Our current average VAP rate is 6.69 per 1000 vent days across all ICU. The S.M.A.R.T intervention goal is to increase VAP bundle compliance to 95 % across all the ICUs and reduce VAP rate to below 2.0 per 1000 vent days over the next 6 months. The proposed VAP bundle are high to moderate evidence-based interventions which are
- Elevating the head of the bed by 300 – 450 to avoid aspiration – this is found to be associated to about 80% reduction in onset of VAP. 4
- Daily sedation interruption and assessment of readiness to extubate – found to reduce ventilation days and ICU length of stay by average of 3 – 5 days in literature. 4
- Use of subglottic secretion drainage, avoidance of scheduled ventilator circuit changes, regular oral care with chlorhexidine, deep venous thrombosis prophylaxis, and gastrointestinal stress ulcer prophylaxis. 1-4,7
Micro costing analysis revealed average cost range of VAP care per patient to be between $10,796.58 and $20,000. 1,6 Compliance with VAP bundle has been shown to reduce patients’ days on ventilation by 2 – 3 days, ICU stay by 3 – 4 days, hospital stay by 4 – 5 days, prevents onset of VAP by above 45% and reduce institutional spending on VAP by $180,000/yr. 4,6,8. Therefore, the benefits in saving VAP cost, reduce morbidity, reduce length of stay, and mortality far outweighs the cost of education and engagement of a full-time staff which may be about $64,000/yr. 9 The possible limitation is the willingness of the nursing staff to embrace the change. However, with continued education and evaluation results, this should be minimized.
In conclusion, the bundle is effective, but continuous education, monitoring, and evaluation of bundle compliance with strict adherence to all the elements listed will integrally reduce VAP rates in the hospital and give improved infection prevention metrics for the hospital.
Summarized By Dr.Joshua Kolawole
(MD, MBA, MASc., FISQua, CPHQ, PMP)
Agile Program Manager & Transformational Leadership Expert, Valdymas Intelligence LLC, Grand Prairie, Texas, USA.
valdymas@valdymasintelligence.org
- Koenig SM, Truwit JD. Ventilator-associated pneumonia: Diagnosis, treatment, and prevention. Clin Microbiol Rev. 2006;19(4):637-657. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1592694/. Accessed Feb 18, 2022. doi: 10.1128/CMR.00051-05.
- Klompas M, Branson R, Eichenwald EC, et al. Strategies to prevent ventilator-associated pneumonia in acute care hospitals: 2014 update. Infection Control and Hospital Epidemiology. 2014;35(8):915-936. https://www.jstor.org/stable/10.1086/677144. Accessed Feb 18, 2022. doi: 10.1086/677144.
- Resar R, Pronovost P, Haraden C, Simmonds T, Rainey T, Nolan T. Using a bundle approach to improve ventilator care processes and reduce ventilator-associated pneumonia. The Joint Commission Journal on Quality and Patient Safety. 2005;31(5):243-248. https://www.sciencedirect.com/science/article/pii/S1553725005310312. Accessed Feb 18, 2022. doi: 10.1016/S1553-7250(05)31031-2.
- Hellyer TP, Ewan V, Wilson P, Simpson AJ. The intensive care society recommended bundle of interventions for the prevention of ventilator-associated pneumonia. J Intensive Care Soc. 2016;17(3):238-243. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5606527/. Accessed Feb 18, 2022. doi: 10.1177/1751143716644461.
5. IHI VAP. Ventilator bundle compliance | IHI – institute for healthcare improvement. http://www.ihi.org/resources/Pages/Measures/VentilatorBundleCompliance.aspx Web site.
http://www.ihi.org:80/resources/Pages/Measures/VentilatorBundleCompliance.aspx. Accessed Feb 19, 2022.
6. Sosa-Hernández O, Matías-Téllez B, Estrada-Hernández A, Cureño-Díaz MA, Bello-López JM. Incidence and costs of ventilator-associated pneumonia in the adult intensive care unit of a tertiary referral hospital in mexico. American Journal of Infection Control. 2019;47(9):e21-e25. https://www.sciencedirect.com/science/article/pii/S0196655319301452. Accessed Feb 18, 2022. doi: 10.1016/j.ajic.2019.02.031.
7. Frequently asked questions about ventilator-associated pneumonia | HAI | CDC. https://www.cdc.gov/hai/vap/vap_faqs.html. Updated 2019. Accessed Feb 18, 2022.
8. Luckraz H, Manga N, Senanayake EL, et al. Cost of treating ventilator-associated pneumonia post cardiac surgery in the national health service: Results from a propensity-matched cohort study. J Intensive Care Soc. 2018;19(2):94-100. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5956688/. Accessed Feb 19, 2022. doi: 10.1177/1751143717740804.
9. Average infection control nurse salary 2022: Hourly and annual salaries. https://www.zippia.com/infection-control-nurse-jobs/salary/. Updated 2020. Accessed Feb 20, 2022.
Summarized By Dr.Joshua Kolawole
(MD, MBA, MASc., FISQua, CPHQ, PMP)
Agile Program Manager & Transformational Leadership Expert, Valdymas Intelligence LLC, Grand Prairie, Texas, USA.
valdymas@valdymasintelligence.org