University Recognized Nationally by HHS for Moving VAPs Toward Zero
(AUGUSTA, GA. April 29, 2011) – Over the past five years, ventilator-associated pneumonias have been reduced to near-zero thanks to a coordinated plan of action by nursing, respiratory therapy and medical staff.
Now, out of 1,200 applicants, University is being recognized by the U.S. Department of Health and Human Services and others with an Outstanding Leadership Award for Achievements in Eliminating Ventilator-Associated Pneumonia. This recognition places University among the nation’s top hospitals in ensuring the safety of its patients and quality of care.
According to national averages, 8 to 28 percent of patients in an ICU setting may develop ventilator-associated pneumonias, or VAPs, which are a leading cause of death and complications for those receiving care in an ICU. “Patient safety and outcomes are extremely important to us,” said Trisha Catalano, RN, MSN, CCRN, Clinical Nurse Specialist for Critical Care Services. “Being on a ventilator is not an uncommon treatment in the ICU, and VAP is a potential complication. Our staff should be congratulated for making a significant impact in patient outcomes by eliminating these infections.”
As part of its standard quality and safety reviews, University Hospital staff began examining VAP data in 2004, and saw an opportunity for improvement. The VAP team and the Critical Care Medicine Committee identified and enacted a VAP bundle, specific evidence-based practices based on CDC and Institute for Healthcare Improvement recommendations, which included:
- Keeping the head of the bed elevated between 30 and 45 degrees;
- Oral and dental care maintenance;
- Sedation “vacation,” where patients are taken off sedation daily;
- Daily checks of patients’ ability to breathe on their own;
- Keeping patients’ blood sugar levels under control;
- Providing deep vein thrombosis prevention measures;
- Providing peptic ulcer disease prevention measures.
In addition, the team introduced use of a CASS tube, a type of endotracheal tube with suction apparatus to prevent subglottic secretions from entering the lungs, which in practice has been shown to have a significant impact on reducing VAP rates. The VAP bundle also coincided with the launch of 24/7 critical care intensivist coverage in the ICUs, which has been shown to decrease morbidity, mortality and length of stay. It took a lot of detailed, consistent work, rounding and communication among the interdisciplinary team, and education, but as a result of the diligence of bedside nurses, along with physicians, respiratory therapy and infection control, VAP rates were reduced by 96 percent, and that rate has been sustained since 2005.
“For us, this award means recognition by experts in the field for being a leader in reducing VAP, and that our data can serve as a national benchmark,” said Ms. Catalano. “Our staff nurses, physicians, respiratory therapists and infection prevention nurse should be congratulated for their collaboration and interdisciplinary approach, leading to success and improved patient outcomes. This award is a great affirmation of their tremendous efforts and wonderful work.”
Ms. Catalano, along with Penny Shute, Infection Prevention Coordinator; Bonnie Weeks, Clinical Coordinator, 6 West; and Kitty Garrett, Nursing Faculty, Georgia Health Sciences University, worked together on the application to HHS to honor our staff with the Outstanding Leadership Award. This is the first-such award presented by HHS and the Critical Care Societies Collaborative — composed of the American Association of Critical Care Nurses, American College of Chest Physicians, American Thoracic Society and Society of Critical Care Medicine.
A representative from University Health Care System will accept the award later this year during a meeting of the Critical Care Societies Collaborative.