Vanquishing Ventilator Associated Events by Re-emphasizing Evidence Based Practices

Abstract

<h3>Background</h3> Patients on mechanical ventilation are at a high risk for a variety of serious complications, including infections that can increase the duration of ventilation, length of hospital stay and morbidity and mortality. In early 2019, our facility noted a significant increase in ventilator-associated events (VAEs) with a total of four (4) events in all of 2018 to seven (7) events in the first six months of 2019. <h3>Methods</h3> A multidisciplinary work group was formed and an evidence-based quality improvement (EBQI) project was implemented to ensure the Society of Healthcare Epidemiology of America (SHEA) guidelines for prevention of ventilator-associated pneumonia practices were being followed. Collaboration by respiratory therapists (RT) and registered nurses (RN) was determined to be a priority in order to ensure daily interruption of sedation (DIS) and spontaneous breathing trials (SBTs) were completed. Respiratory therapists played a critical role in ensuring positive end-expiratory pressures (PEEP) were set appropriately for the patient's body mass index. Staff re-education on the best practices of DIS, SBT, oral care and changing of oral care kits at a specified time was carried out. The Infection Preventionist performed daily audits of ventilated patients and practices. The goal was to reduce the number of VAEs by 50% in the last six months of 2019. Confounding variables were determined to be existing co-morbidities prior to mechanical ventilation and admitting diagnosis. <h3>Results</h3> To date, data from June 2019 to mid-November 2019 has demonstrated a significant decrease in VAEs. Only one VAE, a ventilator-associated condition (VAC), occurred in early November 2019. Since June 2019, our VAEs have decreased by 85% since implementation of the EBQI project. <h3>Conclusions</h3> Going back to the basics and evidence-based guidelines through a multidisciplinary work group and EBQI project which stressed staff education, RT and RN collaboration and appropriate ventilator settings has helped significantly reduce our VAE rate.