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Implementation of VAP Bundle in Critical Care Significantly Reduces Ventilator Associated Pneumonia Rate in Level 1 Trauma Center
June 2006
E117
Publication Number 15-140
Implementation of VAP Bundle in Critical Care Significantly Reduces Ventilator Associated Pneumonia Rate in Level 1 Trauma Center MM McNally, RN, MHA, CIC, CHS1 AE Clark-Milton, RN, MSN1 OE Smith, RN1 RA Thornton, BS1 1
Center for Infectious Diseases, Memorial Health University Medical Center, Savannah, GA, USA
ISSUE: Memorial Health is a 550 bed tertiary care level 1 trauma center. In early 2005, we began participation in the IHI’s 100k Lives Campaign. In an effort to reduce Ventilator Associated Pneumonia (VAP), we made a commitment to implement the VAP Bundle in our critical care units. Our infection rate before implementation was an overal 15.7 infections per 1000 vent days. In addition, other respiratory infections were being inadvertantly diagnosed as a VAP, increasing our rate. PROJECT: With the support of senior leadership, a PI team was formed to implement the bundles in the critical care units. The ventilator bundle has four key components:HOB elevation, sedation vacation, PUD and PVD prophylaxis. Education on compliance was accomplished by departmental inservices and storyboards. All 4 components of the bundle had to be followed to be 100% compliant. Infection Control Practitioners participated in PI activities and critical care committee to enforce bundle compliance. Audit tools were incorporated into care manager and the patient’s daily assessment tool. A physician champion ensured medical staff education and compliance and reviewed all cases who met CDC definition for VAP to determine presence or absence of VAP by clinical parameters and radiographic presentation. RESULTS: Ventilator Associated Pneumonia rate continued to decline through 2005 to a final rate of 5.3 resulting in an overall reduction of over 67%. Audits were performed on all patients for compliance with bundle elements. Problem areas were sedation vacations and assessment of readiness to extubate. Some nurses were reluctant to hold sedation especially when patients could become combative. A steady awareness grew with all caregivers to ensure that all components were necessary to reduce risk of pneumonia. It was identified that mouthcare played a significant role in the eradication of upper respiratory colonizers which could cause lower respiratory infections. LESSONS LEARNED: A physician champion is necessary to advance best practice across the board; a collaborative team effort between Infection Control, Critical Care, Pharmacy, Respiratory Therapy, Education and others is vital to the success of any new implementation efforts; Continuous monitoring is necessary to promote 100% compliance efforts; Compliance with a bundle is only one step in the prevention of infections in our most acute patients but it raises awareness of other factors. Improvement in any process is continuous.
E117
Publication Number 15-140
Implementation of VAP Bundle in Critical Care Significantly Reduces Ventilator Associated Pneumonia Rate in Level 1 Trauma Center MM McNally, RN, MHA, CIC, CHS1 AE Clark-Milton, RN, MSN1 OE Smith, RN1 RA Thornton, BS1 1
Center for Infectious Diseases, Memorial Health University Medical Center, Savannah, GA, USA
ISSUE: Memorial Health is a 550 bed tertiary care level 1 trauma center. In early 2005, we began participation in the IHI’s 100k Lives Campaign. In an effort to reduce Ventilator Associated Pneumonia (VAP), we made a commitment to implement the VAP Bundle in our critical care units. Our infection rate before implementation was an overal 15.7 infections per 1000 vent days. In addition, other respiratory infections were being inadvertantly diagnosed as a VAP, increasing our rate. PROJECT: With the support of senior leadership, a PI team was formed to implement the bundles in the critical care units. The ventilator bundle has four key components:HOB elevation, sedation vacation, PUD and PVD prophylaxis. Education on compliance was accomplished by departmental inservices and storyboards. All 4 components of the bundle had to be followed to be 100% compliant. Infection Control Practitioners participated in PI activities and critical care committee to enforce bundle compliance. Audit tools were incorporated into care manager and the patient’s daily assessment tool. A physician champion ensured medical staff education and compliance and reviewed all cases who met CDC definition for VAP to determine presence or absence of VAP by clinical parameters and radiographic presentation. RESULTS: Ventilator Associated Pneumonia rate continued to decline through 2005 to a final rate of 5.3 resulting in an overall reduction of over 67%. Audits were performed on all patients for compliance with bundle elements. Problem areas were sedation vacations and assessment of readiness to extubate. Some nurses were reluctant to hold sedation especially when patients could become combative. A steady awareness grew with all caregivers to ensure that all components were necessary to reduce risk of pneumonia. It was identified that mouthcare played a significant role in the eradication of upper respiratory colonizers which could cause lower respiratory infections. LESSONS LEARNED: A physician champion is necessary to advance best practice across the board; a collaborative team effort between Infection Control, Critical Care, Pharmacy, Respiratory Therapy, Education and others is vital to the success of any new implementation efforts; Continuous monitoring is necessary to promote 100% compliance efforts; Compliance with a bundle is only one step in the prevention of infections in our most acute patients but it raises awareness of other factors. Improvement in any process is continuous.