1998 OPEN FORUM Abstracts
EFFECT OF IMPLEMENTING MULTIPLE INFECTION CONTROL PRACTICE CHANGES ON VENTILATOR RELATED PNEUMONIA
Bruce Mattus BS RRT, Paul Bettencourt MD, Rose Pachas RN, Bonnie Fallon RN, Margaret Ferguson RRT, Faulkner Hospital, Boston Mass.
INTRODUCTION: Using the CDC diagnosis guidelines we have followed our ventilator-related pneumonia (VRP) rate for over 10 years. Our rate had consistently been less than 15 VRP's per 1,000 ventilator days until 1994 when a rate of 21 occurred. An interdepartmental focus group, the Pneumonia Task Force (PTF) was organized. The PTF, following a review of recent practice changes concluded the most likely causes of the VRP increase were 1) a decrease in use of closed tracheal suction catheters (CSC) and 2) a possible increase in the use of H2 blockers. The committee recommendations to use CSC's on all intubated patients and to reduce the use H2 blockers were approved, implemented and monitored. The VRP rate for 1995 however increased from 21 to 24.
METHOD: The task force made the decision to develop and implement a list of all infection control practices that could be improved. Particular importance was placed on a quote from the 1994 CDC publication "Guidelines for Prevention of Pneumonia", which stated "most bacterial pneumonia's occur by aspiration of the bacteria colonizing the orophyaranx or upper gastrointestinal tract". A review of the 1) 1994 CDC guidelines, 2) recent published ventilator related pneumonia studies and 3) our respiratory department and nursing ventilator-related procedures resulted in a list of seven recommended infection control practice changes. The seven interventions, which were implemented in February 1995 and are monitored diligently to this day, are:
Practice Practice change
1. Mouth care every 8 to
16 hours - Performed every 4 hours
2. Different mouth care
solutions used - Mouth care solution to be 50%
peroxide and 50% mouth wash
3. Ventilator tubing
replaced twice a week -Changed once a week
4. Respiratory medications
delivered via small -All medications delivered by MDI
nebulizer or MDI
5. Manual resuscitators -Capped between use
uncapped between use
6. Endotracheal tube cuff -Deflated only for extubation
sometimes deflated
7. Head of the bed at
different levels -Head of the bed at 30 degrees
when possible
Results:
Year VRP Rate
1992 14.0
1993 21.1
1994 24.0
1995* 8.4
1996 9.9
1997 10.0
*Practice changes implemented 2/95
CONCLUSION: Instituting and assuring compliance with specific infection control procedures decreased our VRP rate 65%.
The 44th International Respiratory Congress Abstracts-On-Disk®, November 7 - 10, 1998, Atlanta, Georgia.