Ventilator-associated pneumonia (VAP) is a leading cause of morbidity and mortality in critically ill patients. We implemented a performance improvement project over 2 years to reduce VAP incidence in the medical ICU (MICU) and surgical ICU (SICU).
From 1 January 2004 to 31 December 2005 a prospective intervention was undertaken. Results were compared with historic controls (2003). In year 1 we introduced aggressive oral care using chlorhexidine mouthwash, an early extubation strategy, changing respiratory equipment only when visibly soiled or malfunctioning, and aggressive enforcement of hand-washing and barrier protection methods. At the end of year 1 we augmented the project with the addition of the FAST-HUG (feeding, analgesia, sedation, thromboembolic prevention, head of bed elevation, ulcer prophylaxis, and glucose control) evaluation. During year 2 FAST-HUG was emphasized daily on patient rounds by the intensivists. The CDC VAP definition was used; the Friedman test and Wilcoxon signed ranks test were used for data analysis.
The VAP rates in the MICU and SICU for the control period, 1 January–31 December 2003, were 13.41 and 19.37 VAPs/1,000 ventilator-days, respectively. The MICU VAP rate declined to 3.02 VAPs/1,000 ventilator-days and the SICU rate declined to 8.16 VAPs/1,000 ventilator-days over 2 years. The greatest declines occurred during year 2 (Table 1).
Daily FAST-HUG review on ICU rounds, with aggressive oral care, an early extubation strategy, and aggressive infection control practices, decreases VAP rates.