Ventilator-Associated Pneumonia (VAP): Reduction, Accountability & Commitment

Purpose:
A special cause variation in the ICU's Ventilator-Associated Pneumonia (VAP) rate drove review of current practices, incorporation of best practices in the literature, and development of protocols and tools to monitor care.

Significance:
VAP leads to increased morbidity & mortality and is the leading cause of death among healthcare acquired infections. VAP prolongs ventilator use, increases length of stay, and has a mortality of 46%. Implementing evidenced-based interventions and holding staff accountable for practice saves lives.

Strategy and Implementation:
A rise in the ICU VAP rate led to the formation of a multidisciplinary team to improve the care of the mechanically ventilated patient. The team included staff representation from Respiratory Care, PACU, and ED. Practice guidelines were updated based on the Institute for Healthcare Improvement's "bundled" care interventions for the ventilated patient and American Association for Respiratory Care recommendations. Comprehensive education regarding guidelines was completed. Critical care rounds as well as Nursing and Respiratory Care audits ensured standards adherence. In the moment peer review identified educational opportunities and held staff accountable for patient care. Ongoing review of current research findings led to the adoption of endotracheal tubes with continuous aspiration subglottic suctioning. Chlorhexidine was also added to oral care packets. Implications for improved patient outcomes fostered "buy in" from staff and adherence to evidence-based guidelines.

Evaluation:
Vigilance, accountability and commitment decreased the ICU VAP rate from 12.2 in 2006 to 1.7 in 2010. Effective strategies included best practice education, a multidisciplinary approach to continuous improvement, and holding staff accountable for care.

Implications for Practice:
Practice changes require comprehensive education, ongoing compliance assessment, and communication of performance outcomes. Reflection on the patient advocacy role and caregiver accountability fosters a professional practice environment, safer patient environment and outstanding quality of care.