Preventing Ventilator-Associated Pneumonia in Neuro Trauma ICU Patients: When Evidence-Based Practice is Not Enough

Friday, 21 July 2006
10:00 AM - 10:30 AM
Friday, 21 July 2006
3:00 PM - 3:30 PM

This presentation is part of : Poster Presentations III

Paul T. Loflin, PhD, RN¹, Belle Davis, RN², Audrey Fisk, RN¹, and Robert Crommett, MD¹. (1) Neurotrauma ICU, Memorial Hermann Hospital, Houston, TX, USA, (2) Dept of Infection Control, Memorial Hermann Hospital, Houston, TX, USA

Ventilator-associated pneumonia (VAP) is one of the most common nosocomial infections in a Neuro Trauma unit resulting in increased morbidity, length of stay, resources and mortality. An open ward ICU as well as the tendency of neuro trauma patients to be at increased risk of aspiration prompted an intensive effort over that of present literature based evidence. A multidisciplinary approach was developed to decrease the VAP rates by greater than 80% over a six month period. Initial success was attained through literature based nursing interventions involving strict adherence to gloves, gowns and frequent hand washing. Patients were turned every 2 hours while maintaining the head of bed at least 30 degrees and using inline suctioning every 4 hrs. Daily chest x-rays for the onset of atelectasis were performed and warranted further pulmonary toiletry or possible bronchoscope suctioning. Although these literature based interventions resulted in the lowering the VAP rate below the 90^th percentile according to the Center for Disease Control (CDC) National Nosocomial Infection Surveillance System (NNISS), the unit initiated interventions to lower the rate further.

Chlorohexidine oral rinse was performed every 4 hrs including rinsing the laryngopharyngeal cavity with chlorohexidine and suctioning with a special catheter that was slender and long enough to reach the top of the endotracheal cuff. Precautions were also taken to prevent aspiration by keeping circuit condensation draining away from patients to an inline trap as well as adhering to strict post-pyloric feeding. Patients were also taken to diagnostic test using a portable ventilators in an attempt to maintain circuit sterility. One final measure was a daily VAP bundle assessing adherence to suctioning, oral care, GI prophylaxes, out of bed to chair, yonkauer sterility and other items. When 100% compliance was approached, a further decrease of VAP’s below the 25^th percentile ranking was achieved.

Learning Objective #1: The learner will be able to see new ideas outside the present literature base on the prevention of Ventilator-Associated Pneumonia.
Learning Objective #2: The learner will learn the importance of a multidisciplinary team approach to prevent nosocomial infections involving close cooperation between nursing, respiratory and intensivists.