PURPOSE: Ventilator associated pneumonia (VAP) occurs in 9-27% of all intubated patients. It is associated with a high attributable mortality and excessive hospital costs. Many strategies have been developed in an attempt to prevent VAP. We organized a VAP committee to review reported cases and developed hospital-wide protocols to reduce our occurrence of VAP.
METHODS: Allegheny General Hospital is a tertiary care, academic facility in Pittsburgh, PA with 778 beds including 120 critical care beds consisting of NICU, MICU, CCU, CTSICU, and a level 1 trauma ICU. In January 2004, a VAP committee consisting of physicians in Pulmonary/Critical Care and Infectious Diseases and an infection control team was organized to evaluate the hospitals VAP rate. Over the next two years, a series of pre-printed protocols were introduced hospital-wide. These included protocols on bag-valve-mask care, oral decontamination, yankauer suction devices, sedation, head of bed elevation, and ventilator weaning. Monthly audits were then performed to assess compliance. The VAP committee met monthly and reviewed all suspected cases. Total number of VAP cases were collected from January 1, 2004 to February 28, 2007. Hospital cost was also analyzed.
RESULTS: A total of 288 cases of VAP were prevented in the 38 month period with a total cost savings of $7.64 million. Our VAP rate decreased from 159 cases per year (10.0/1000 ventilator days) to an average of 68 per year (4.3/1000 ventilator days).
CONCLUSION: The formation of a VAP committee and adoption of hospital-wide protocols utilizing evidence-based prevention guidelines can result in a large reduction in VAP with considerable cost benefits.
CLINICAL IMPLICATIONS: Reducing VAP decreases morbidity in patients with presumed benefits in mortality along with considerable cost savings.
DISCLOSURE: Alan Kanouff, No Financial Disclosure Information; No Product/Research Disclosure Information