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(Editor’s note: The following describes the winning entry for the patient safety category in our 2001 Infection Control Innovation Awards. The article "Teaching right by showing wrong" in this issue describes the innovations that won second place and honorable mention. Look for reports on the other winning categories in upcoming issues.)
Our 2001 Infection Control Innovation Awards winning innovation in the protecting patients category has a title suggestive of a slap in the face: "WHAP VAP!" But as a result of this comprehensive educational campaign, many patients could be saying, "Thanks. I needed that." The acronyms translate to a prevention approach to a costly, serious infection, ventilator-associated pneumonia (VAP). The whap stands for: Wean the patient; Hand washing; Aspiration precautions; Prevent contamination.
The campaign was developed by Teresa Garrison, RN, MSN, CIC, an ICP, and colleagues at Barnes-Jewish Hospital in St. Louis. The multidisciplinary education program is designed to improve infection control practices and reduce risk of infection in the mechanically ventilated intensive care patient. Bottom line: The intervention resulted in a 47% reduction in VAP infections and saved $582,270 over three-quarters of a year. "This cost saving alone is almost the entire annual budget for the infection control department."
The facility has six intensive care units [ICUs] totaling 101 beds. In 1998, the infection control department focused surveillance on ventilator-associated pneumonia (VAP) in the ICUs. They found that a single VAP resulted in additional hospitalization for six days and added $8,330 in costs. To lower VAP rates and associated costs, they created a self-study booklet and pre-/ post-test for documenting competency. The educational content was supported by a series of fact sheets and a poster highlighting key points of the WHAP VAP! campaign.
All respiratory therapists and ICU nursing staff were offered the educational module. Although nursing compliance varied unit to unit, 100% of the respiratory therapists completed the module and testing. The intervention took place July to September 2000. Results were measured at the end of March 2001, showing a clear cost impact. Excess cost of VAP prior to the intervention was $1.26 million, which dropped 46% ($582,270) to $683,060. Providing feedback to the staff about infection rates, excess length of stay, and cost factors helped them realize the impact of poor clinical outcomes for the patient and the facility, Garrison says. "A successfully decreased VAP infection rate in our ICUs excited the nursing and respiratory staff and has lowered their tolerance for infections," she adds. "They remind each other about the rates and infection control practices. The success also has resulted in stronger partnerships and more requests for infection control’s assistance with other types of infections. We are seen as part of their team and not the hand-washing police."