2003 OPEN FORUM Abstracts
REDUCING VENTILATOR ASSOCIATED PNEUMONIA RATES- A TEAM APPROACH
Jody Page RRT, M. McNally RN, MHA, CIC, L. Dominey RRT, MHA, P. Prescott RRT,
J. Ramage MD, FCCP Memorial Health University Medical Center, Savannah, Georgia
Background: A 12 bed Neuro ICU in a Level One Trauma Center with high VAP rates for three consecutive years (1999-2001) managed to reduce those rates by nearly one half with a multidisciplinary process.
Methods: VAP rates (# of infections per 1000 vent days) for 1999-2001, in the Neuro ICU were consistently higher than the NNIS (National Nosocomial Infection Surveillance System) mean rates. During the year 2001, a task force was created to develop a process to reduce VAP rates. The task force included the Neuro ICU staff nurses, Respiratory Therapists, Infection Control nurses, a Critical Care Pulmonologist, and a Trauma Surgeon, collaborating with physical and occupational therapy departments.
Specific respiratory therapists (RT) were dedicated to the Neuro ICU. RTs instituted heated wire circuits, extended ventilator and suction equipment change outs to 30 days or prn, changed in-line suction catheters every 48 hours, used spring valve "t" adapters for in-line neb treatments, minimized opening the ventilator circuit, and covered the vent circuit during patient transport/disconnects. RTs also cleaned any unused equipment and covered it for storage. The nursing staff developed procedures for oral and sinus care, separate suction set ups for oral and in-line suction, and positioned the patient in high fowlers or sitting position at least twice daily as able. Physical and occupational therapists were asked to assist with patient positioning, and early stage PT/OT.
RESULTS: After intervention there was a 47% reduction in the Neuro ICU mean VAP rate [12.2% (2002), 26% (2001), 21.6% (2000), 21% (1999)]. The mean VAP rate was also 4.6% less than the NNIS mean rate (12.2% vs.16.8%) for 2002. The VAP task force evolved into a hospital wide performance improvement project and was extended to the other ICUs within the hospital. Policies were modified to reflect the extension of change outs for ventilator circuits and suction equipment, and the use of separate suction set ups for oral and in-line suction catheters. ICU staff education and compliance monitors for patient positioning, oral/sinus care, and early PT/OT continues.
Conclusions: Multidisciplinary performance improvement plans can substantially lower VAP rates in high acuity adult ICU.