The Science Journal of the American Association for Respiratory Care

2007 OPEN FORUM Abstracts

PREVENTING VENTILATOR ASSOCIATED PNEUMONIA IN THE CRITICAL CARE PATIENT

P. A. Dailey1, J. Fitzgerald2, S. Elliot3, K. Johnson2, C. Langone1, M. E. Scales4, J. St. Georges4, D. Thomas3, M. Tidswell3, M. Cushman2, P. Lasardi3


Background. We studied the reliable application of “VAP Prevention Bundle” to determine its impact at reducing the VAP rate at our academic tertiary care referral medical center Methods. We assembled a multidisciplinary team of physicians, nurses, pharmacists, and respiratory therapists from the departments of critical care medicine, infection control, pulmonary medicine and healthcare quality to identify prevention strategies and develop a model to provide standardized care for the ventilator patient to reduce our VAP rate. Multiple resources were utilized including CDC recommendations, IHI “how to guide” and the latest evidence based research. These strategies were reviewed, discussed, consensually agreed upon and placed into a “VAP Prevention Care Set”. They were then inserted into Clinical Information System (CIS), our Computerized Physician Order Entry system (CPOE). Results. The basic VAP Prevention Bundle included elevation of the head of the bed (30-45°), sedation vacations with a daily assessment of readiness to wean, stress ulcer prophylaxis, and DVT prophylaxis. We expanded the VAP Prevention Bundle to include; subglottic suction prior to movement of the patient or device, frequent mouth care, and verification of placement of the endotracheal and gastric tubes. In addition, the Respiratory Care Department instituted three major changes: conversion from wet nebulizer to MDI, humidifier upgrade to the Fisher & Paykel MR 850 and standard heated-wire circuits were upgraded to Fisher & Paykel Evaqua circuit. There has been a steady drop in VAP from 13.9/1000 vent days (CY 2004 Q2) to the current rate of 3.1/1000 vent days (CY 2007 Q1); an overall decrease by 62% since implementation of the VAP Prevention Bundle.

Conclusions:
Modifications in practice to adopt current evidence based practice can reduce VAP rates and promote improved patient outcomes. The combination of VAP Prevention Bundle orders and the conversion to latest Fisher & Paykel humidifiers and circuits contributed to our impressive reduction in VAP rates.


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