Best Practice Guidelines for Prevention of Ventilator Associated Pneumonia

Purpose:
Ventilator Associated Pneumonia (VAP) is a common nosocomial infection that is associated with poor clinical outcomes in the critically ill patient. Our organization aimed to change and deliver care through evidence based guidelines modeling the Institute for Healthcare(IHI)100,000 Lives Campaign.

Significance:
VAP leads to a significant increase in ventilator days and prolongs ICU length of stay. VAP is associated with increases in morbidity and mortality in ICUs, and contributes to an additional hospital costs of $50,000 per patient.

Strategy and Implementation:
CDC NNIS definition determined a VAP diagnosis. In June 2005, our organizations team of nursing, clinical support staff and quality joined the IHI and adopted a ZAP the VAP ventilator bundle in our ICUs to target the prevention of VAP. Measures included HOB elevation, oral hygiene, endotracheal tube suctioning, daily sedation interruption, peptic ulcer disease prophylaxis, deep vein thrombosis prophylaxis, and strict glucose control. In the care of our ICU mechanically ventilated patients, the two crucial initiatives of our ZAP the VAP campaign were the implementation of a comprehensive oral-hygiene program and the elevation of the HOB to 30°. An oral-hygiene program every 4 hours included kits with oral cleansing tools, cleansing solutions, and suctioning systems. Other vigilant nursing interventions incorporated into the care of these patients included turning a minimum of every 2 hours, and utilizing beds with continuous lateral rotation therapy to increase pulmonary drainage.

Evaluation:
Daily rounding on patients ensured compliance with oral hygiene and head of the bed elevation. The rate of VAP decreased to 0.98 per 1,000 ventilator patient days in December 2008 from 7.72 per 1,000 ventilator patient days pre-bundle. Current analysis demonstrates 24 months without a VAP episode.

Implications for Practice:
Education, acquistion of tools, nursing empowerment to improve patient outcomes and change practice are key. Patient's plan of care to include a VAP bundle using evidence-based practices recommended by IHI and CDC. ICUs must be diligent to prevent harm, and economic burdens associated with VAP.