Multidisciplinary Protocol Eliminates Ventilator Associated Pneumonia

A new study describes a multidisciplinary protocol for the treatment of ventilator-associated pneumonia (VAP) that has all but eliminated such infections.

A researcher at Crozer-Chester Medical Center (CCMC; Chester, PA, USA) analyzed data on 2,290 trauma patients brought to the CCMC shock trauma unit between 2005 and 2009, and 1,006 of whom were on mechanical ventilation for more than 24 hours. The study was divided into two periods: 2005-2006, when education of the VAP bundle was taking place, and 2007-2009 when the VAP bundle was fully implemented. The study results showed that the VAP rate dropped to 1.5 per 1,000 ventilator days in 2007-2009, compared with 7.9 during the education period. The study further showed that no cases had developed in the last eight months of 2009; additionally, no further cases of VAP occurred during the first three months of 2010. The study was presented at the annual clinical congress of the American College of Surgeons (ACS), held during October 2010, in Washington (DC, USA).

"Society today expects that when patients come to the hospital that they will not get an infection. One of the goals of the health care team should be to prevent any complications or side effects, whether it's a hospital-acquired infection or an injury,” said study presenter and lead author Riad Cachecho, M.D., M.B.A, medical director of the Crozer regional trauma center. "It is not impossible to eradicate ventilator-associated pneumonia from a trauma unit.”

The VAP multidisciplinary protocol consists of several steps in the care of the trauma unit patient, including elevating the patient's head, cleaning the patient's mouth every two hours, and rinsing the mouth with a germicidal mouthwash every six hours. Other parts of the VAP bundle include blood-glucose control and preventative measures against gastrointestinal bleeding and blood clots in the legs. A further initiative limits the amount of blood drawn for routine daily labs, limiting the blood loss caused by the unnecessary blood tests. The team uses a checklist to review every item of the VAP bundle, as well as all other bundles used in the trauma unit.

VAP is defined as a lower airway infection that occurs more than 48 hours after a patient has been placed on a breathing tube. Some estimates have put the incidence of VAP at 250,000 to 300,000 cases a year in the United States alone, or approximately 5-10 cases per 1,000 hospital admissions.

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Crozer-Chester Medical Center