Evelyn Mello, BSMT, (ASCP) MS, CICInfection Control Practitioner

Ventilator-Associated PneumoniaMetroWest Medical Center’s Journey

MWMC is a 2-hospital system Framingham Union Hospital in Framingham Leonard Morse Hospital in Natick

269 bed community teaching hospital 2 critical care units, total of 21 beds 24/7 Intensivist / Pulmonologist ICU / CCU coverage 4 days average length of stay on ventilator

Ventilator-Associated Pneumonia Project

BackgroundStarted in 2005 – IHI 100K Lives CampaignReview of our VAP rates –

In 2004 – 4 VAP cases, 2.8/1000 vent. days

VAP Bundle and education / Implementation Aim

Reduce VAP at MWMC to 0% within 1 year

Ventilator-Associated Pneumonia Project

Multidisciplinary Team Approach ICU/CCU Staff, Respiratory Therapy, Intensivists, Infectious Disease

MDs, Infection Control Practitioners, Pharmacy, Quality

Developed VAP Bundle Checklist and signage Additional Interventions

Increased use of non-invasive ventilation – CPAP Chlorhexidine Mouthwash Spontaneous breathing trial done on all vent. patients daily Fast-track all vent. patients – wean and extubate quickly Resp. staff monitoring of VAP bundle with vent. checks (q 2 hours)

Lessons Learned Teamwork leads to Positive Patient Outcomes & Quality Patient Care

MetroWest Medical Center Ventilator Associated Pneumonia

4

1

2 2

0 0

2.80

0.40

1.001.20

0.00 0.00

0

1

2

3

4

5

2004 2005 2006 2007 2008 2009 Quarter 1

# VAP Cases

VAP Rate per 1,000 vent days

2004 - Baseline 2005 - VAP Bundle Implemented (Education)

2006 - 2007Maintained 50% decrease from

baseline

2008 - Q1 2009 100% decrease from

baseline