Strategies To Prevent Resistance in the ICU*
P: Prophylactic administration of antibiotics should be discouraged unless clinically indicated in high-risk patients. R: Routine appropriate (ie, active against the identified pathogen) and adequate (eg, optimal dosing, duration of therapy) antimicrobial treatment of infections should be administered. E: Encourage avoidance of unnecessary use of antimicrobial agents (eg, empiric antibiotics in the absence of clinical and microbiologic data supporting the presence of infection). V: VAP and other specific infection prevention and treatment protocols should be established for the local ICU. E: Employ antiseptic techniques for all invasive procedures. N: Noncompliance with local infection prevention and antibiotic treatment protocols should not be tolerated. T: Try always to de-escalate to more narrow-spectrum antibiotic regimens on the basis of culture results and antimicrobial susceptibility data. R: Restricted formulary control for specific antimicrobial agents or drug classes if there are outbreaks of antibiotic-resistant bacteria. E: Evade antimicrobial homogeneity. Promote appropriate use of multiple drug classes (eg, avoid highly restricted antibiotic formularies; consider use of antimicrobial mixing). S: Strict isolation precautions for patients at high risk for (eg, patients transferred from long-term care facilities) or found to have infection/colonization with clinically important antibiotic-resistant bacteria. I: Infectious disease consultation for difficult-to-manage antibiotic-resistant infections and infection control problems. S: Systematic disinfection of commonly used instruments, devices, patient-care materials, and rooms between uses. T: Teach infection control procedures and optimal antibiotic utilization practices to all staff participating in the care of ICU patients. A: Active culture surveillance programs to identify patients infected/colonized with clinically important antibiotic-resistant bacteria. N: Narrow-spectrum antibiotics should be used when appropriate on the basis of microbiology data. C: Cease appropriate antibiotics for bacterial infections 24 to 48 h after achieving an appropriate clinical response. E: Embrace locally developed antibiotic guidelines and protocols aimed at balancing antimicrobial efficacy and preventing the emergence of resistance.
Respiratory Hygeine in the ED Recs (Ann Emerg Med 2006;48:570)
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