The Science Journal of the American Association for Respiratory Care

2008 OPEN FORUM Abstracts


Thomas A. Madrin1

Background: Our 604 bed teaching hospital had struggled for years with Ventilator Associated Pneumonia (VAP) above the National Infections Surveillance (NNIS) now the National Healthcare Safety Network (NHSN) benchmark rate. At the time the benchmark rate was 17.4 cases per 1,000 ventilator days our rate would spike to 20-21 cases per 1,000 ventilator days.

During the period of April 2004 through June 2005 our Respiratory Care Service (RCS) in collaboration with adult intensive care units gradually and randomly implemented each of the elements of the Institute for Healthcare Improvement (IHI) bundle which include Head of Bed (HOB) 30-45 degrees, Deep Vein Thrombosis (DVT) prophylaxis, Peptic Ulcer Disease prophylaxis, SV/SBT. Our VAP rates continued to spike very erratically then would drop half or more then spike up again and looked much like a Premature Ventricular Contraction (PVC) on an Electrocardiogram (ECG) tracing.

Methods: Beginning in June 2006, at the recommendation of the infectious disease physician and chair of the Infection Control Committee (IC) we implemented unannounced, daily bundle compliance rounds. Two Registered Respiratory Therapist (RRT) used a data collection sheet to make random ventilator bundle compliance rounds in the adult ICU's.

Randomly and unfortunately infrequently we had two therapist make compliance rounds. The data collection tool and process was adjusted many times until we had an effective tool that tracked the most important bundle data that respiratory had an influence on. We also created a ZAP VAP Fair much like a Halloween fair in elementary school to educate hospital staff about the seriousness and impact of VAP.

Results: Within the month following the unannounced implementation of the bundle compliance monitoring the VAP rate began dropping from 13 in June 2006 to 3.2 in 2007. During this period ventilator days increased 23% compared to the prior year. Results of monitoring are reported to the IC, Critical Care and Medical Executive Committees on a monthly basis. Rate for first seven months of FY 08 has dropped to 1.04 cases/1,000.

Conclusion: Each of the components of the IHI VAP Bundle is an important contributor to the reduction of VAP cases. Increased awareness of the bundle's importance through ongoing education and daily monitoring of compliance requirements maximize the impact of the individual components and make them into a bundle.