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Safer Healthcare Now! Ventilator Acquired Pneumonia. Presented by Amanda Thompson, Safer Healthcare Now Facilitator April 12, 2007. Safer Healthcare Now! Background. Largest patient safety initiative in Canadian history Adopted from IHI Over 600 teams registered across Canada

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Safer Healthcare Now!

Ventilator Acquired Pneumonia

Presented by

Amanda Thompson, Safer Healthcare Now Facilitator

April 12, 2007

safer healthcare now background
Safer Healthcare Now! Background
  • Largest patient safety initiative in Canadian history
  • Adopted from IHI
  • Over 600 teams registered across Canada
  • Goal to improve health care delivery through 6 initiatives
safer healthcare now initiatives
Safer Healthcare Now! Initiatives
  • Acute Myocardial Infarction (AMI)
  • Ventilator Associated Pneumonia (VAP)
  • Central Line Associated Infection (CLI)
  • Prevention of adverse drug events through Medication Reconciliation (Med. Rec)
  • Prevention of Surgical Site Infection (SSI)
  • Rapid Response Teams (RRT)
vap ventilator associated pneumonia
VAP - Ventilator Associated Pneumonia

DEFINITION – “An airway infection developed more than 48 hours after a patient was intubated”

  • Leading cause of death
  • Increased ICU stay
  • Increased hospital stay
  • Increased costs
signs symptoms of vap
Signs & Symptoms of VAP

New, worsening or persistent infiltrate on CXR compatible with pneumonia and 2 of the following:

  • WBC > 11 or neutropenia
  • Temp > 38
  • Change in sputum
  • Pathogen isolated form sputum in last 48 hrs
  • Increasing O2 requirements for > 2 hrs

Note: Presence of crackles or bronchial breathing, and confusion in older pt’s is a good indicator of pneumonia.

  • Decrease VAP by 50% in one year
vap bundle
VAP Bundle
  • HOB increased 30 – 45°
  • Daily sedation vacation with SBT
  • OG vs. NG
  • EVAC tubes
vap bundle cont d
VAP Bundle cont’d

“Teams that have unfailingly accomplishedevery bundle element, on every patient, every time ,have gone months without a single case of pneumonia associated with the ventilator”.

initiation of vap
Initiation of VAP


  • Closed systems
  • Good mouth care
    • Oral decontamination
  • Proper hand washing
head of bed hob
Head of Bed (HOB)
  • Constant HOB elevation
  • Decreased VAP by 78%
  • Decreased risk of aspiration
  • Pt’s in supine position have lower spontaneous tidal volumes on pressure support
  • Minimize atelectasis
sedation vacation with sbt
Sedation Vacation with SBT
  • Stopping sedation at regular times every day. For example: morning assessment
  • RT to do a SBT
  • Decreases MV time from 7.3 days to 4.9 days
  • Weaning becomes easier
  • Use Riker Scale
oral vs nasal
Oral vs. Nasal
  • Oral endotracheal as well as oral gastric
  • Reduces frequency of nosocomial sinusitis from 73% to 34%
  • Nosocomial infections is a leading cause of death
evac tubes
EVAC Tubes
  • Removes pooled secretions from subglottic region
  • Reduces VAP from 39.6 to 19.9
additional components of quality ventilator care
Additional Components of Quality Ventilator Care
  • Peptic Ulcer Disease (PUD) prophylaxis
    • Decreased PH of gastric contents, may protect against pulmonary inflammatory response to aspiration
    • Decreased hospital stay
  • Deep Venous Thrombosis (DVT) prophylaxis
    • Decreased complications = Decreased Hospital Stay
  • Early Nutrition
    • Shown to decrease nosocomial infections
vap checklist
VAP Checklist

HOB: HI = Hemodynamic Instability SP = Spinal Precautions PR = Undergoing Procedure AG= Agitated NR = No Reason

OG: OT= Oral Trauma SU = Post Oral Surgery TR = Trach Insitue NGS = NG Sutured PE= Planned Extubation

SBT: CNM = Criteria Not Met

EVAC: NA = Not Available SI = ETT size > 6.0 TR = Trached

*Adapted from a tool created by Dominical Hospital (Santa Cruz, CA) March 20, 2007

vap improvement
VAP Improvement
  • Since implementing 2 of the 4 elements, VAP has decreased.
  • With continued use and implementation of all bundle elements, we can and will decrease VAP dramatically.
contact information
Contact Information

Amanda Thompson