The Science Journal of the American Association for Respiratory Care

2002 OPEN FORUM Abstracts

VENTILATOR ACQUIRED PNEUMONIA: A MODEL FOR IMPROVING PATIENTCARE WHILE DECREASING COST.

Gary J. Hospodar, MAOM, RRT, RCP, Charles Riley, MD, Donald Romig, MD, Barbara Benzaquen, MSN, RN. St. Vincent Hospital, Santa Fe, New Mexico.

A six-month investigative study was performed in 175 patients in the critical care unit of a community hospital. The study hypothesis was that the less often the ventilator circuit was interrupted, the lower the incidence of acquiring VAP. In addition, modification to existing oral care practice would have a significant role in decreasing VAP rate as well. Existing patient care protocol was modified to decrease exchange frequency for in-suction catheters from Q24 hours to Q7 days/prn while mechanical ventilator circuit exchange frequency was decreased from Q7 days to Q30 days/prn. All change in practice standards were implemented simultaneously after educational sessions that outlined changes, study purpose and period. Study data analysis included; number of mechanically ventilated patients, ventilator acquired pneumonia (VAP) rates and ventilator days. Additional data analyzed included average length of mechanical ventilation and supply expense per ventilator day. Study in-line suction and mechanical ventilator circuit exchanges would immediately terminate and revert to pre-study clinical practice if the VAP benchmark was ever exceeded.

Median data for benchmarking purposes was derived from aggregate data collected over a 2 year period. In the Table below, Quarter One represents median, pre-study benchmarked data. Quarter Two and Three represent impact of clinical practice changes. Evidence demonstrated that with modification to existing practice surrounding oral care and equipment exchange frequency, even with an increase in ventilator days, a marked impact on decreasing VAP rates was reported. Average for the study period revealed 11.56 VAP rate opposed to the 14.14 benchmarked VAP rate. This represents an average decrease in critical care unit VAP rate by 2.58 or 18.26%. Average length of mechanical ventilation increased during the study period but data deemed inconclusive and not study related. Operational expenses for the period were also decreased. Average expense per ventilator day significantly decreased $17.81 to $7.79 representing a 56.2% reduction in operational supply expense.

Period Patients Vent Days VAP # VAP Rate Benchmark Outcome Variance # Outcome Variance %
Median N/A 284 6.5 14.14 14.14 N/A N/A
Q 1 86 320 5 15.6 14.14 1.46 10.32%
Q - 2 80 426 4 9.39 14.14 -4.75 -33.61%
Q - 3 95 510 7 13.73 14.14 -0.42 -2.95%

We recognize that continued research on this topic is required. Subsequently, this study supports the ability to modify clinical oral care while decreasing the exchange frequency of routine in-line suction catheter and mechanical ventilator circuit changes while reducing costs associated with providing mechanical ventilation without negatively impacting patient care outcomes.

OF-02-105

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