2010 OPEN FORUM Abstracts
15 YEAR EXPERIENCE ON REDUCTION OF VENTILATOR ASSOCIATED PNEUMONIA (VAP) ONE INSTITUTIONS EXPERIENCE.
Joy K. Hargett, John Sabo; Respiratory Care, St. Lukes Episcopal Hospital, Houston, TX
Background: In 1997, a multidisciplinary team consisting of infection control practitioners, respiratory therapists, nurses, pulmonary and infectious disease physicians was established to address increasing VAP rates. Method: We developed a screening tool that identified pneumonia risk patients and an intervention protocol. This tool evaluated patients who were mechanically ventilated for greater than 24 hours and did not have an infectious disease physician or pulmonologist. The protocol included (1) obtain sputum sample (2) obtain chest x-ray if not done within last 24 hours, (3) order complete blood count if not done in last 24 hours, (4) institute closed suction catheter, (5) twice daily chlorhexidine mouth care (6) daily replacement of SVN on ventilator patients (7) repeat orders every 48 hours until patient was extubated, trached, a positive sputum culture obtained or pulmonary/infectious disease physician consult occurred. Attending physicians were notified if the sputum gram stain was positive or if certain organisms were identified and physicians received guidelines for empiric therapy. This was piloted in our 41-bed cardiovascular ICU and then expanded to all ICUs. Since the inception of the project continued performance improvement has occurred. Evaluation of the project from 1996-2006 or the 10 year report card showed an 86% reduction in the VAP rate house wide. Since then, we have instituted a number of practices that we feel have led to a continued reduction in VAP rates. These practices include (1) institution of water free heated wire circuits on all ventilators patients, (2) continued replacement of inline nebulizers daily (3) use of the closed suction catheter on all ventilator patients and (4) changing the ventilator circuit prn. In 2009, we introduced a revised order set on ventilator care, including spontaneous awakening and breathing trials, and sedation management. All staff (respiratory care and nursing) was educated on this new tool. In 2010, we changed the products utilized for oral care. Results: Since 2006 the VAP rate continued to decrease another 33% or 91% from the 1997 baseline. Conclusion: Continued decline in the VAP rate has been seen and in some months, no VAPs are reported. We currently focus on maintaining/improving this quality level by continually monitoring our VAP rate. As VAPs do occasionally occur, we review individual cases in order to determine if certain causation factors can be identified. Sponsored Research - None