent position | ++ | Reduces aspiration of gastric contents (randomised crossover trial) |
| Avoidance of H2blockers | + | May be of some benefit in reducing nosocomial pneumonia (meta-analysis) but increased risk of gastrointestinal bleeding |
| Kinetic beds | + | Reduces incidence of nosocomial pneumonia (randomised controlled trial) but not well tolerated by some patients |
| Influencing host response | ||
| Early enteral nutrition | +++ | Reduces risk of infection (meta-analysis); jejunal feeding may be preferable (randomised trial); immune supplemented feeds may provide more protection (randomised trial) |
| Cytokine administration | ? | Remains experimental |