1998 OPEN FORUM Abstracts
VENTILATOR ASSOCIATED PNEUMONIA (VAP) REDUCTION IN A COMMUNITY HOSPITAL, METHODS AND OUTCOMES
Peter Hansen RRT, Madeline M. Emanuelsen MS; Bayley Seton Hospital Staten Island. NY
BACKGROUND: 198 bed community hospital with a low VAP rate (# VAP/1,000 mech. vent. Pt. days) further reduced VAP rate and cost of care via multidisciplinary effort between Resp. Care, Infection Control Dept. and Nursing.
Methods: Retrospective review of VAP rate determined rates for years 1992-1994 to be 2.71, 2.55, 0.88 respectively and rising to 4.3 in 1995. The majority of the year 1995 cases (9) occurred during the first six months of 1995. All suspected cases of VAP undergo a multidisciplinary review by the Infection Control Dept. and Respiratory Care Dept. to determine if CDC criteria for Nosocomial Pneumonia are met. Ventilator equipment protocol was the use of heated wire circuits with heater/humidifiers exclusively throughout stay on M.V., with circuit changes every 48 hrs. and use of disposable bacterial/viral filter on manual resuscitator at pt. interface with filter changes every 48 hrs. Patient suctioning was accomplished with single use catheters. In Sept. 1995, when clinically appropriate, heat and moisture exchangers were utilized for the first 96 hrs. of M.V. Then pts. are ventilated with heated wire circuits and heater/humidifiers which were changed every 48 hrs. In October, the Nursing Dept. initiated the use of closed system suction catheters with 24 hr. changes. VAP rate for 1996 decreased to 1.78 (4 cases in 2243 M.V. pt. days). In February 1997 a six month pilot program of weekly circuit changes commenced. For the first 96 hrs. HME's are used on M.V. circuits, then heated wire circuits with heater/humidifiers are utilized and changed at 7 days; closed system suction is still utilized as is change of bacterial/viral filter on manual resuscitators every 48 hrs.
OUTCOMES: VAP rate showed no increase during the pilot period of weekly circuit changes and therefore policy was altered to provide for weekly circuit changes. Resource utilization was enhanced as M.V. pt. days increased 40 % during this period compared to the previous year, but ventilator supply item consumption excluding oxygen remained the same. Our VAP rate for 1997 as a total year decreased to 1.50 (4 cases in 2659 M.V. pt. days), demonstrating that high quality care can be maintained while managing the steadily increasing costs of healthcare.
The 44th International Respiratory Congress Abstracts-On-Disk®, November 7 - 10, 1998, Atlanta, Georgia.