Blue Ribbon Abstract Award:

BACKGROUND/OBJECTIVES: Ventilator associated pneumonia (VAP) is the leading cause of nosocomial infection in the ICU with mortality rates as high as 50%. Evidence suggests that control of oral colonization, plaque removal, prevention of aspiration, and removal of subglottic secretions may reduce the incidence of VAP.

METHODS: This study describes the impact of a VAP prevention protocol on VAP rates for a 40 bed Level I Trauma/Regional Burn intensive care unit. Evidence based protocols were developed and implemented to target the causative mechanisms of VAP: colonization of the oropharynx and aspiration of contaminated secretions. Educational modules were used to educate staff on ventilator care, aspiration prevention measures, and specific oral care interventions derived from the literature. Patient outcomes were monitored for two years. Chart audits were performed to determine compliance with VAP prevention measures. Data were collected from 876 patient days.

RESULTS: The percentage of mechanically ventilated ICU patients who develop VAP decreased 68% during the study period. Results suggest there is a significant relationship between head of bed (HOB) positioning and VAP rate (p = 0.0001). As staff compliance with HOB positioning at ≥30 degrees increased, the VAP rate decreased (See Figure 1). Multiple regression analysis revealed that the interventions of covered Yankauer use, toothbrushing, subglottic suctioning, oral care, and monitoring the ETT cuff pressure independently did not significantly impact VAP rates (p > 0.05). The combined interventions of HOB elevation, toothbrushing, subglottic suctioning and checking the ETT cuff pressures was nearly significant (p = 0.07) explaining 46.28% of the variance in VAP rates for the study period (See Table 1). Surprisingly, HOB elevation alone explained 52.52% of the variance in VAP rates and accounted for the single most significant factor in reducing VAP rates for this sample.

CONCLUSIONS: Initial data suggests that patient positioning is the most effective intervention in significantly reducing the VAP rate in a 40 bed Level One Trauma Center ICU with a heterogeneous population at high risk for developing VAP. Further research is necessary to determine which nursing interventions are the most effective in reducing VAP.

I have given four lectures for SAGE Products which manufactures the oral care items used in our study.

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