The Science Journal of the American Association for Respiratory Care

2007 OPEN FORUM Abstracts


THE IMPACT OF SYSTEMATIC ASSESSMENT AND EARLY VOLUME EXPANSION AND SECRETION CLEARANCE INTERVENTION ON VENTILATOR ASSOCIATED PNEUMONIA

M. J. Hewitt1, M. H. Bernstein1, B. C. Becker2


Background: Ventilator-associated pneumonia (VAP) is a common problem in the intensive care unit and accounts for significant morbidity and mortality as well as an increase in the cost of care. Numerous strategies have been implemented to decrease the incidence and the impact of VAP. Though many of these interventions and strategies have resulted in improvement in pneumonia rates, VAP remains a significant problem. In April of 2006, the Respiratory Care Services Department at Memorial Hermann Hospital implemented a revised policy and procedure calling for specific assessments of cough, inspiratory capacity, oxygenation, secretions and patient mobility as well as available chest x-rays in all ICU patients. The purpose of this change in policy was to facilitate early intervention with volume expansion and secretion clearance in patients determined to be at risk for VAP.

Methods: A retrospective review of infection control records was conducted to determine the ICU census, the number of number of mechanically ventilated patients, the number of ventilator days and the number of VAP’s that occurred in five intensive care units between April and December for three consecutive years beginning two years prior to the change in protocol. The standard calculation of VAP rate (VAP/1000 ventilator days) was completed for each month in the analysis period. Data were analyzed using a paired t-test comparing monthly VAP rates in consecutive years.

Results: A reduction in VAP rate with a trend toward significance (p = 0.07) was observed in the 9-month period following the change in protocol. No difference was observed in the VAP rate comparing the same time period during the two years prior to the change (p = 0.28).

Conclusions: A reduction in overall VAP rate was achieved in the period following the change in policy and procedure to facilitate systematic patient assessment and early intervention with volume expansion and secretion clearance therapy. Additional studies are needed to evaluate the role of specific lung expansion and secretion clearance therapies in reducing VAP.

VAP’s per 1,000 pt. days 2004 2005 2006
April 5.96 4.03 7.44
May 10.86 3.74 10.16
June 10.48 9.47 7.18
July 5.20 11.84 3.36
August 6.68 15.20 3.45
September 7.34 14.93 7.34
October 5.26 7.10 3.74
November 9.35 7.64 2.23
December 5.18 11.40 4.42
Mean 7.37 9.48 5.48
SD 2.30 4.23 2.63



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THE IMPACT OF SYSTEMATIC ASSESSMENT AND EARLY VOLUME EXPANSION AND SECRETION CLEARANCE INTERVENTION ON VENTILATOR ASSOCIATED PNEUMONIA