VAP Presentation

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Ventilator-Associated Pneumonia:

Jamie Carson, Ashley Raley, and Patty Whaley Maryville University Ventilator-Associated Pneumonia

Introduction to Ventilator-Acquired Pneumonia (VAP):

VAP is defined as “pneumonia occurring more than 48 hours after the patient has been intubated and received mechanical support” (Koenig & Truwit, 637) The Institute for Healthcare Improvement defines VAP, there is no minimum timeframe of the pneumonia occurrence VAP is noted to be the number one acquired nosocomial infection in the ICU setting Introduction to Ventilator-Acquired Pneumonia (VAP)

Definition of the Problem: VAP:

Statistics the likeliness to get VAP 10-30% risk of death 25-50% even higher mortality rate associated with resistance pathogens as of 2008, Medicaid and Medicare along with most other insurance companies do not cover nosocomial infections cost to a facility ranges $6,000-$ 50,000 - Significance to patient care Increased hospital stays Muscle wasting, non-optimal nutrition status for healing, potential for kidney dysfunction related to antibiotic therapy Highly likeliness of developing a resistant pathogen Definition of the Problem: VAP

Prevalence and Ideal Benchmark:

Research and major interest sparked in the late 1990s Major Quality Initiative Goal is ZERO prevalence CDC recommends a benchmark of 1.6 per 1,000 ventilator days Not a realistic goal, therefore should not be used as a benchmark Lack of consistency in diagnosis Variable Case mix Patient’s age Severity of illness Comorbidities Trauma or surgical status Hospital environment or equipment Immunologic status and condition of oral health Disease processes that mimic VAP -Pulmonary edema –Sepsis – Acute Respiratory Distress Syndrome -Pulmonary embolism –Atelectasis Prevalence and Ideal Benchmark

VAP Bundle:

Infection Control and Prevention Equipment & Environment Infection Control Patient Positioning Sedation Interruption/Vacation Routine Assessment of Readiness to Wean Routine Oral Care Peptic Ulcer Disease (PUD) Prophylaxis VAP Bundle

Data Collection: Data Needed:

Collect data to establish baseline Identify rates of compliance Compare rates to state, regions, or national rates Data collected: Determining compliance rates for interventions Observed performance versus observed opportunities Numerator: # of observed performances (67) Denominator: # of observed opportunities (100) Result: 67% compliance Data Collection: Data Needed

Analysis:

VAP can be drastically reduced Mercy Hospital in Minnesota-ventilator bundle eliminated VAP Ochsner Medical Center in New Orleans- reported a zero VAP rate for 2011 East Jefferson General Hospital in Louisiana-reported a decrease from 2.3 to 1.9 VAPS per 1,000 ventilator days Barnes-Jewish Hospital-St. Louis Missouri has been able to decrease VAP rates from 12.6 to 5.7 per 1000 ventilator days. Analysis

Selecting a Solution:

Best solution: Quality Improvement Plan Initiation of VAP Bundle Ties together each solution previously described VAP Bundle: Standard of care for most institutions Must haves: P roper guidance from leadership Necessary Data Developed plan to bring about change Supporting Change Model: Lewin’s Change Model Selecting a Solution

Communication Plan:

Good communication is vital Leadership should communicate the following: 1. Inform staff of plan for change and developed method 2. Educate staff and address staff questions/concerns 3. Emphasize importance of why change is being made 4. Support rationale with evidence-based findings End Result: Staff works cohesively to achieve greater patient outcomes New-norm New Standardization of Care Increased compliance Prevention of VAP Communication Plan

Discussion:

Detriment of VAP to staff and patients VAP may never be completely eliminated but greatly reduced with simple measures such as: Timed oral care, stress ulcer prophylaxis, elevating HOB, draining condensation for ventilator tubing, early intervention Implementing change Lewin’s change model Communication with team to sustain change Cost savings and outcomes data Discussion

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