Prevention of Ventilator Associated Pneumonia (VAP) Improved Patient Outcomes at
St. Edward Mercy Medical Center
VAP is a hospital acquired airway infection that can develop 48 hours after the patient is on mechanical ventilation. It is the leading cause of death among hospital acquired infections and has a high rate of associated mortality. VAP is also associated with an increased length of time spent on a ventilator, Intensive Care Unit (ICU) length of stay and hospital length of stay after transfer from ICU. In addition, VAP is responsible for increased healthcare costs. The Institute for Healthcare Improvement’s (IHI) 5 Million Lives Campaign has a goal to prevent VAP by implementing the four components of care called the ventilator bundle.
The four components of Ventilator Associated Pneumonia (VAP) Prevention are as follows:
- Elevation of the head of the bed between 30 and 45 degrees
- Daily “sedation vacation” and assessment of readiness to extubate
- Peptic Ulcer Disease (PUD) Prophylaxis
- Deep Vein Thrombosis (DVT) Prophylaxis (unless contraindicated)
St. Edward Mercy Medical Center has fully implemented the IHI’s Prevention of Ventilator Associated Pneumonia (VAP) initiative.
The development of a VAP team was the first step in meeting our goal. The team consisted of medical staff, ICU nurse leaders, respiratory therapy, and quality management. Our first initiative was the development and implementation of an Oral Care Protocol. The Centers for Disease Control (CDC) recommended frequent oral hygiene for all ventilated patients.
Second, a DVT prophylaxis protocol was developed and implemented. This allowed for every patient in the ICU to be assessed for the need for DVT prophylaxis by the physician.
Third, ventilator order sets were developed which included medications to prevent PUD immediately after the start of mechanical ventilation.
Fourth, the team provided education to the nursing staff on “sedation vacation” for patients receiving continuous sedation while on mechanical ventilation based on a protocol.
St. Edward Mercy Medical Center has seen a significant decrease in the rate of VAP in the Intensive Care Unit after the implementation of the IHI’s Prevention of Ventilator Associated Pneumonia (VAP) initiative. Our efforts have improved the overall outcomes for our patients.
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