The Science Journal of the American Association for Respiratory Care

2005 OPEN FORUM Abstracts

A SERIES OF VENTILATOR ASSOCIATED PNEUMONIA (VAP) CASES AFTER SUCCESSFUL IMPLEMENTATION OF A VAP-PREVENTIVE CARE BUNDLE.



Theresa Cain RN, Alexander Adams FAARC, RRT, Stephanie Tismer RN, ICP, Avi Nahum M.D., Noe Mateo M.D., David Dries M.D., Healthpartners/Regions Hospital, St. Paul, Minnesota.

Background: Significant morbidity and mortality is associated with VAP - a common infection in ICUs. Several preventive efforts have been reported to reduce the incidence of VAP.

Methods:
By 2003 we had implemented the following care bundle in each of our ICUs to reduce the incidence of VAP: 1) Head of bed > 30 degrees to prevent/minimize aspiration risk, 2) Peptic ulcer prophylaxis- H2-blocker or proton pump inhibitor , 3) DVT prophylaxis, 4) Daily sedation interruption and daily weaning assessment per weaning protocol.

Results:
A reduction in VAP rates for our MICU was realized since implementation of the care bundle: 2003 - 6.7/1000 vent-days (before bundle), 2004 - 2.9, 1st quarter 2005 - 0 cases. Nevertheless, while the VAP rate for the SICU had been declining as well - during the initial 5 month monitoring period in 2005, 7 cases of VAP were identified with several common features: 7/7 orally intubated, 7/7 male, 4/7 obese, 5/7 traumatic brain injury, and 7/7 had copious secretions. These patients had a mean age 35.4 y/o and they contracted VAP after a mean of 6.6 days of mechanical ventilation.

Conclusions:
In spite of preventive measures that had reduced VAP rates in our ICUs, we report 7 cases of VAP from our SICU that had several important features. Current VAP preventive efforts do not specifically address the issues of excess secretions and an impaired ability to cough. Our cases indicate that there should be attention to a specific patient profile that may require aggressive airway clearance, prompt culturing and early treatment.

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