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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 Goal to improve health care
delivery through 6 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
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
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.
Goals
Decrease VAP by 50% in one year
VAP Bundle
HOB increased 30 – 45° Daily sedation vacation with SBT OG vs. NG EVAC tubes
VAP Bundle cont’d
“Teams that have unfailingly accomplished every bundle element, on every patient,
every time ,have gone months without a single case of pneumonia associated with the
ventilator”.
Initiation of VAP
Required:
– Closed systems– Good mouth care
• Oral decontamination
– Proper hand washing
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
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 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
Removes pooled secretions from subglottic region
Reduces VAP from 39.6 to 19.9
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
Date/Time Bed#, Pt.
Initials
HOB ≥30°
If HOB not Elevated
Why
OG & Oral
Tracheal Tube
If No OG Or Oral
ETT Why
Mouth Care q4h/Brushing
BID
Sedation Vacation-Daily SBT
If no SBT Why
EVAC tube
If no why
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 MetEVAC: 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
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.
Questions?
Thank You!
