The Science Journal of the American Association for Respiratory Care

2001 OPEN FORUM Abstracts


Darnetta Clinkscale RRT;Jeanne Zack RN; Marin Kollef MD; Peggy Reed-Watts RRT; Lloyd Thompson RRT; MaryFinayev RRT; Donna Clayton RRT; Pulmonary and Critical Care Division, RespiratoryCare Services and Infection Control, Washington University School of Medicineand Barnes-Jewish Hospital (BJH), St. Louis, Missouri,

Background: Ventilator-AssociatedPneumonia (VAP) Education Intervention was undertaken at BJH to address VAPin our ICUs. The literature shows that VAP is the leading cause of death ofhospital-acquired infections with mortality rates of 20-50%. The Centers forDisease Control and Prevention estimates that an episode of VAP adds 5.9 daysto a patient?s hospital stay. We hypothesized that comprehensive training ofRT could reduce the rate of VAP, improve patient outcomes and reduce cost atour hospital.

Method: A multi disciplinaryeducation module, ?WHAP VAP!? was developed by the Infection Controldepartment at BJH. The acronyms ?WHAP VAP!? stands for W-weanthe patient. H-hand washing. A-aspiration prevention precautions.P-prevent contamination. The education module consisted of staff inservices,a self-study booklet and pre/post tests for documenting competency. The educationalcontent was supported by a series of fact sheets and a poster highlighting keypoints of the ?WHAP VAP!? campaign. All RT (100%) staff and ICU nursingstaff were offered the education module. Although nursing compliance variedunit by unit, 100% of the RT staff completed the module and testing.

Results: The ?WHAPVAP!? intervention successfully decreased the VAP rate by 49% in the ICU?s.The total number of VAP cases and excess length of hospitalization decreasedby 47%. The cost of VAP prior to the intervention was $1,265,330 and after theintervention was $683,060. This 46% decrease in excess cost resulted in savingthe hospital $582,270.

Before theIntervention (1999 Q4, 2000 Q1 & Q2)After the Intervention (2000 Q 3, Q4, & 2001 Q1)Percent ofDecrease
Total # VAP 154 82 47%
VAP/1000 ventilatordays 25.012.7949%
Excess daysof hospital length of stay 92449247%
Excess cost$1,265,330.00$683,060.00 46%

Experience: Our experiencedemonstrated (see table) that with 100% training and competency verificationof RT staff, we could decrease the number of patients with VAP and the riskto this high risk ICU patient population.

Conclusions: ?WHAPVAP!? was added to the orientation for all new RT staff and a mandatorybiannual update with testing for 100% of all RT.