1. Reducing Ventilator Associated Pneumonia in Adults Intensive Care Units
Confidential: Quality Improvement Material

2. Goals
Reduction of nosocomial VAP in the adult intensive care unit based on the National Healthcare Safety Network (NHSN) percentiles and the goal for the first year is to be below the 50th percentile which is 2.92.
The stretch goal is to be at the 25th percentile which is equivalent to 1.02 or below the 25th percentile.
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3. Interventions Implemented
VAP Task Force consisting of physicians, nurses, respiratory therapist and pharmacist
Education of healthcare workers in the adult ICU’s through the VAP computer based learning (CBL)
The VAP Bundle with 5 elements were instituted and utilized in all adult ICU’s
ICP collected data that supported identification of VAP (i.e., chest x-ray results, blood culture results, minimally contaminated respiratory cultures, vital signs, oxygen saturation, sputum quality & quantity, WBC)
All identified VAP infections were discussed 1:1 with the medical director of infection control
Confidential: Quality Improvement Material

4. Interventions continued
VAP infection rates were reported back to clinicians, nursing staff, IC Committee and senior leadership
Consistent use of hand hygiene
Implementation of Standard Precautions at all times
Consistent use of additional isolation practices as indicated (airborne, etc.)
Maintain closed suction system at all times
Contaminated condensate are carefully emptied from ventilator circuits and condensate prevented from entering into the lower airway
Confidential: Quality Improvement Material

5. Interventions continued
Continuous removal of subglottic secretions
Breathing circuits are not changed routinely, only when visibly soiled and mechanically malfunctioning
Appropriate cleaning of ventilator during and in between use
Avoidance of re-intubation
Provided education to patient and families
Confidential: Quality Improvement Material

6. Loyola VAP Bundle Elements
VTE/DVT Prophylaxis
Head of Bed Elevation
Peptic Ulcer Disease Prophylaxis
Daily Discussion of Readiness to Extubate/Wean
Oral Care / Hygiene
Confidential: Quality Improvement Material

7. VAP CHECKLIST-BUNDLE Date: VAP Patient On Ventilator: Bundle
Yes / No
VTE/DVT PROPHYLAXIS
Does the patient have orders for heparin or enoxaparin for VTE prophylaxis? NA
ACTION ITEMS (if on ventilator)
HEAD ELEVATION
Is the HOB elevated at least 30 degrees?
PUD PROPHYLAXIS
Does the patient have PUD Prophylaxis orders?
Discussion of Readiness to Extubate/Wean
Yes, when readiness to extubate/weaning & sedation reduction is discussed (even in very ill patients)
No, when above is not discussed
ORAL CARE / HYGIENE
Oropharyngeal cleaning/decontamination every 4 hours and prn
Confidential: Quality Improvement Material

8. Confidential: Quality Improvement Material

9. Next Step
Work in progress for VAP bundle to be completed electronically
Mandatory annual VAP CBL for all healthcare workers in all adult ICU’s
To scrutinize VAP cases to identify patterns and trends
To develop a culture of zero VAP philosophy among clinicians and doing the minimum is not enough
Confidential: Quality Improvement Material

10. References
Strategies to Prevent Ventilator Associated Pneumonia in Acute Care Hospitals byInfection Control Hospital Epidemiology of America 2008
Tablan OC., Anderson, LJ., Besser, R., Bridges, C., Hajjeh, R. CDC Guidelines for Preventing Health Care Associated Pneumonia 2203 (Internet). MMWR Recommendations and Reports March 26 (53(RR03): 1-36
American Thoracic Society and the Infectious Diseases Society of America. Guidelines for the management of adults with hospital acquired , Ventilator Associated and Healthcare-associated Pneumonia. Am J Respir Crit Care Med Feb; 171 (4):
IHI 100,000 Lives Campaign. Getting Started Kit. Prevent VAP. How to Guide (Internet). Cambridge: IHI; 2006 (cited 2008 May 16). 34p. Available from: to GuideFINAL.pdf
Confidential: Quality Improvement Material