The Science Journal of the American Association for Respiratory Care

2006 OPEN FORUM Abstracts



10 YEAR EXPERIENCE ON REDUCTION OF VENTILATOR ASSOCIATED PNEUMONIA - ONE INSTITUTION'S EXPERIENCE

 John Sabo, MS, RN, RRT and Joy Hargett, BS, RRT, St. Luke's Episcopal Hospital, Houston, Texas

Background: Advances in critical care have led to more patients receiving mechanical ventilation. Quality initiatives should include prevention of disease whenever possible. Our institution faced a growing trend in ventilator-associated pneumonias in the mid 1990's. Between 1995 and 1996, an increase from 5.68 to 8.19 pneumonias per 1000 patient days was noted.

Method:
A task force was formed, consisting of infection control practitioners, respiratory therapists, nurses, pulmonary physicians and infectious disease physicians. That group developed a screening tool to identify patients at risk for developing pneumonia, which was called the Nosocomial Pneumonia Protocol.  This protocol evaluated patients who were mechanically ventilated for greater than 24 hours and did not have an infectious disease or pulmonary consulting physician. The nosocomial pneumonia protocol included (1) obtain sputum sample (2) obtain chest x-ray if not done within last 24 hours, (3) order complete blood count if not done in last 24 hours, (4) institute closed suction catheter, (5) repeat orders every 48 hours until patient was extubated, trached, positive sputum culture obtained or pulmonary or infectious disease physician consult occurred. Attending physicians were notified if the sputum gram stain was positive or if certain organisms (pseudomonas aeruginosa, klebsiella pneumoniae, enterobacter specifies, serratia marcescens, staphylococcus aureus) were identified. Physicians were also given guidelines for empiric therapy.

Results:
This project was piloted in a 41-bed cardiovascular intensive care unit and then moved to other intensive care units. From October 1996 - September 1997, a 29% reduction in the pneumonia rate house wide was noted. Other changes in practice occurred through the next 9 years.  These included use of heated wire circuits, replacement of the inline nebulizer canister every 24 hours, use of the closed suction catheter on all ventilator patients and changing the ventilator circuit once per week. In 2004, ventilator circuits were not longer changed out routinely. In 2005, all Methicillin-Resistant Staphylococcus Aureas patients were no longer placed in isolation unless they had a draining wound. Also in 2005, the Fisher Paykel RT 240 circuit was initiated, which evaporates water molecules into the atmosphere. No changes in practice caused the VAP rate to increase.

The following table shows the rate of ventilator-associated pneumonia from FY 95 - FY 05:

Fiscal Year (fiscal years run October 1 - September 30, until 2005) VAP rate Average number of ventilators per day
1995 5.68 41
1996 8.19 40
1997 8.97 45
1998 7.65 49
1999 5.4 55
2000 3.79 60
2001 3.32 59
2002 2.66 60
2003 2.17 56
2004 1.90 58
Oct- Dec 2004 (3 months) 1.4 54
05 1.2 63

Conclusion:  We have seen continuing reduction in the VAP rate with implementation of the protocol and adjuncts to the protocol. Our current focus is to maintain this level of quality by continually monitoring our institution's infection rate.

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10 YEAR EXPERIENCE ON REDUCTION OF VENTILATOR ASSOCIATED PNEUMONIA - ONE INSTITUTION'S EXPERIENCE