Results from a Quality Improvement Project to Decrease Infection-Related Ventilator Events in Trauma Patients at a Community Teaching Hospital

Abstract

Ventilator-associated pneumonia (VAP) is linked to increased morbidity and mortality and clinical protocols (VAP bundles) have evolved to minimize VAP. In 2009, a quality improvement project was implemented at our institution to decrease VAP rates in adult trauma patients. AVAP prevention committee was developed, and formal evidence-based education for the nursing and physician staff was introduced. During the study period (2009–2016), 2380 patients required ICU admission to our Level II trauma center. The mean Injury Severity Score was 33 1 12, and there were 17 per cent penetrating and 83 per cent blunt injuries. The early compliance (2010) with the VAP bundle was 65 per cent. Within one year of the implementation of VAP prevention, the compliance increased to >90 per cent. Compliance has been carefully trended and has remained at 100 per cent. All of the aforementioned interventions have resulted in a sustained dramatic decline in VAP, from 12 per cent in 2009 to 0 per cent in 2016. Ongoing education and ICU policy development has become the mainstay of our trauma ICU program. The introduction of evidence-based care education imparted a culture of excellence resulting in favorable outcomes in high-risk trauma patients related to VAP prevention. Ongoing monitoring and education is required to sustain these promising outcomes.

Assessment of Knowledge, Barrier in Implementation, and Compliance to Ventilator Bundle among Resident Doctors and Nurses Working in Intensive Care Units of a Tertiary Care Center of Western India: A Cross-sectional Survey

“…The impact of training and educational activities on VAP prevention strategies has been shown to improve the compliance of healthcare workers to VB and thereby reduction in the incidence of VAP. 13 – 15 A continuous educational program, including of teaching, video presentation, seminars and group discussion, repeat training of new employees, and continuous educational activities of healthcare workers in a 20-bed ICU for a 2-year period, has shown to improve the median composite score from a baseline of 2–5 points over time and VAP incidence also decreased by 51%. 16 Another study also has shown that education and training of staff nurses for VB for a certain period do not lead to reduction in the incidence of VAP; however, intensive and continued training, bedside skill demonstration, and feedback are essential.…”

Making Ventilator Associated Pneumonia Rate a Meaningful Quality Marker

“…VAP is also a complication with some evidence of a degree of preventability. 25 –27 VAP could be a better metric of quality of care if we have a better understanding of how to standardize the reporting of VAP rates between facilities, and thus account for different patient populations.…”

Strategies to prevent ventilator-associated pneumonia, ventilator-associated events, and nonventilator hospital-acquired pneumonia in acute-care hospitals: 2022 Update

“…21,[77][78][79][80][81][82][83] The best-studied interventions to date that have been associated with lower VAE rates in interventional trials include spontaneous awakening trials, spontaneous breathing trials, and conservative fluid management.…”