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Reducing Ventilator Associated Pneumonia in Adults Intensive Care Units

Reducing Ventilator Associated Pneumonia in Adults Intensive Care Units. Confidential: Quality Improvement Material. Goals.

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Reducing Ventilator Associated Pneumonia in Adults Intensive Care Units

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  1. Reducing Ventilator Associated Pneumonia in Adults Intensive Care Units Confidential: Quality Improvement Material

  2. Goals • Reduction of nosocomial VAP in the adult intensive care unit based on the National Healthcare Safety Network (NHSN) percentiles and the goal for the first year is to be below the 50th percentile which is 2.92. • The stretch goal is to be at the 25th percentile which is equivalent to 1.02 or below the 25th percentile. Confidential: Quality Improvement Material

  3. Interventions Implemented • VAP Task Force consisting of physicians, nurses, respiratory therapist and pharmacist • Education of healthcare workers in the adult ICU’s through the VAP computer based learning (CBL) • The VAP Bundle with 5 elements were instituted and utilized in all adult ICU’s • ICP collected data that supported identification of VAP (i.e., chest x-ray results, blood culture results, minimally contaminated respiratory cultures, vital signs, oxygen saturation, sputum quality & quantity, WBC) • All identified VAP infections were discussed 1:1 with the medical director of infection control Confidential: Quality Improvement Material

  4. Interventions continued • VAP infection rates were reported back to clinicians, nursing staff, IC Committee and senior leadership • Consistent use of hand hygiene • Implementation of Standard Precautions at all times • Consistent use of additional isolation practices as indicated (airborne, etc.) • Maintain closed suction system at all times • Contaminated condensate are carefully emptied from ventilator circuits and condensate prevented from entering into the lower airway Confidential: Quality Improvement Material

  5. Interventionscontinued • Continuous removal of subglottic secretions • Breathing circuits are not changed routinely, only when visibly soiled and mechanically malfunctioning • Appropriate cleaning of ventilator during and in between use • Avoidance of re-intubation • Provided education to patient and families Confidential: Quality Improvement Material

  6. Loyola VAP Bundle Elements • VTE/DVT Prophylaxis • Head of Bed Elevation • Peptic Ulcer Disease Prophylaxis • Daily Discussion of Readiness to Extubate/Wean • Oral Care / Hygiene Confidential: Quality Improvement Material

  7. VAP CHECKLIST-BUNDLE Confidential: Quality Improvement Material

  8. Confidential: Quality Improvement Material

  9. Next Step • Work in progress for VAP bundle to be completed electronically • Mandatory annual VAP CBL for all healthcare workers in all adult ICU’s • To scrutinize VAP cases to identify patterns and trends • To develop a culture of zero VAP philosophy among clinicians and doing the minimum is not enough Confidential: Quality Improvement Material

  10. References • Strategies to Prevent Ventilator Associated Pneumonia in Acute Care Hospitals byInfection Control Hospital Epidemiology of America 2008 • Tablan OC., Anderson, LJ., Besser, R., Bridges, C., Hajjeh, R. CDC Guidelines for Preventing Health Care Associated Pneumonia 2203 (Internet). MMWR Recommendations and Reports. 2204 March 26 (53(RR03): 1-36 • American Thoracic Society and the Infectious Diseases Society of America. Guidelines for the management of adults with hospital acquired , Ventilator Associated and Healthcare-associated Pneumonia. Am J Respir Crit Care Med. 2005 15 Feb; 171 (4): 388-416 • IHI 100,000 Lives Campaign. Getting Started Kit. Prevent VAP. How to Guide (Internet). Cambridge: IHI; 2006 (cited 2008 May 16). 34p. Available from: http://www.ihi.org/NR/rdonlyres/A448DDB1-E2A4-4D13-8F02-16417EC52990/0/VAPHow to GuideFINAL.pdf Confidential: Quality Improvement Material

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