2004 OPEN FORUM Abstracts
MEASURES TO DECREASE VENTILATOR ASSOCIATED PNEUMONIA.
Brian Fox RRT,
Joanne Casella RRT, Carmelita Cornaglia RN, Brian Glynn RRT, Raymond
Malloy BS RRT. Departments Of Pulmonary Care and Infection Control,
Thomas Jefferson University Hospital, Philadelphia, Pa.
BACKROUND:
The policy for ventilator tubing changes at Thomas Jefferson
University Hospital (TJUH) was to change the circuit every 7 days
regardless of the length of stay. Current Center for Disease Control
(CDC) and American Thoracic Society (ATS) recommendations are to
decrease the incidence of opening the ventilator circuit to limit the
possibility of circuit contamination.
HYPOTHESIS: We
hypothesized that if we changed our ventilator tubing once a month
instead of once a week and compared humidification devices i.e.: HME
and MR750 heaters, we would decrease our ventilator associated
pneumonia percentages.
METHOD: In December 2003, we started
to list all adult ventilator patients and match the following
information: Patient unit, age, sex, attending physician, admitting
diagnosis, admission date, discharge date, surgical procedures,
Co-morbidity’s, total number of days in ICU, date placed on
ventilator, total number of ventilator days, date of sputum culture,
sputum cultures results, febrile: yes/no, was the patient
re-intubated and CXR confirmation of pneumonia. In December 2003 we
collected the above data while utilizing once a week tubing change
using the Fisher Pyckel MR 730 heater. In January 2004 we started to
change the ventilator tubing exactly one month from when the patient
was started with no changes in the humidification policy. Lastly in
February 2004, every patient was placed on an Intersurgical HME and
we noted any patient that needed to be placed back on heated
humidification due to increased secretions or increased resistance.
RESULTS:
VAPS: DECEMBER
JANUARY FEBRUARY 5.21% 3.87% 3.39%
CONCLUSIONS:
We conclude that our VAPS rates are lower than hypothesized. The
changes we have made with our tubing change policy as per the CDC and
American Thoracic Society recommendations have lowered our VAPS rates
consistently in the first quarter. Furthering monitoring is
necessary to make a final conclusion.