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Cape Coral ICU nurses tackle ventilator-associated pneumonia with positive results

By Staff | Apr 29, 2009

The Intensive Care Unit at Cape Coral Hospital has gone back to the basics to offer even better care for patients, and it is working, hospital officials said Wednesday: For more than two years, CCH has not had one case of ventilator-associated pneumonia.
Ventilator-associated pneumonia, or VAP, has the highest mortality rate of any hospital-acquired infection, at 14 percent, says Dr. Larry Antonucci, chief administrative Officer for CCH in a prepared statement. “The steps the nursing staff and respiratory therapists are taking in the ICU to prevent occurrences of ventilator-associated pneumonia are pretty low-tech. This is really a bedside nursing phenomenon. We’re saving lives in a big way here.”
It costs, on average, about $40,000 to treat a case of VAP, which is very costly for the patient and for Lee Memorial Health System. VAP also increases a patient’s length of stay by four to seven days, putting more strain on the patient and his or her family members, said Annette Forlenza, RN, BSN, CCRN, director of Critical Care Services for CCH. However, it’s a fairly common occurrence in hospitals throughout the nation.
About four and a half years ago, the ICU at CCH joined the Institute for Healthcare Improvement’s Critical Care collaborative to focus on reducing occurrences of VAP in ICUs. The Institute for Healthcare Improvement, or IHI, is a nonprofit organization founded in 1991 that has become a leader in the improvement of health care practices.
The IHI’s treatment protocol for VAP focuses on a “care bundle” with five specific steps that are practiced daily in the ICUs:
– Elevating the head of the patient’s bed 30 degrees.
– Providing mouth care every two hours.
– Preventing deep vein thrombosis, or DVT, which is the formation of a blood clot in a deep vein.
– Preventing peptic ulcer disease, or PUD, which is the formation of painful ulcers in the lining of the stomach or small intestine.
– Giving patients a “sedation vacation,” which means evaluating patients regularly to begin weaning them off sedatives as soon as possible.
As part of the IHI’s initiative, a multi-disciplinary team does rounds each day to ensure that the five steps of the care bundle are being practiced, said Forlenza. “This care bundle is a lot to do, so going two years without a case of ventilator-associated pneumonia is really a tribute to the dedication of the nurses and respiratory therapists,” she says.
The ICU at CCH is not only beating the national average for VAP, but only one other hospital out of the 25 participating in the IHI’s Critical Care collaborative for VAP has gone two years without an occurrence.
All of the LMHS ICUs are practicing the IHI’s care bundle for VAP, and the system also is focusing on reducing central-line infections and urinary tract infections. There have been reductions in both system-wide, said Forlenza.
“These types of initiatives generally start in the ICUs, but the goal is not to keep the success to ourselves but to spread it. We want to make sure all areas of LMHS are giving their patients the best possible care,” she said.

Source: Lee Memorial Health System