To describe a multidisciplinary approach and implementation of evidence-based practices directed to the decrease the rate of ventilator-associated pneumonia (VAP) in five adult and pediatrics intensive care unit (ICU) in a tertiary-care teaching institution.
A prospective surveillance program was used to identify cases admitted to any of our five ICUs. The definition of VAP was standardized in all units and we included microbiologically confirmed cases using mini-BAL. Methods: In 3/2007 a multidisciplinary team developed a definition for VAP and implemented a multipronged approach that included education, standardized diagnosis and direct confirmation of the use of the VAP “bundle” measures. Oral care implemented by Nurses started in 11/2007, Respiratory Therapists assumed oral care in 11/2008 and use of chlorhexidine in oral care was implemented in 2/2009. Use of silver coated endotracheal tube was introduced in 2/2009. We compared the rate of VAP in 2 periods of 3 months in 2008 and 2009. We report descriptive statistics and Wilcoxon's test was used to compare the two groups.
Results: The rate of VAP was 4.8±2.4 cases per 1000 ventilator/days during 2008 and 0.4±0.7 in 2009 (P=0.004, Wilcoxon's test). There was a tendency when we compared the first 3 months of 2008 vs 2009 (P=0.10).
Conclusion: There is a significant reduction in the rate of VAP with the implementation of a multipronged approach including oral care done by Respiratory therapist.
Multidisciplinary involvement is key to reduce incidence of VAP.
Alejandro Arroliga, No Financial Disclosure Information; No Product/Research Disclosure Information