Making sure that the head of a patient bed is elevated 30% is just one of the important elements for preventing ventilator-associated pneumonia (VAP) in critical care units. It may sound simple to do, but many hospitals still believe that you can judge the elevation strictly by sight, which is not necessarily the case. In fact, at one hospital, when they measured, only 15% of beds were elevated to the appropriate angle.
However, there are some very low or no cost, easy ways to ensure that the patient bed is elevated 30%. For example, one nurse at Stony Brook University Medical Center cut a piece of cardboard in the shape of a slice of pizza, which is now used to measure the elevation of the patient bed. Based on input from staff at Beth Israel Medical Center, a red stripe was placed on each bed by the Engineering Department to ensure accuracy in the elevation of the patient bed.
These and other practical solutions are having a significant impact on preventing and reducing VAP in hospitals. This is merely a sample of the solutions and best practices that were shared by 50 New York hospitals through a statewide collaborative focused on VAP prevention conducted by the Healthcare Association of New York State (HANYS).
As part of its extensive quality and research agenda, HANYS and its member hospitals have been focusing on the prevention of hospital-acquired infections, including VAP. Grant funding from the New York State Department of Health Division of Epidemiology-Hospital Acquired Infection (HAI) Program helped to support a quality improvement collaborative, led by HANYS, called the VAP prevention (VAPP) program.
"After conducting an assessment of our members, we chose VAP because it is a leading cause of death—due to healthcare acquired infection (HAI)—in critical care, and experiences by other national initiatives demonstrated that focused efforts on the VAP bundles could prevent a pneumonia infection, which in turn improves patient care, decreases mortality rates, and lower costs," said Nancy Landor, senior director of HANYS Strategic Quality Initiatives.
"After conducting an assessment of our members, we chose VAP because it is a leading cause of death—due to healthcare acquired infection (HAI)—in critical care, and experiences by other national initiatives demonstrated that focused efforts on the VAP bundles could prevent a pneumonia infection, which in turn improves patient care, decreases mortality rates, and lower costs," said Nancy Landor, senior director of HANYS Strategic Quality Initiatives.
The Collaborative used the Institute for Healthcare Improvement's (IHI's) VAP bundle elements, plus additional elements from the IHI's Critical Care IMPACT Program as the core of improvement activities.
The initiative relied on the hospitals' infection control practitioners for leadership, education, and data. At the end of the first quarter of 2008, the advisory committee set a stretch goal: achieving an overall VAP rate of less than one event per 1,000 ventilator days in the last quarter of 2008.
"Like many stretch goals, it seemed only possible, even only somewhat doable, but we felt it was important for promoting real change," said Landor.
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