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Source:http://www.tdn.com/news/local/articl...cc4c03286.html
St. John staff curtails pneumonia cases among ventilator patients
By Cheryll A. Borgaard / The Daily News | Posted: Friday, January 15, 2010
Patients on ventilators at St. John Medical Center's intensive care unit rarely develop pneumonia ? hospital officials proudly say ? usually none or maybe one case a month. To have more than one per month is unusual, they said.
So when the number of pneumonia cases for ventilator patients rose in late 2008, hospital staff started looking for clues for the cause.
"We opened an investigation and reviewed all our practices," said Angie Dickson, St. John infection preventionist. "Then we started looking at all the cases to see if there was a common denominator, a common room, common staff or a common bacteria."
This medical detective story has a happy ending and has made the hospital safer. It also helped St. John get ready to comply with a new state program for consumers to judge how well hospitals control infections.
Ventilators control the amount, pressure, temperature and the humidity of air flowing into a patient's lungs. Since the mouth, nose and throat are not sterile, fluids from those areas contain germs. If enough germs enter the lungs, they can cause pneumonia. Patients on ventilators have a higher risk for developing pneumonia.
"Ventilator-associated pneumonia is one of those tough things to combat," Dickson said. "There are a gazillion different things that can cause it. You have to look at your numbers, and you notice a trend, an increase, and you have to get back and figure out why."
Hospital investigators went looking for bacteria, a logical suspect.
"These particular organisms like moist, warm environments," Dickson said. "That tweaked us to look at water sources in the room ? are we cleaning the canisters and tubes, anything that would have an effect, anything that could cause moisture. We even looked at how we were bathing patients."
What they learned is that a step they were taking to fight germs contributed to the problem. The hospital routinely uses antiseptics on its mouth swabs for ventilator patients. But, upon investigation, they learned the swabs were coated with sodium bicarbonate (baking soda).
The bicarbonate "renders the antiseptic we use with oral care ineffective," Dickson said. "So, we got rid of those swabs, and our vendor helped get swabs that were safe to use with the antiseptic."
Dickson said St. John not only changed its procedure for oral care, but also upped the frequency of oral care for ventilator patients from every six hours to every three hours.
A state Department of Health report released this month showed St. John to have the highest occurrence of ventilator-associated pneumonia cases in the state among similar hospitals ? 6.67 per 1,000 ventilator hours from January to June last year. However, the report also noted the hospital "recognized a problem late in 2008 and has initiated various investigations to determine the cause."
"The long-term trend is low and declining," hospital spokesman Randy Querin said. "This bump just happened to be at the same time period the state was gathering information for the first time."
St. John has been tracking ventilator-associated pneumonia cases since the early 1990s, but the state is just now putting the data on line for all hospitals in the state (see related article).
The frequency for ventilator-associated pneumonia at St. John has been back down to zero or one case per month since early 2009. There have been no cases since November, hospital officials said.
"It's very rigorous and documented," Dickson said. "We truly take every single case as a big deal. A few cases over a couple of months is a big deal for us. We would have gone through the (investigative) process even without state reporting."
St. John staff curtails pneumonia cases among ventilator patients
By Cheryll A. Borgaard / The Daily News | Posted: Friday, January 15, 2010
Patients on ventilators at St. John Medical Center's intensive care unit rarely develop pneumonia ? hospital officials proudly say ? usually none or maybe one case a month. To have more than one per month is unusual, they said.
So when the number of pneumonia cases for ventilator patients rose in late 2008, hospital staff started looking for clues for the cause.
"We opened an investigation and reviewed all our practices," said Angie Dickson, St. John infection preventionist. "Then we started looking at all the cases to see if there was a common denominator, a common room, common staff or a common bacteria."
This medical detective story has a happy ending and has made the hospital safer. It also helped St. John get ready to comply with a new state program for consumers to judge how well hospitals control infections.
Ventilators control the amount, pressure, temperature and the humidity of air flowing into a patient's lungs. Since the mouth, nose and throat are not sterile, fluids from those areas contain germs. If enough germs enter the lungs, they can cause pneumonia. Patients on ventilators have a higher risk for developing pneumonia.
"Ventilator-associated pneumonia is one of those tough things to combat," Dickson said. "There are a gazillion different things that can cause it. You have to look at your numbers, and you notice a trend, an increase, and you have to get back and figure out why."
Hospital investigators went looking for bacteria, a logical suspect.
"These particular organisms like moist, warm environments," Dickson said. "That tweaked us to look at water sources in the room ? are we cleaning the canisters and tubes, anything that would have an effect, anything that could cause moisture. We even looked at how we were bathing patients."
What they learned is that a step they were taking to fight germs contributed to the problem. The hospital routinely uses antiseptics on its mouth swabs for ventilator patients. But, upon investigation, they learned the swabs were coated with sodium bicarbonate (baking soda).
The bicarbonate "renders the antiseptic we use with oral care ineffective," Dickson said. "So, we got rid of those swabs, and our vendor helped get swabs that were safe to use with the antiseptic."
Dickson said St. John not only changed its procedure for oral care, but also upped the frequency of oral care for ventilator patients from every six hours to every three hours.
A state Department of Health report released this month showed St. John to have the highest occurrence of ventilator-associated pneumonia cases in the state among similar hospitals ? 6.67 per 1,000 ventilator hours from January to June last year. However, the report also noted the hospital "recognized a problem late in 2008 and has initiated various investigations to determine the cause."
"The long-term trend is low and declining," hospital spokesman Randy Querin said. "This bump just happened to be at the same time period the state was gathering information for the first time."
St. John has been tracking ventilator-associated pneumonia cases since the early 1990s, but the state is just now putting the data on line for all hospitals in the state (see related article).
The frequency for ventilator-associated pneumonia at St. John has been back down to zero or one case per month since early 2009. There have been no cases since November, hospital officials said.
"It's very rigorous and documented," Dickson said. "We truly take every single case as a big deal. A few cases over a couple of months is a big deal for us. We would have gone through the (investigative) process even without state reporting."