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SCCM: Teamwork Cuts ICU Pneumonia

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  • SCCM: Teamwork Cuts ICU Pneumonia

    Source: http://www.medpagetoday.com/MeetingCoverage/SCCM/17934

    SCCM: Teamwork Cuts ICU Pneumonia
    By Ed Susman, Contributing Writer, MedPage Today
    Published: January 13, 2010
    Reviewed by Dori F. Zaleznik, MD; Associate Clinical Professor of Medicine, Harvard Medical School, Boston and
    Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner Earn CME/CE credit
    for reading medical news
    Action Points

    * Explain that this study suggests that prevention of hospital-acquired infections requires a team approach.


    * Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.

    MIAMI BEACH -- A coordinated effort among physicians, nurses, therapists, and other intensive care staff produced a dramatic reduction in the incidence of ventilator-associated pneumonia at a Tennessee hospital, according to a study reported here.

    Researchers told attendees at the annual meeting of the Society of Critical Care Medicine that nosocomial pneumonia cases decreased from 34 episodes in one 12-month period to four in the most recent year -- including a 10-month period when no cases of ventilator-associated pneumonia were reported.

    "The use of a collaborative team approach, daily multidisciplinary rounds, and implementation of a ventilator-acquired pneumonia protocol has led to ventilator-acquired pneumonia reductions while improving patient care and outcomes," said Lisa Boghozian, MSN, RN, a clinical nurse specialist at Johnson City Medical Center.

    "We learned to work together," she said at a poster presentation. "We learned to share jobs and to make sure the patients received the protocol-required treatment. But the success of these programs may have to be nurse-driven."

    By cutting the incidence of ventilator-associated pneumonia by 88%, the effort reduced ICU intensive care unit expenses by $2.2 million and overall hospital expenses by $9 million, according to Pamela Ditto, MBA, RRT, a respiratory therapist and the team's record keeper.

    She said that the reduction in ventilator-associated pneumonia cases resulted in avoiding 2,470 days in the intensive care unit and 207 days on ventilation.

    "We educated our staff that the six components of ventilator-acquired pneumonia prevention had to be performed every day on every shift," she said.

    The protocol requires:

    * Keeping the patient's head raised 30?
    * Performing oral hygiene
    * Performing deep vein thrombosis prophylaxis
    * Performing gastrointestinal prophylaxis to prevent reflux
    * Regularly assessing the ability to wean patients from the ventilator
    * Giving adequately sedated patients vacations from sedation

    In the year before the study period -- when the hospital counted 34 cases of ventilator-associated pneumonia -- Boghozian said it seemed that the staff simply accepted that there would be cases and there wasn't a concentrated effort to control the occurrence.

    The four cases of ventilator-associated pneumonia in the year ending in June 2009 all occurred in April -- after 10 consecutive months without a single case. "We might have become complacent," she speculated, but she also noted that during that period the hospital cared for several trauma cases that included patients with facial injuries that might have prevented careful oral hygiene known to be a major factor in ventilator-associated pneumonia.

    "Prevention of ventilator-acquired pneumonia and other nosocomial infections are the types of things that healthcare providers will be looking at to improve conditions for patients and to cut costs," Ditto said.
    "The only security we have is our ability to adapt."
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