The Science Journal of the American Association for Respiratory Care

2009 OPEN FORUM Abstracts

EFFECT OF EDUCATIONAL OUTREACH IN ACHIEVING VENT-BUNDLE COMPLIANCE AND DECREASING VAP RATE

Sally Whitten1, John Dziodzio1, Christopher Hirsch1, Sally Brewer1, Cynthia Honess2, Nicole Manchester2, Sonja Orff2, Micheline Chipman2; 1Division of Pulmonary and Critical Care Medicine, Maine Medical Center, Portland, ME; 2Department of Nursing, Maine Medical Center, Portland, ME

Background. As part of a strategy toward decreasing incidence of VAP in our institution, we introduced a “vent bundle” of best-practice procedures and policies. Although we were (by electronic data collection) 100 percent compliant with the bundle, subsequent VAP rate tracking did not indicate a satisfactory level of response to the intervention. We decided to examine the specific elements constituting vent-bundle compliance. In order to increase compliance with the component constituents of the vent bundle a follow-up remedial educational effort was conducted for Respiratory Therapists (RTs), Nurses, and Physicians. Methods. A questionnaire touching on the main concepts of the bundle was provided in 2007 to assess the general level of understanding, and again in 2008, to assess the effect of the educational program amongst caregivers. Questions addressed oral care, suctioning, use of HME, timely weaning, and other aspects of VAP prevention and general knowledge. Results. Among all respondents, there was a 25% overall increase in positive responses across all questions in 2008 compared to 2007. Respondents increased most strongly in their feeling that they were kept aware of the recent VAP rate (Δ%=69.7, P<0.0000001), VAP reporting requirements (Δ%=58.9, P<0.0000001), VAP as the leading cause of nosocomial infection (Δ%=30.3, P=0.0005), and the need in diligence to maintain appropriate endotracheal tube cuff inflation pressure (Δ%=21.6, P=0.0048). Other statistically significant increases concerned the evidence supporting use of HME vs. heated-wire circuits (Δ%=26.4, P=0.0032), and that VAP is preventable (Δ%=21.2, P=0.0357). Non-statistically significant increases were seen in questions of timely weaning (Δ%=11.1, P=0.18), and understanding of causes and definition of VAP (Δ%=13.4, P=0.15) as these responses were fairly high in both the 2007 and 2008 evaluations. Conclusions. Comparison of the mean VAP rate in the months preceding and following the vent-bundle educational effort, together with the effects of implementation of the bundle, demonstrated an overall decrease of 28% (P=0.011). We attribute the dissemination of knowledge about the bundle components as a motivation for the caregivers to come more fully into compliance, and to more significantly impact VAP incidence. Sponsored Research - None

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