ICU care bundles and infection prevention

Daily ICU checklist (FAST HUGS BID)

Reviewed Nov 2026·11 references
New· views rounded down, updated weekly

A structured daily review that catches the routine preventive items most often missed.

Definition
FAST HUGS (Vincent 2005) is a mnemonic for daily ICU review: Feeding, Analgesia, Sedation, Thromboprophylaxis, Head-of-bed elevation, Ulcer (stress ulcer) prophylaxis, Glycaemic control. 'BID' is a widely used extension: Bowel care, Indwelling catheter removal, De-escalation of antimicrobials.

At the bedside

  1. 1

    Feeding

    Is the patient fed? Enteral nutrition within 48 h unless contraindicated; review target and tolerance.

  2. 2

    Analgesia and sedation

    Analgesia first; target light sedation (RASS 0 to -1) unless a specific indication for deep sedation; daily sedation interruption paired with SBT.

  3. 3

    Thromboprophylaxis

    Pharmacological prophylaxis unless contraindicated; mechanical (IPC) if bleeding risk; reassess daily.

  4. 4

    Head of bed

    Elevate 30-45° in ventilated patients unless contraindicated (spinal injury, haemodynamic instability).

  5. 5

    Ulcer prophylaxis

    PPI/H2RA only in high-risk patients (ventilated, coagulopathy, shock, chronic liver disease); stop when the risk resolves.

  6. 6

    Glucose

    Insulin when glucose ≥ 180 mg/dL; target 144-180 mg/dL; avoid hypoglycaemia.

  7. 7

    Bowel care

    Bowels opened? Laxative protocol for patients on opioids; check for diarrhoea (C. difficile testing when indicated).

  8. 8

    Indwelling devices

    Is each central line, arterial line, urinary catheter and drain still needed? Remove if not.

  9. 9

    De-escalation

    Review cultures and antimicrobial need daily; narrow, stop or set a duration.

FAST HUGS BID checklist

LetterItemDaily question
FFeedingFed? Route, target, tolerance?
AAnalgesiaPain score acceptable (CPOT/BPS/NRS)?
SSedationAt RASS target? Can sedation stop?
TThromboprophylaxisPrescribed and given? Dose correct for renal function and weight?
HHead-of-bed30-45° if ventilated?
UUlcer prophylaxisStill indicated?
GGlucoseWithin 144-180 mg/dL? Any hypoglycaemia?
BBowel careLast bowel movement? Laxatives?
IIndwelling cathetersEach line and catheter still needed?
DDe-escalationAntimicrobials narrowed or stopped?

Use at the morning round and document each item.

Red flag · call your senior now
A missed thromboprophylaxis dose for > 24 h in an immobile ventilated patient - restart or document why it is held.
Pitfall
Ticking the checklist without acting on it - assign each item to a named person.
Pitfall
Continuing stress ulcer prophylaxis indefinitely after extubation or transfer.
Pearl
Pair the spontaneous awakening trial with the spontaneous breathing trial each morning - both reduce ventilator days.

Calculators for this topic

Richmond Agitation-Sedation Scale

Single-item sedation/agitation score from +4 to −5.

References

  1. 1

    Vincent JL. Give your patient a fast hug (at least) once a day. Crit Care Med 2005;33:1225-9.

  2. 2

    Farkas J. The Internet Book of Critical Care (IBCC). EMCrit Project; continuously updated.

  3. 3

    Devlin JW, Skrobik Y, Gelinas C, et al. Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU (PADIS). Crit Care Med 2018;46:e825-73.

  4. 4

    Klompas M, Branson R, Cawcutt K, et al. Strategies to prevent ventilator-associated pneumonia, ventilator-associated events, and nonventilator hospital-acquired pneumonia in acute-care hospitals: 2022 update. Infect Control Hosp Epidemiol 2022;43:687-713.

  5. 5

    Schünemann HJ, Cushman M, Burnett AE, et al. American Society of Hematology 2018 guidelines for management of venous thromboembolism: prophylaxis for hospitalized and nonhospitalized medical patients. Blood Adv 2018;2:3198-225.

  6. 6

    Cook D, Deane A, Lauzier F, et al. Stress ulcer prophylaxis during invasive mechanical ventilation (REVISE). N Engl J Med 2024;391:9-20.

  7. 7

    Ye Z, Reintam Blaser A, Lytvyn L, et al. (Scandinavian/European) Clinical practice guideline on gastrointestinal bleeding prophylaxis for critically ill patients. Acta Anaesthesiol Scand 2021;65:681-94.

  8. 8

    Prescott HC, Antonelli M, Alhazzani W, et al. Surviving Sepsis Campaign: international guidelines for management of sepsis and septic shock 2026. Intensive Care Med. 2026;52(5):863-936. Co-published in Crit Care Med. 2026 (doi:10.1097/CCM.0000000000007075)

  9. 9

    Buetti N, Marschall J, Drees M, et al. Strategies to prevent central line-associated bloodstream infections in acute-care hospitals: 2022 update. Infect Control Hosp Epidemiol 2022;43:553-69.

  10. 10

    Patel PK, Advani SD, Kofman AD, et al. Strategies to prevent catheter-associated urinary tract infections in acute-care hospitals: 2022 update. Infect Control Hosp Epidemiol 2023;44:1209-31.

  11. 11

    National Centre for Disease Control, DGHS, MoHFW. National guidelines for infection prevention and control in healthcare facilities. New Delhi: Government of India; January 2020.

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