The Science Journal of the American Association for Respiratory Care

2009 OPEN FORUM Abstracts

INCIDENCE OF VENTILATOR ASSOCIATED PNEUMONIA IN ADULTS IN THE HOMECARE SETTING

Louis M. Kaufman; Roberts Home Medical, Inc., Germantown, MD

BACKGROUND: Ventilator-associated pneumonia (VAP) is a significant complication among mechanically ventilated patients. An increasing number of ventilator-dependent patients are cared for at home. Epidemiologic data from a study performed in Michigan from 1995 to 2001 indicated the incidence of VAP is much lower in the homecare setting. METHOD: A retrospective review of adult ventilator-dependent patients cared for at home during 29 consecutive months was conducted. Roberts Home Medical, a privately owned for-profit durable medical equipment supplier, provided equipment, education and monitoring. Results were compared with published data of VAP infection rates in the hospital, skilled nursing facility and home. Eighty-four adult patients (age range 24 to 85; mean 53) received invasive mechanical ventilation in their home during the period January 2007 to May 2009 (total number of ventilator days = 47,806). A Respiratory Care Practitioner (RCP) visited each patient monthly to provide ongoing patient and caregiver training, perform environmental and patient assessments and maintain equipment. RCP documentation included all respiratory infections reported by the patient and/or caregiver. RESULTS: There were 36 reported cases of pneumonia and 7 reported upper respiratory infections; or 0.90 episodes per 1,000 ventilator days. The patient and/or caregiver information may have been non-specific for VAP; therefore, all reported respiratory infections were included in the data. Recently published reports include data from the National Healthcare Safety Network (NHSN) during 2006 to 2007 noting 3.75 incidents of VAP per 1,000 ventilator days in a variety of adult intensive care units (ICU) and 4.6 incidents of VAP per 1,000 ventilator days in adult step down units (SDU); the Boston University (BU) during 2006 to 2008 noting 1.67 incidents of VAP per 1,000 ventilator days in a long-term acute care hospital (LTACH); and the University of Michigan during 1995 to 2001 noting 1.55 incidents of VAP per 1,000 ventilator days in the homecare setting. CONCLUSION: In this population of adult ventilator-dependent patients receiving invasive mechanical ventilation at home, the incidence of respiratory infections is lower than in recently published reports of infection data in the ICU, SDU, LTACH and homecare settings. Sponsored Research - None

You are here: RCJournal.com » Past OPEN FORUM Abstracts » 2009 Abstracts » INCIDENCE OF VENTILATOR ASSOCIATED PNEUMONIA IN ADULTS IN THE HOMECARE SETTING