VAP program results in infection rate reduction

A unit takes ownership of the problem

The adult neuro/trauma unit at Essentia Health System of Duluth, MN, targeted ventilator-associated pneumonia (VAP) for an intervention several years ago and it's a gift that keeps on giving.

"Our infection rates are continuing to decline," says Rennae Houle-Burns, RN, CIC, an infection preventionist at Essentia.

The neuro/trauma unit's rate of VAP was reduced from 22.1 to 4.5 per 1,000 ventilator days between 2008 and 2011, she says.

The VAP rate in 2008, before the intervention was implemented was 31 VAPs during 1402 ventilator days. In 2010, the total number of ventilator days had fallen to 1205 in 2010, and the number of VAPs had fallen to just nine.

The goal now is to maintain the success and make certain employees continue the infection control measures that led to this reduction in VAP, she adds.

Recently, the neuro/trauma unit broke a record for the number of days between VAP infections, Houle-Burns notes.

"Then they had just one infection, and they were so disappointed when I told them," she says. "Staff knew they had done everything they could possibly do to prevent this infection; all of our best practice elements were met 100%. Unfortunately, some VAPs will occur despite all of our best efforts."

The unit's VAP rate became a focal point for a quality improvement initiative after leaders compared the hospital's VAP rate with national benchmarks and found the unit's rates were consistently higher, Houle-Burns explains.

"Other units with similar populations were doing a better job, so why shouldn't we?" she says. "We recognized we needed the right people at the table and not just the provider group, nursing, respiratory therapy, and/or infection prevention staff, so we pulled together a multidisciplinary work group to address the VAP problems and to see how we could correct them."

Taking ownership

The key was realizing that the unit and providers hadn't taken ownership of reducing VAP, and correcting that issue.

"We needed unit-based champions 24 hours a day," Houle-Burns says. "They took ownership of this program and recognized they needed to have reinforcement of best practices bundles."

The team consisted of 10 to 12 people who initially met each month. Later they were able to communicate on an informal basis through information Houle-Burns distributes each month via emails, and with staff during infection prevention round in unit.

While the team worked on the infection prevention project in regular meetings they identified key areas where improvements would be the most efficient at meeting the goals of reducing the VAP rate, she notes.

"They recognized there were a number of nursing-driven interventions that could be done," Houle-Burns says.

The main goal is to get patients off the ventilator in a timely fashion to prevent VAP, and nursing played an important role in this process. Essentia Health System was successful in achieving this goal after developing best practice interventions, which were reinforced with staff education and monitoring.

Staff buy-in was an important step in achieving these goals, Houle-Burns says.

"These front-line healthcare workers are amazing and care for very challenging patients," she says. "They recognized that they could do a better job, and they wanted to do a better job, so they took ownership."

The nurses had good leadership that intervened when necessary and reinforced the VAP prevention intervention, she adds.

"I was [originally] on the unit participating in daily care rounds, talking about the VAP bundle and making sure all elements were met," she says. "It became such an integral part of the workflow and daily care rounds that I don't have to go on the care rounds anymore. I periodically stop in, but there's nothing for me to remind or reinforce, so now I'm more in a consultant role."