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The value of infection control prevalence rounds in a large teaching hospital
American
148
Abstracts
COMPARISON OF THE INCIDENCE OF NOSOCOMIAL VENTILATOR ASSOCIATED PNEUMONIA IN CHRONIC VENTILATOR DEPENDENT PATIENTS ON A RESPIRATORY CARE UNIT AND THE GENERAL MEDICAL/SURGICAL UNITS IN A LARGE TEACHING HOSPITAL. M. Ninivaggi,* I. Selva, A. Toledo, A. Mamney. S. Forlenza. Nassau County Medical Center, East Meadow, NY. Nosocomial pneumonia frequently is associated with endotracheal intubation and ventilator assisted respiration. Instrumentation of the respiratory tract facilitates entry of bacteria into the lower respiratory tract and thus increases the likelihood of pneumonia. Ventilator associated pneumonia (VAP) has a reported mortality of up to 70%. Due to ita frequency and high case-fatality rate., prevention of VAP in the chronically ill ventilator dependent patient (VDP) population is a primary infection control concern. The purpose of this study is to determine whether the placement of chronic VDPs on a Respiratory Care Unit (RCU) specifically designated for optimal cam of these patients decreases the incidence of VAP at this institution. Using National Nosocomial Infections Surveillance (NNIS) criteria for the diagnosis of nosocomial pneumonia, a prospective analysis was done comparing the incidence of nosocomial VAP in chronic VDPs cohorted on a RCU with that of VDPs scattered on general medical/surgical units (GMfSUs). The 12-bed RCU provides a private mom. a nursing staff trained in the cam of VDPs and a satellite Respiratory Therapy Department with staff and equipment located on the unit. In general, patients housed in the GM/SUs were in 2-bed rooms with regular nursing staff providing day-today care and mspiratory therapy providing intermittent therapy as needed. All patients in the RCU and GM/SUs had been ventilator dependent for at least 2 weeks and had similar underlying diseases and severity of illness scores. The decision to house chronically VDPs on the RCU or GM/SUs was based strictly on bed availability in the RCU. During the period of surveillance there were 20 VAPs per 2265 ventilator days on the RCU and 7 VAPs per 301 ventilator days on the GM/SW, giving an incidence of 8.4 versus 23 VAPs per loo0 ventilator days on the RCU and GM/SUs respectively. These findings support the concept that the incidence of nosocomial VAP on a specialty RCU is significantly less than the incidence of VAP in VDPs cared for on the GM/SUs. The use of such a unit may result in a lower incidence of VAP and its related morbidity and mortality in chronically VDPs.
INFECTION
THE VALUE OF INFECTION IN A LARGE TEACHING A. Mamney, M. Nbrivaggi, Center, East Meadow, NY.
Journal
of
CONTROL
CONTROL PREVALENCE ROUNDS HOSPITAL. I. Selva,* A. Toledo, S. Forlenza. Nassau County Medical
Infection Control Prevalence Rounds (ICPRs) can be advantageous to all hospital departments in affecting good infection control practices and maintaining the health care facility at top operating capacity to meet the Infection Control Standards set by goveming agencies and hospital administration. ICPRs are designed to optimize hospital environment and patient care practices and may decrease the severity and number of infection control citations to the health care facility by regulatory agencies. Nassau County Medical Center (NCMC) is a 700-bed universityafiiliated teaching hospital which serves as a primary and tertiary care center serving patients from all socioeconomic levels. In 1988, ICPRs were instituted at NCMC by the Infection Contml Practitioner (KP), using a team approach. The team consisted of representatives from infection control and the department being evaluated. Each department was evaluated utilizing pmdetennined criteria specific to the department being evaluated. During the ICPRs, immediate consultation with feedback and recommendations am given to the department representatives. In addition, written reports using a quality assurance (QA) format are generated with stated findings and recommendations which require timely corrective action. A time limit is provided for written corrective action response. The report is then presented to the Infection Control Committee for review and approval. This report is documented in the minutes which am disseminated to the Executive Committee of the Medical Staff (ECMS) and the QA Committee. Since implementing ICPRs at NCMC, the following benefits have been documented: (1) a decrease in the number of citations from the Joint Commission on Accreditation of Healthcare Organizations, the state and local Health Departments relevant to infection control practices (mean # citations/year preXPRs=190, post-ICPRs=37), (2) the ICF’Rs serve as an excellent educational tool to the hospital staff; (3) recognition by departmental staff of the ICP as a tesource for infection control information and practices resulting in improved communications between infection control and various other departments; and (4) development of an ongoing high standard of compliance to infection control practices allowing the institution to be continuously prepared for mandatory inspections by federal, state, and local agencies. In addition to optimizing standards of cam and safety of patients and staff, the ICPRs have resulted in increasing the ICP’s influence on the medical staff, individual departments and administration in maintaining high standards in the Health Care Facility. Prevalence Rounds by Infection Control had a detinitc impact on the reduction of Infection Controls citations for this institution.
148
Abstracts
COMPARISON OF THE INCIDENCE OF NOSOCOMIAL VENTILATOR ASSOCIATED PNEUMONIA IN CHRONIC VENTILATOR DEPENDENT PATIENTS ON A RESPIRATORY CARE UNIT AND THE GENERAL MEDICAL/SURGICAL UNITS IN A LARGE TEACHING HOSPITAL. M. Ninivaggi,* I. Selva, A. Toledo, A. Mamney. S. Forlenza. Nassau County Medical Center, East Meadow, NY. Nosocomial pneumonia frequently is associated with endotracheal intubation and ventilator assisted respiration. Instrumentation of the respiratory tract facilitates entry of bacteria into the lower respiratory tract and thus increases the likelihood of pneumonia. Ventilator associated pneumonia (VAP) has a reported mortality of up to 70%. Due to ita frequency and high case-fatality rate., prevention of VAP in the chronically ill ventilator dependent patient (VDP) population is a primary infection control concern. The purpose of this study is to determine whether the placement of chronic VDPs on a Respiratory Care Unit (RCU) specifically designated for optimal cam of these patients decreases the incidence of VAP at this institution. Using National Nosocomial Infections Surveillance (NNIS) criteria for the diagnosis of nosocomial pneumonia, a prospective analysis was done comparing the incidence of nosocomial VAP in chronic VDPs cohorted on a RCU with that of VDPs scattered on general medical/surgical units (GMfSUs). The 12-bed RCU provides a private mom. a nursing staff trained in the cam of VDPs and a satellite Respiratory Therapy Department with staff and equipment located on the unit. In general, patients housed in the GM/SUs were in 2-bed rooms with regular nursing staff providing day-today care and mspiratory therapy providing intermittent therapy as needed. All patients in the RCU and GM/SUs had been ventilator dependent for at least 2 weeks and had similar underlying diseases and severity of illness scores. The decision to house chronically VDPs on the RCU or GM/SUs was based strictly on bed availability in the RCU. During the period of surveillance there were 20 VAPs per 2265 ventilator days on the RCU and 7 VAPs per 301 ventilator days on the GM/SW, giving an incidence of 8.4 versus 23 VAPs per loo0 ventilator days on the RCU and GM/SUs respectively. These findings support the concept that the incidence of nosocomial VAP on a specialty RCU is significantly less than the incidence of VAP in VDPs cared for on the GM/SUs. The use of such a unit may result in a lower incidence of VAP and its related morbidity and mortality in chronically VDPs.
INFECTION
THE VALUE OF INFECTION IN A LARGE TEACHING A. Mamney, M. Nbrivaggi, Center, East Meadow, NY.
Journal
of
CONTROL
CONTROL PREVALENCE ROUNDS HOSPITAL. I. Selva,* A. Toledo, S. Forlenza. Nassau County Medical
Infection Control Prevalence Rounds (ICPRs) can be advantageous to all hospital departments in affecting good infection control practices and maintaining the health care facility at top operating capacity to meet the Infection Control Standards set by goveming agencies and hospital administration. ICPRs are designed to optimize hospital environment and patient care practices and may decrease the severity and number of infection control citations to the health care facility by regulatory agencies. Nassau County Medical Center (NCMC) is a 700-bed universityafiiliated teaching hospital which serves as a primary and tertiary care center serving patients from all socioeconomic levels. In 1988, ICPRs were instituted at NCMC by the Infection Contml Practitioner (KP), using a team approach. The team consisted of representatives from infection control and the department being evaluated. Each department was evaluated utilizing pmdetennined criteria specific to the department being evaluated. During the ICPRs, immediate consultation with feedback and recommendations am given to the department representatives. In addition, written reports using a quality assurance (QA) format are generated with stated findings and recommendations which require timely corrective action. A time limit is provided for written corrective action response. The report is then presented to the Infection Control Committee for review and approval. This report is documented in the minutes which am disseminated to the Executive Committee of the Medical Staff (ECMS) and the QA Committee. Since implementing ICPRs at NCMC, the following benefits have been documented: (1) a decrease in the number of citations from the Joint Commission on Accreditation of Healthcare Organizations, the state and local Health Departments relevant to infection control practices (mean # citations/year preXPRs=190, post-ICPRs=37), (2) the ICF’Rs serve as an excellent educational tool to the hospital staff; (3) recognition by departmental staff of the ICP as a tesource for infection control information and practices resulting in improved communications between infection control and various other departments; and (4) development of an ongoing high standard of compliance to infection control practices allowing the institution to be continuously prepared for mandatory inspections by federal, state, and local agencies. In addition to optimizing standards of cam and safety of patients and staff, the ICPRs have resulted in increasing the ICP’s influence on the medical staff, individual departments and administration in maintaining high standards in the Health Care Facility. Prevalence Rounds by Infection Control had a detinitc impact on the reduction of Infection Controls citations for this institution.