The Science Journal of the American Association for Respiratory Care

2010 OPEN FORUM Abstracts

A SCREENING TOOL USED TO ASSIST IN IDENTIFYING VAP IN A LARGE VENTILATOR POPULATION.

Michael Bocci, Rob Todd, Ken Hargett, Romar Reyes, Jose Rodriguez, Margaret Berger, Peggy Turner; Respiratory Care Services, The Methodist Hospital, Houston, TX

Background: Ventilator Associated Pneumonia (VAP) is an important topic for all institutions especially those that have a large population of ventilator patients. Infection Control departments often do not have sufficient resources to evaluate these patients. The National Nosocomial Infection Surveillance System allowed rotational sampling to determine VAP rates. This process often created questions regarding accurate reporting. Our institution averages 60-65 ventilators/day in 5 Intensive Care Units. A screening tool was developed by Respiratory Care to assist Infection Prevention Practitioners identify patients suspected of VAP. Method: Utilizing the Respiratory Care Management Information System, a VAP screening activity that incorporated components of the CDC definition of VAP was created. It included 1) change in color, consistency or amount of sputum 2) new or persistent infiltrate, 3) P/F< 240, 4) Fever>38 C, 5) VAP suspected in progress note. All vent patients were screened daily. A report that included all patients with a yes to any of the criteria was provided to Infection Prevention Practitioners for individual patient evaluation and discussion with the MD. Results: In 6 months 1308 patients with 10,802 vent days were screened. 392 (30%) patients had one or more indicators during their ventilation. 18 patients (4.5%) had VAP suspicion documented in the progress note. A breakdown of the indicators is included in the chart below. During the data collection period 2 patients were confirmed with a diagnosis of VAP (VAP rate < 1/1000 vent days). Conclusion: New or progressive infiltrate and P/F < 240 is common on ventilator patients but not specific enough to be the only indicator for VAP. The diagnosis of VAP is difficult and suspected by attending physicians even when the patient does not meet CDC definitions. Infection Prevention Practitioners follow stringent CDC definitions to properly diagnose VAP but cannot see all patients on a daily basis. A Respiratory Care screening tool utilizing the CDC definitions of VAP can be used to target surveillance by Infection Prevention Practitioners. Sponsored Research - None Percent of Screening Criteria Responses