Ventilator-Associated Pneumonia Ventilator-Associated Pneumonia: - PowerPoint PPT Presentation

Ventilator-Associated Pneumonia Ventilator-Associated Pneumonia: Sustaining the Gain A Success Story

Ventilator-Associated Pneumonia Presenters: Georgia Jackson, BSN, RN, MPH Unit Director Medical Intensive Care Unit Monica Maher, BA, RN, CIC Infection Prevention and Control Coordinator Emory University Hospital Midtown

VENTILATOR-ASSOCIATED PNEUMONIA Emory University Hospital Midtown

EUHM Cumulative ICU Ventilator-Associated Pneumonia Rate 2000-2012 12.00 Alcohol Gel in New VAP 10.00 Patient Rooms #VAP/Vent Days x 1000 Definition 8.00 6.00 Hand 4.00 Ventilator Hygiene Bundle Campaign 2.00 0.00 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

Ventilator-Associated Pneumonia Ventilator-Associated Pneumonia 31ICU Neurosurgery 21ICU Cardiac Surgery 15.00 15.00 #VAP / 1000 Vent Days 12.00 # VAP / 1000 Vent Days 12.00 9.00 9.00 6.00 6.00 3.00 3.00 0.00 0.00 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 Ventilator-Associated Pneumonia Ventilator-Associated Pneumonia 71ICU Medical/Surgical Teaching 41ICU Cardiac Care 15.00 15.00 #VAP / 1000 Vent Days 12.00 #VAP / 1000 Vent Days 12.00 9.00 9.00 6.00 6.00 3.00 3.00 0.00 0.00 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

VENTILATOR-ASSOCIATED PNEUMONIA Staff Engagement was high due to sustained decrease in rates Staff did not wish to see competing priorities impact the excellent work that had already been done

VENTILATOR-ASSOCIATED PNEUMONIA Multidisciplinary Team: • Representatives include front line champions and unit based VAP Team members • Respiratory Therapy • ICU Intensivist Teams • Physician Champions

Clinical Excellence Executive Oversight Committee (CEEOC) • Establishment of high level Administrative Support for all HAI Prevention Teams • Comprised of CEO, CMO, CNO for each entity • Progress, Results and Barriers identified at monthly meetings • Ability to identify barriers and needs and obtain support on ongoing basis

VENTILATOR-ASSOCIATED PNEUMONIA The EUHM VAP Team meets bimonthly VAP Cases Reported to staff in real time Root Cause Analysis (RCA) done On every identified case of ventilator-Associated Pneumonia by the front line care providers to help identify areas for improvment

VENTILATOR-ASSOCIATED PNEUMONIA Process Measures Need for true assessment of where we were with Bundle Compliance

VENTILATOR-ASSOCIATED PNEUMONIA Rigorous data collection efforts 24/7 collection of bundle compliance data on every ICU ventilated patient every 12 hours for 6 months

VENTILATOR-ASSOCIATED PNEUMONIA The Team looked at barriers in completing the oral care task Survey Monkey to nursing staff to determine real time barriers to performing oral care for ventilated patients

Ventilator-Associated Pneumonia Test of Change #1 for FY 2012 standardized placement of oral care kits for a 24 hour period of care outside of each room visible to all staff.

VENTILATOR-ASSOCIATED PNEUMONIA Test of Change #2 for FY 2012 Incorporating oral care as a line item in bedside change of shift report allowed for increased accountability.

ORAL CARE SELF ASSESSMENT ZOOMERANG TOOL

ORAL CARE SELF ASSESSMENT REASONS ORAL CARE IS MISSED

Ventilator-Associated Pneumonia Test of Change #3 for FY 2012 Beginning November 30 th 2011 for all new admissions to ICU , Oral Care fires as a task in I-View which is our electronic documentation system

EUHM Pareto Charts Pre Oral Care Task vs. Pareto Post Oral Care task Oral care accounted for 40% of defects prior to task Oral care accounts for 10% of defects post task Oral care went from largest defect to 4 th largest defect

Recommendations/Next Steps Sedation Pause/Daily Awakening Trials Team divided into subgroups with physician champion leads Change to a randomized collection of bundle compliance data (2 days a week at 7am and 7pm Tuesdays and Saturdays) Continue the important work of doing RCA’s on identified VAP’s

Ventilator-Associated Pneumonia Test of Change #4 for FY 2012 Transport Bundle • Suction patient before transporting • Attempt to maintain HOB 30 degrees during transport • OR patients from recovery to ICU’s -maintain HOB elevation

Conclusions Sustained VAP rates for the last 4 and a half years • 63% reduction in EUHM VAP rates compared to same time period in FY 2011. • Bundle compliance data monitoring across all ICU’s to identify areas for improvement (every ventilated patient every 12 hours 2 days a week) • Oral Task Firing in Emory electronic Medical Record (eeMR) improved the largest defect in bundle compliance

Recommendations/Next Steps We anticipate a sustained decrease in VAP rates and a decrease in length of stay on a ventilator as a benefit of the ICU model Established by Emory Healthcare’s Critical Care Center for Excellence: • 24/7 ICU Intensivist/Midlevel providers • Promotes Timelier Extubation • Decreased Ventilator Utilization

THANK YOU ( Some of EUHM’s VAP Team)