EliminateVentilator-Associated Pneumonia

What Is a Ventilator?

• A machine that supports breathing for those that have lost the ability to breathe

• Short term use– During surgery– During treatment

• Long term use

• After surgical procedures – Lung, heart, prolonged

procedures, • Impaired breathing

– Heart attack, stroke, trauma, head injury, drug overdose, chronic lung disease

Who Needs a Ventilator?

What is Ventilator-Associated Pneumonia?• A lung infection that develops in a

person who is on a ventilator• Occurs in 10-20% of ventilated

patients• Common healthcare-acquired

infection– 250,000 infections annually

• Most lethal healthcare-acquired infection– Mortality likely exceeds 10%– Up to 36,000 deaths annually

• Cost per episode- $23,000+

Safdar CCM 2005, Kollef Chest 2005,Perencevich ICHE 2007, Public Health Rep. 2007.

• Ineffective hand washing• Agents that impair patient’s natural defense and/or

increase the chance of swallowing oral secretions• Prolonged antibiotic use• Prolonged mechanical

ventilation• Lung disease• Impaired mental status• Excessive sedation• Cigarette smoking

Risk Factors for Ventilator-Associated Pneumonia

Eliminate Ventilator-Associated Pneumonia• Led by Dr. Sean Berenholtz, of the Armstrong

Institute for Patient Safety & Quality

• Funded by NIH/NHLBI and AHRQ• Only two states invited to participate- Maryland

and Pennsylvania• Two year intervention period with a 1 year sustainability• Based on the latest science and research• Includes unit-based Technical and Adaptive components• Goals:

– To achieve significant reductions in VAP/VAE rates– To achieve significant improvements in safety culture

Benefits to Participation• Improve patient outcomes

– Build upon and spread efforts to date– Focused specifically on VAP prevention, including structural

measures• Get “a leg up” on the new CDC VAE definition

– Predicted to increase current VAP rates– Aligned with public reporting of VAP

• Enhance performance-Health Service Cost Review Commission's quality initiatives including Maryland Hospital Acquired Conditions (MHACs) Initiatives

• Supports the Maryland Health Care Commission’s Healthcare-Associated Infections Prevention Plan

The Problem in Maryland*

• 583 ventilator-associated pneumonia cases in FY2011 equates to an estimated:– 130 deaths– 4,198 excess length of stay days– $47,289,462 excess cost*Source: Health Services Cost Review Commission Maryland Hospital Acquired Conditions database and VAP national estimator -http://www.hopkinsmedicine.org/quality_safety_research_group/our_projects/ventilator_associated_pheumonias/estimator.html

‘VAP Prevention’ Bundle

• ORAL • CARE

• ELEVATE • HOB at >30°

• SUBGLOTTIC • SUCTIONING

• SPONTANEOUS AWAKENING &

• BREATHING TRIALS

Early Ambulation

• Improved return to independent functional status after discharge

• Shorter duration of delirum

• Increased ventilator-free days

Implementation StrategyTechnical

• Clinical Bundle– HOB > 30°– Oral care with chlorhexidine– Subglottic suctioning– Spontaneous awakening &

breathing trials

• Data– Outcome Measures– Process Measures– Structural Measures

Adaptive Comprehensive Unit-based

Safety Program (CUSP)

• Educate staff on science of safety

• Identify defects

• Assign executive to adopt unit

• Learn from one defect per quarter

• Implement teamwork tools

Maryland’s Participation

Kick-off October 12100 attendees

26 hospitals participating36 patient care units