PURPOSE: Prior research has shown adherence to best practice guidelines for VAP/CLABSI reduce incidence. Implementing guidelines has variable success. Elevated rates of VAP/CLABSI exist despite these measures. This study examines how interventions to improve education and accountability for the VAP/CLABSI bundle reduced VAP/CLABSI.
METHODS: Cornerstones of education and compliance were used. "Patient and family centered care" education encouraged patients and family to inquire about handwashing. "CRUSH OUT VAP" and "SMASH BSI" educated visitors and staff (fig1). Critical care educators attended staff meetings and conducted in-services. Daily multidisciplinary rounds included a checklist on the physician note to improve compliance. Chlorhexidine gluconate oral care was added to the VAP bundle and medicine record. Bundle checklists were added to nurse checkout and MICU charge nurse tasks. Central line insertion required nursing supervision, checklist completion, and physician signature. A retrospective data review utilizing the hospital infection control database calculated standardized infection ratios (SIR) using NHSN benchmarks. Rates and SIRS were compared using z-tests with P-values of <0.05 statistically significant.
RESULTS: VAP/CLABSI rates for 2009-2010 and timing of specific interventions are show in fig2. The incidence rate of VAP was 9.88 to 0 occurrences/1000 vent days (p<0.001). CLABSI occurrences/1000 line days were 2.86 in 2009 and 0.97 in 2010 (p=0.0187). The SIR for VAP was 4.12 in 2009 and 0 in 2010 (p<0.001). For CLABSI the SIR was 1.1 in 2009 and 0.37 in 2010 (p=0.04).
CONCLUSIONS: Efforts to ensure compliance were bolstered by improving physician, patient, and staff education. Interventions to ensure compliance were integrated into daily procedures. Following this system allowed use of VAP/CLABSI guidelines to decrease VAP/CLABSI.
CLINICAL IMPLICATIONS: Prior studies illustrated the high financial cost of VAP/CLABSI and associated problems with increased morbidity, mortality, length of stay, antibiotic usage, and antibiotic resistance. This study provides a role model for ensuring compliance with existing best practices for VAP/CLABSI prevention.
DISCLOSURE: The following authors have nothing to disclose: Scott Kellie, Michael Scott, Mohamed Saad, Rodrigo Cavallazzi, Timothy Wiemken, Deanna Parker
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