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