2004 OPEN FORUM Abstracts
REDUCING VENTILATOR-ASSOCIATED PNEUMONIA
Ava J.
Dobin, BSN, CIC, Janette Moss, RN, MSN, Coral Springs Medical
Center, Coral Springs, Florida. Although Pneumonia is a risk faced
by any patient being admitted to a hospital, when patients are placed
on a ventilator, the risk increases from 3 to 10-fold. The Critical
Care Unit at Coral Springs Medical Center (CSMC) experienced 14.9
cases of Ventilator-Associated Pneumonia (VAP) per 1,000 ventilator
days in 2001 and 19.9 cases in 2002, exceeding the Center for Disease
Control’s (CDC) median rates of 4.2 to 16.3. Subsequently, the
team established a data collection plan to gather baseline
measurements on these areas. The data was displayed in Pareto charts,
histograms, run and control charts. Performance benchmarks served as
the basis for further root cause identification. Our practices for
providing oral care did not meet the best practices identified
in evidence-based protocols. Our team chose three processes to trial.
The top three products included a homegrown oral care product and the
products from two different vendors. The two vendor-based products
were trialed for comparison and assessed against an array of factors
considered critical to quality. Our team used multi-voting to find
the highest priority for product use. We saw 100% standardization in
the technique, times, and overall process. The financial impact to
the organization was striking, since the cost of VAP over the fiscal
year was over $800,000! CSMC achieved 1.9 cases per 1,000 ventilator
days in 2003 – an 89% reduction in VAP, and well below the
median rates published by the CDC. Our goal was to reduce the
incidence rate to at most 10% - but we surpassed our goal. CSMC
achieved 0% VAP incidence rates for the last twelve (12) consecutive
months.