2003 OPEN FORUM Abstracts
IMPROVEMENT IN VENTILATOR ASSOCIATED PNEUMONIA RATES CAN BE ACHIEVED WITH INTERDISCIPLINARY APPAROACH IN MECHANICALLY VENTILATED, TRACHEOSTOMISED LONG-TERM CARE PATIENTS
Deepak Shrivastava, MD, FCCP; Rachel Steele, RRT, RCP; Usman Ali, MD; Chris Frey, Pharm.D
San Joaquin General Hospital, French Camp and St Dominic Hospital, Manteca, CA
Background: Ventilator associated pneumonia (VAP) is a common complication. The impact of VAP is well known. The problem is compounded by presence of tracheostomy, polymicrobial colonization of the airways and poor immunity in residents of the long-term care units. Multiple variables affecting incidence of VAP, like frequency of ventilator circuit change and level of humidity have been well described.
In a fifty bed sub-acute care unit higher than expected VAP rates were identified. An extensive review of the data and potentially modifiable variables was undertaken utilizing the quality improvement model.
Methods: The recommendations regarding the evaluation and management of VAP from American Association of Respiratory Care, Center for Disease Control and Prevention and best practices from other organizations were reviewed by a interdisciplinary task force including but not limited to physicians, respiratory therapists, infection control nurse, pharmacist and quality improvement coordinator.
The current practices and equipment use was critically reviewed. The current and past fiberoptic bronchoscopy rates, infection control data on VAP rates and pharmacy antibiotic use and cost were reviewed.
The initial trial of improvement measures started on 8 patients for a 30 days period in a Rapid Cycle Improvement model. The implemented changes were then extended to all tracheostomised, ventilator dependent patients. The ventilator heaters were upgraded with heated circuitry at 440 C and wire circuits. The equipment replacement frequency was changed from weekly to bi-weekly and as needed. Patients were prospectively followed for next 24 months. Data collection included total numbers of fiberoptic bronchoscopies, ventilator associated pneumonias, length of stay and use and cost of antibiotic therapy.
RESULTS: VAP rate decreased by average of 28% (3.6 to 2.6), bronchoscopy rate by 48% (140 to 72) and length of stay decreased by 31% (301 to 207 days). Corresponding savings in inventory cost and antibiotic use (mean=$30 per day per patient) were documented.
Conclusions: Providing optimal humidity at 440 C can reduce incidence of ventilator-associated pneumonias in chronically ventilated patients in long-term care. There is a decreased need for invasive procedures and antibiotic therapy as well as reduced length of stay in these patients.