A Two–Hospital Multidiscinary Approach towards the Reduction of Ventilator Associated Pneumonia (VAP)

Abstract

ISSUE: VAP is the second most frequent health-care acquired infection and contributes to significant morbidity and mortality. Many studies have shown the cost of a VAP to be at or above $40,000 per patient. Other published studies have shown a significant reduction in VAP rates when a multidisciplinary approach to established risk-reduction strategies is taken. Infection control surveillance from January-December of 2004 showed a low rate of VAP in the two hospitals below the NNIS pooled mean for benchmarking. Both hospitals had a 10 bed Med/Surg ICU with 1785 vent device days combined in 2004. While both institutions had low VAP rates, the taskforce felt that the numbers could be even lower. Download : Download full-size image Head of the Bed at 30 Degrees Daily Sedation Vacation/Assessment of Rea diness to Extubate PUD Prophylaxis DVT Prophylaxis Use of Oral Care Product Compliance to All Components Baseline n = 129 (May-July 2005) 79% 82 87% 64% 95% 48% Post-training/Education n = 127 (Aug.-Nov.2005) 95% 95% 83% 86% 96% 68% PROJECT: As part of a multidisciplinary taskforce, IC worked collaboratively with the ICU nurses and the RT department towards the implementation of a ventilator bundle that included all components outlined by CDC and IHI recommendations. This includes elevation of the head of the bed by >30 degrees, daily sedation vacations, DVT & PUD prophylaxis, oral care every 4 hours with deep oral pharyngeal suctioning and tooth-brushing every 12 hours, and assessment of readiness to extubate. Both ICU nurses and RT staff received one-hour VAP education with training and rationales in the form of a video. The oral care kits and laminated protocols were affixed to the ICU wall for easy access for staff. Additional education emphasized hand hygiene, adherence to aseptic technique and oral cavity assessments. Compliance was measured using a daily protocol check-sheet. RESULTS: Our performance improvement initiatives resulted in a significant reduction in VAP rates from 7 infections at both sites in 2004 to 0 infections at both sites for 2005. These VAP rates are all well below the CDC benchmark for a med/surg ICU. Significant improvement was also achieved for the head of the bed and daily sedation vacation components with continued compliance to the oral care standards (see Figure 1 and Table 1). LESSONS LEARNED: Implementation of a collaborative effort lead to a significant reduction in VAP rates in two 10-bed ICU units when ICU nurses and respiratory therapists consistently implemented all CDC guidelines.