Best-practices protocol significantly reduces ventilator-associated pneumonia

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By medwireNews Reporters

An intensive care unit (ICU)-initiated protocol implementing "best practices" significantly reduces ventilator-associated pneumonia (VAP), research shows.

The process and outcomes-based protocol cut VAP rates to nearly zero and sustained these low rates for more than 2 years.

"Since 2007, we have set as a priority in our hospital the eradication of nosocomial infections," said lead researcher Raquel Caserta (Hospital Israelita Albert Einstein, Sao Paulo, Brazil). "To this end, we have developed a set of best practices for prevention of VAP."

As published in BMC Infectious Diseases, the researchers evaluated a total of 21,984 patient-days and 6052 ventilator-days.

In 2009, the VAP rate was 1.3 cases per 1000 ventilator days. In 2010, the VAP rate was 2.0 cases per 1000 ventilator days.

Data from the ICU unit in 2011 and the first quarter of 2012 shows that the VAP rate continues to be low at 1.5 and 1.9 cases per 1000 ventilator days, respectively.

The VAP-reduction protocol included elevation of the head of the bed (30-40 degrees), daily "sedation vacations," and assessment of extubation readiness, peptic ulcer disease prophylaxis, and venous thromboembolism prophylaxis.

A trained ICU nurse monitored the process and intervened if any of the protocols were not followed.

In addition, US Centers for Disease Control (CDC) evidence-based practices were followed, including not routinely changing humidified ventilator circuits, periodically draining and discarding condensate collected in the ventilator, and changing heat-and-moisture exchangers on evidence of signs of wear or malfunction.

The researchers note that they also applied other preventive measures, including the incorporation of continuous aspiration of subglottic secretions (CASS) endotracheal tubes and oral hygiene using oral chlorhexidine 0.12%.

In a previous study, achieving a near-zero VAP rate was "only possible when the compliance with the VAP prevention bundle exceeded 95%," state Caserta and colleagues.

In the present study, getting VAP rates to zero only occurred in the months when there was a greater than 95% compliance with the protocol, use of oral decontamination with chlorhexidine 0.12%, and CASS.

The researchers note that the VAP rates were discussed monthly during a multidisciplinary meeting with staff in order to ensure that their healthcare practices supported a program for infection prevention.

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