Chest Infections: Respiratory Care |

Ventilator-Associated Pneumonia Reduction Strategies: Single Institution Experience FREE TO VIEW

Arjun Madhavan, MD; Patricia Ford, RN; Amy Gram, RN; Paris Charilaou, MD
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Saint Peters University Hospital, New Brunswick, NJ

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):154A. doi:10.1016/j.chest.2016.08.163
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Published online

SESSION TITLE: Respiratory Care

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 26, 2016 at 01:30 PM - 02:30 PM

PURPOSE: Ventilator associated infectious complications are directly associated with longer duration of mechanical ventilation, longer stays in the ICU and hospital, increased health care cost and increased risk of disability and death. We determined two key strategies that reduced ventilator associated pneumonia in our institution.

METHODS: As part of a performance improvement project, we collected VAP data per 1000 ventilator days for the year 2009 and 2010. For the year 2011-2014 this was collected every quarter. Ventilator associated pneumonia was determined as the rate per 1000 ventilator days. In addition to the usual care that included head of bed elevation, hand hygiene, maintenance of closed respiratory circuit with inline suctioning, patient mobility, protocol based liberation and sedation, we introduced endotracheal tubes with a subglottic suctioning device (Mallinckrodt Taper Guard Evac Oral Endotracheal Tube) and Q4 chlorhexidine gluconate/biotene oral care kits in the 1st quarter of 2012. This included all endotracheal tubes that were placed in the institution except for outside hospital transfer and field intubation performed by EMS. The oral care was provided by the RN q4 hourly with medline CHG kits in all intubated patients upon admission to the ICU untill the day of liberation. The compliance of these two steps was monitored during daily interdisciplinary rounds. VAP was diagnosed by CDC/NHSN guidelines. This is prior to the change in VAE surveillance algorithm guidelines introduced in January 2015 by CDC/NHSN.

RESULTS: For 2009 and 2010 overall VAP rate/ 1000 ventilator days was observed. From 2011 until 2014 VAP rate/1000 ventilator days was observed by quarter. In 2009 and 2010 the VAP rate was 2.3 per 1000 ventilator days and 1.2 per 1000 ventilator days respectively. The VAP rate/1000 vent days in the 1st, 2nd and 3rd quarter of 2011 were 2.1, 4.3, 3.1 respectively. The two specific interventions, Mallinckrodt Taper Guard Evac Oral Endotracheal Tube and Q4hr chlorhexidine gluconate/biotene oral care were trialed in the 4th quarter of 2011 and implemented in the 1st quarter of 2012. The VAP rate/1000 vent days was 1.7 in the 4th quarter of 2011. Since the 1st quarter of 2012 we observed 0 VAP rate/1000 ventilator days. This has been consistent until the 4th quarter of 2014. In addition this trend was observed to continue until the 2nd quarter of 2015.

CONCLUSIONS: Tapered cuff endotracheal tubes with sub glottic suctioning port and sequential chlorhexidine gluconate/biotene oral care in addition to the usual care reduced VAP events in our institution. We recommend these measures to be included in standard practices performed in adult ventilated patients to reduce VAP events.

CLINICAL IMPLICATIONS: Endotracheal tubes with tapered cuff and sub glottic suctioning port reduce VAP events

DISCLOSURE: The following authors have nothing to disclose: Arjun Madhavan, Patricia Ford, Amy Gram, Paris Charilaou

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