2005 OPEN FORUM Abstracts
IMPLEMENTING QUALITY CORE MEASURES FOR THE PREVENTION OF VENTILATOR ASSOCIATED PNEUMONIA.
Gary Turner, BS, RRT; Kathy Jones-Boggs Rye, EdD, RRT; University of Arkansas for Medical Sciences, College of Health Related Professions, Department of Respiratory & Surgical Technologies, and Central Arkansas Veterans Administration Health System, Little Rock, AR .
BACKGROUND: A leading cause of morbidity and mortality in the intensive care unit (ICU) is ventilator associated pneumonia (VAP). Depending on patient risk factors, the incidence of VAP has been reported to vary from 10 to 65% of intubated patients and is associated with a mortality of up to 40%. Furthermore, the hospital cost and length of stay for patients who develop VAP is substantial.
OBJECTIVES: To implement quality core measures for the prevention of VAP and to examine the incidence of VAP in the ICU population. Criteria for determining VAP were based on Center for Disease Control (CDC) recommenda-tions that include development of an infiltrate after being on the ventilator for 72 hours accompanied by purulent sputum production or culture of pneumonia causing organisms as documented by the physician.
METHOD: An inception cohort study was conducted in the ICU of a 245-bed acute care facility located in a rural Southern area. A total of 72 medical and surgical patients required mechanical ventilation during the period of July 2004 through March 2005. A retrospective chart review of 24 patients who required mechanical ventilation for the period of January through March of 2003 were reviewed to determine a baseline ventilator length of stay (VLOS). Baseline VAP rates were also calculated for that period. Intervention included implementation of a ventilator weaning/extubation protocol, semi-recumbent positioning of patients, appropriate sedation management, patient surveillance, and data collection.
RESULTS: The VAP rate in Quarter 1 (July - September 2004) was 27; Quarter 2 (October - December 2004) was 0 and Quarter 3 (January - March 2005) was 0 as compared to the baseline of 41.7. Ventilator LOS in Quarter 1 was 55 hours, Quarter 2 was 44.9 hours, and Quarter 3 was 43.6 hours as compared to the baseline of 24 hours.
CONCLUSION: Data suggest that use of daily weaning assessments, semi-recumbent positioning and appropriate sedation management of mechanically ventilated patients decreases VAP rates in the ICU. While VLOS did increase from baseline, it decreased over the 3 quarter period. This finding confirms other reports that specific types of ICU populations possess certain characteristics that increase their risk for developing VAP. If effectively implemented, quality core measures for the prevention of VAP may decrease morbidity, mortality, and costs of VAP in mechanically ventilated patients.