Abstract
Background:
Ventilator-associated pneumonia (VAP) has become archetypal among hospital-acquired infections. A higher prevalence rate for VAP increases LOS, significant hospital costs and mortality. The Trauma Quality Improvement Program reports the VAP national benchmark prevalence rate at 0.8% in level I and II trauma centers. In 2020 the VAP prevalence was reported by TQIP at 0.9%, over the national benchmark. By implementing a strict VAP adherence bundle and post-intubation N-BAL procedure for all qualifying trauma patients, the VAP prevalence significantly decreased in the trauma population.
Methods:
Evidence-based VAP prevention guidelines were executed as a monitored standard of care. Adherence to outlined VAP prevention model was guaranteed with collaboration between the respiratory and ICU nursing staff. Subjects were identified by the necessity for mechanical ventilation immediately following a trauma-related incident. Implementation of adherence management was completed in 2 stages over 6 months. The VAP bundle included: oral care Q4h, suction supplies/cannisters changed Q24h and head of bed (HOB) greater than 30 degrees, assessed Q4h. The N-BAL procedure was completed within 24 h post intubation specifically to capture presence of infection on admission.
Results:
A decrease in VAP prevalence rate was rapidly achieved. TQIP reported VAP prevalence at 0.9% in 2020. TQIP reported VAP prevalence rate decreased below the TQIP benchmark of 0.8% to 0.6% in 2021. Post-implementation performance revealed a 9.7% increase in patient volume and 33% decrease in VAP prevalence.
Conclusions:
Initiation of adherence to the VAP guideline bundle and early administration of N-BAL procedures significantly decreased VAP prevalence resulting in hospital percentages falling below the national average.
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