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.