The Science Journal of the American Association for Respiratory Care

2007 OPEN FORUM Abstracts

VENTILATOR-ASSOCIATED PNEUMONIA: IN ACCORDANCE WITH PENNSYLVANIA HEALTHCARE COST CONTAINMENT COUNCIL (PHC4) INITIATIVES TO REDUCE VAP RATES AT THOMAS JEFFERSON UNIVERSITY HOSPITAL (TJUH).

B. R. Nuthulaganti1, B. Alexander-Bucher1, R. Glenn1, C. Cornaglia1, R. Malloy1


Background: Ventilator-associated pneumonia (VAP) rates, according to the 2004 National Nosocomial Infections Surveillance (NNIS) System Report, range from 4 to15 per 1000 patient days. In 2004, Pennsylvania hospitals had 11,668 hospital-acquired infections (HAI), resulting in 1,793 deaths and 205,000 additional inpatient days with $ 2 billion additional hospital charges. The HAI has an enormous impact on the societal healthcare costs. In 2005, TJUH has been selected as one of the six recipients of a grant awarded by PHC4 to reduce infections, improve quality, and contain healthcare costs associated with HAI. Objectives: Explore PHC4 initiatives for patients who are on ventilators and make changes that are appropriate to achieve a zero percent rate of ventilator associated pneumonia in neurological intensive care unit. We hypothesized that making comprehensive interventions (evidence-based protocols, education, and appropriate equipment changes) would decrease ventilator-associated pneumonia at TJUH. Setting: A major urban teaching hospital’s neurological intensive care unit (NICU) Design: A retrospective VAP analysis. Interventions: Educational inservices, instituting oral care guidelines, adhering to ventilator bundles, and ventilator equipment changes.

Measurements and Results: VAP rates declined in the 1st quarter 2007 by 2 per 1000 patient days when compared with 4th quarter 2006. In addition, utilization ratio remained relatively stable and VAP attack rate dropped by 1%.

Conclusion: An on-going program including evidenced-based protocol, appropriate equipment changes, and educational VAP prevention in-services to current and new employees has not only decreased the VAP rate but also improved the overall quality and cost of care. Limitations: The retrospective analysis was done for one quarter. However, we believe that a full year’s worth of data is required to more accurately analyze the trends and demonstrate the impact of the interventions.

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