The Science Journal of the American Association for Respiratory Care

2009 OPEN FORUM Abstracts

INTENSIVE CHANGE-MANAGEMENT AND ENHANCED COMPLIANCE RESULTS IN SUCCESSFUL AND CONSISTENT IMPLEMENTATION OF VENTILATOR BUNDLE AND ORAL CARE PROTOCOL, 0 VAP FOR OVER 685 DAYS, AND SUBSTANTIAL ECONOMIC SAVINGS

Patricia DeJuilio; Respiratory Care, Central DuPage Hospital, Winfield, IL

Background: Ventilator-associated pneumonia (VAP) is calculated per 1,000 ventilator days, and ranges from 2.1 to 10.7, making it the most frequently reported healthcare-acquired infection in mechanically ventilated patients.1 Patients intubated >72 hours have VAP incidence rates of 20%.2 Prevalence rates are between 10% and 20%.3 Two 16-bed Intensive Care Units (ICUs) noted that after implementation of the Institution for Healthcare Improvement (IHI) ventilator bundle, the ICUs continued to have cases of VAP. A clinical practice specialist from the Department of Respiratory Care conducted a literature review to determine best practices for VAP prevention, and implemented a protocol incorporating additional oral care, change management, and a focus toward ventilator bundle and oral care compliance. Methods: The protocol consisted of the IHI bundle and oral care with cetylpyridinium chloride suction toothbrush and hydrogen peroxide (H2O2) swabs q2h oral care kit (changed from prior H2O2 oral care kit); intensive change-management strategies including evidence-based caregiver bundle and oral care protocol education and multi-disciplinary team approach; compliance tracking; awards and incentives for protocol compliance; family education and “family involvement posters”; ongoing qualitative metrics to determine need for additional education and change management; and quantitative metrics to track compliance in relation to VAP rates. Results: - Compliance with oral care protocol increased from 30% in July 2006 to 96% by end-2008 - Compliance with oral care was 60% in 04/07 and the VAP rate was 12.82; however, in 05/07 compliance rose to 72% and continued with an upward trend, with VAP rates dropping to 0 through 2008 - 650 days with 0 VAPs indicate 28.4 VAPs were prevented and 14 lives possibly saved - IHI bundle compliance is 100% Conclusion: Multidisciplinary change-management is essential to ensure compliance with a ventilator bundle and oral care protocol and prevention of VAP. Cost estimates range widely from $11,897 to $150,841 per case.4,5 Savings are calculated based on prevention of 28 VAPs and a cost per case of $40,000, resulting in an estimated savings of $1,120,000. 1. Edwards JR, et al. Am J Infect Control 2008;36:609- 26. 2. Piazza O, et al. Panminerva Med 2005;47:265-7. 3. Safdar N, et al. Crit Care Med 2005;33:2184- 93. 4. Warren DK, et al. Crit Care Med 2003;31:1312-7. 5. Kollef MH, et al. Chest 2005;128:3854-62. Sponsored Research - None

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