Website Last Updated on March 12, 2026
When you bring ICU-level care into your home, hygiene stops being a preference — it becomes a lifeline.
In our setup, my sister and I learned this early. A PALS on a ventilator, with a tracheostomy and feeding tube, has limited natural defenses against infection. The equipment surrounding them — circuits, catheters, suction tubes — can all become vectors if not handled with discipline. One lapse can mean a chest infection. One chest infection can mean a hospital visit. And a hospital visit, for a medically fragile patient, carries its own serious risks.
What surprised us was that even trained ICU nurses sometimes fell short of the hygiene standards we expected. That pushed us to take ownership — to observe, learn, and build our own rigorous routines. Over time, meticulous handwashing, regular surface sanitization, and a strict protocol around touching medical devices became second nature to us.
We are not sharing this to overwhelm you. We're sharing it because it works. Consistent hygiene has kept our father out of the hospital and has preserved his quality of life in ways that no medication alone could. No one can replace the attentiveness of a family that truly cares — and hygiene is one of the most powerful ways that care shows up, every single day.
Oral hygiene is easy to overlook in the broader demands of ALS caregiving, but neglecting it can lead to infections and significant discomfort for the patient.
If your PALS cannot spit, swallow, or open their mouth fully, a suction machine must be on hand during oral care to prevent accidental aspiration of the cleaning solution.
Our method: We use several pieces of sterile gauze cloth soaked in a diluted Listerine mouthwash solution — mixed with RO water in a 1:4 ratio (one part Listerine, four parts water). Each piece of gauze is held with an artery forceps and used to gently clean the teeth, gums, inner cheeks, and tongue. The suction catheter is kept ready throughout to clear any pooled liquid immediately.
This approach is gentle, effective, and keeps the mouth fresh and clean without the risks associated with liquid rinsing.
The tracheostomy tie — the cloth (or velcro band) that holds the tracheostomy tube in place — needs more attention than most people expect.
We change our father's tie at least once daily, typically after his morning sponge bath. However, we change it more frequently whenever needed — saliva drooling onto the tie, excessive sweating in warm weather, or simply visible soiling can make the tie damp and uncomfortable. A wet tie is not just unpleasant — it can irritate the skin around the stoma and increase the risk of skin breakdown and infection.