The Science Journal of the American Association for Respiratory Care

2008 OPEN FORUM Abstracts

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

Bhaskar R. Nuthulaganti1, Rachel Sorokin1, Monica Purcell1, Carm Carnaglia1, Roberta Glenn1, Chip B. Malloy1



Background: This study demonstrates how a multidisciplinary team implemented collaborative efforts to reduce VAP rates and improve patient safety at a major urban teaching institution. VAP has become a major concern in the intensive care settings with an incidence rate ranging from 4 to 15 per 1,000 device days. In 2006, Pennsylvania hospitals reported risk adjusted average mechanical ventilator duration ranging from 4.1 to 16.1 days

TJUH's medical and administrative leadership has taken major proactive initiatives to bring the VAP rate to zero, foster facilitation among the multidisciplinary teams, and improve the quality in hospital-wide ICU's. In 2007, a VAP committee was formed to curtail VAP rates in ICU's.

Our original abstracted published in 2007 reflected one quarter's data, this abstract includes more than four quarters data.

Objective: Achieve a zero VAP rate in hospital-wide ICU's.

Setting: A major urban teaching hospital licensed for 1,000 beds with five adult ICU's

Design: A retrospective VAP analysis

Interventions: Implement evidenced-based interventions - educational in services, VAP bundle, oral care, oral decontamination, and other measures.

Measurements and Results: Since the implementation of interventions, average mechanical ventilator duration (MVD) ranged from 4.1 to 5.2 days across the intensive care units from the first-quarter 2007 to first-quarter 2008. Overall, there has been a significant improvement in VAP rates in ICUs. The increased VAP rates in the surgical coronary care unit (SCCU), the medical coronary care unit (MCCU), and the neurological intensive care unit (NICU) in the first quarter of 2008 can be explained by increased patient comorbidities (Figure 1). These units, along with the other ICUs will continue to be monitored closely.

Conclusion: Evidenced-based interventions, hospital-wide education, and multidisciplinary collaboration among caregivers have made a positive impact in the VAP rates.

Limitations: We believe our case-mix remains to be complex partly because a significant percentage of patient population is referred here from outside hospitals. Of these patients, the majority of them are intubated on the field with the conventional endotracheal tubes, thus a potential for aspiration prior to intubation.