“W.H.A.P. VAP!”: A Multidisciplinary Team Approach for Reducing the Incidence of Ventilator-Associated Pneumonia in a Community Hospital

Abstract ISSUE: Missouri Baptist Medical Center is a 499-bed community hospital with two 10-bed, medical-surgical intensive care units (ICUs). The 2001 ventilator-associated pneumonia (VAP) mean rate for both ICUs was 9.54/1,000 ventilator days. A VAP prevention team was formed with Infection Control, critical care (CC) medical director, nurse managers and educators, respiratory therapy (RT) managers, and a pharmacist, dietician, and pulmonologist. PROJECT: Analysis of actual versus recommended care of ventilated patients identified areas for improvement. Assessment of 2001 VAP data, 70% of patients developed VAP 2–7 days after intubation. Our ventilator discontinuation protocol (VDP) was revised. RT and the CC nurse assessed patient tolerance for spontaneous breathing using set criteria. If a wean was tolerated, an extubation order was obtained. WHAP VAP (Wean Patient, Hand Hygiene, Aspiration Precautions, Prevent Contamination) education was used in posters and a self-study module. CC physicians, staff, and RT completed the module. Staff received education on elevating the head of bed (HOB), VAP risk factors, and prevention strategies. VAP rates were shared and posters were placed in ICUs, RT, and physical therapy. An intubated doll with HOB elevated 30 degrees was placed in a chair next to the educational poster. RESULTS: In 2001, pre-intervention HOB data was collected (n=154): patients HOB elevated >30 degrees = 72 (46%); patients able to tolerate HOB elevation >30 degrees but not elevated = 62 (40%). One-month post-intervention HOB data (n=197): patients HOB elevated >30 degrees, 113(57%)—a 27% increase after education; patients able to tolerate the HOB >30 degrees but not elevated = 69 (35%)—a 14% decrease. Our VAP mean rate decreased from 9.54 to 4.15/1,000 ventilator days. LESSONS LEARNED: The VDP improved communication between CC and RT. Staff compliance with hand hygiene continues to be a challenge. Staff were taught to correctly read the HOB level, which had often been misread. When a multidisciplinary team dedicates resources and education for VAP prevention, infection rates can be reduced.