Abstract P124: Reduction of Ventilator Associated Pneumonia Rates Associated With Two Stage Intervention in a Cardiovascular Intensive Care Unit

Abstract

Background: Prevention of hospital acquired infections in the critically ill patient is paramount to improving patient outcomes. A ventilator associated pneumonia (VAP) prevention bundle (head of bed elevation, hypopharyngeal suctioning, oral care, stress ulcer prophylaxis, deep vein thrombosis prophylaxis, and sedation management/spontaneous breathing trials) was instituted in a medical/surgical cardiovascular intensive care unit (ICU) in early 2007, but VAP rates remained above target goals for cardiac surgery patients. Aim: To identify patients at high risk for VAP and implement a second stage intervention (chest physiotherapy-CP) in addition to the VAP prevention bundle to decrease infection risk. Methods: An intensive analysis was done on VAP cases that occurred during a 5 month period (July-November 2008, n=7 cases). We determined that cardiac surgery patients who acquired VAP all shared the following factors: 1) prolonged intubation (>6 hours post-operatively and not able to complete rapid extubation pathway), 2) prolonged operative time (>8 hours) or reoperation within 24 hours, and 3) reintubation after post-operative extubation. In early 2009 we incorporated into the prevention bundle an automated CP option integrated into the ICU bed features for cardiac surgery patients identified with one or more risk factors. Results: The incidence of VAP decreased after implementation of the secondary stage of VAP prevention with CP in patients identified as high risk (Figure). Conclusions: We identified risk factors associated with VAP in cardiac surgery patients in our ICU. Addition of CP to the VAP prevention bundle was associated with lower VAP rates in the ICU.