2005 OPEN FORUM Abstracts
ANNIHILATING VENTILATOR-ASSOCIATED PNEUMONIA WITH A RESPIRATORY THERAPY EMPHASIS ON ORAL CARE
Authors: Thomas C. Button, ICP, RN, CNA, BC, Debra Culmer, Infection Control Specialist, CIC, Tammy Southard RTT, RCP, Scott Donaldson, M.D., FCCP Medical Center of McKinney 4500 Medical Center Drive, McKinney, Texas 75069
Background: Each case of ventilator-associated pneumonia (VAP) increases ventilator days, critical care and hospital lengths of stay, and results in additional costs of over $40,000. An increase in the VAP rate at the Medical Center of McKinney led to formation of a Performance Improvement (PI) team to assess the impact of prevention interventions. The PI team, which included Respiratory Therapy, Nursing, and Infection Control conducted a review of current literature regarding processes to decrease VAP risk and increase patient safety. Based on the latest evidence-based research, the team developed a plan that included awareness, education and a comprehensive oral care protocol.
Method: The plan was implemented in the first quarter of 2004. Critical Care & Respiratory staff where made aware of the VAP rate and its impact on patient outcomes. Respiratory Therapy accepted responsibility for implementing oral care every two hours and documenting the process. The oral care protocol addressed oropharyngeal colonization, oral secretions management, and dental plaque formation through brushing, cleansing, suctioning and moisturizing. For further reinforcement of VAP prevention strategies, staff attended an additional off-site education seminar.
Results: Due to the protocol intervention, the facility's annual VAP rate in 2003, 8.2 per 1000 vent days, was reduced to 0 for 2004. An estimated 11 cases of VAP were avoided, along with over $440,000 in facility costs for treatment. The facility continues to maintain a VAP rate of zero to this date.
Conclusions: This dramatic improvement in patient safety may be attributed to the implementation of heightened staff awareness, increased staff education regarding VAP, and compliance to a comprehensive oral care protocol. The sustained improvement of patient outcomes is credited to the Respiratory Therapy staff's diligence in making VAP prevention a priority.