Lesley Wood, RN, CIC Infection Control Practitioner
Sue LaPointe, RN, MSEd, CIC Infection Control Practitioner
Dr. Luis Jauregui, MD, Chairman, Infection Control Committee
Deb O’Brien-Goedde RRT, BS, Respiratory Therapy Program Coordinator
Tom Dilkens RRT, Application Analyst
Dr. Srinivas Katragadda, MD, Medical Director Medical – Surgical Intensive Care Unit
Marlene Smith RN, Clinical Nurse Educator
Sandy Sutter RN, Clinical Nurse Educator
Anders Jacobsen, RN, Manager Medical – Surgical Intensive Care Unit
Charla Ulrich RN, BSN, MOD, CIC, Director Quality/Infection Control
Verette Neeb RN, MSN, Director Nursing Support Services

To decrease ventilator-associated pneumonia by 33 percent by the 4th quarter of 2003 in the eight facility Intensive Care Units.

• Number of ventilator-associated pneumonias
• Number of ventilator days

In 2003, St. Vincent Mercy Medical Center developed an organizational Patient Safety Plan, which was incorporated into orientation and annual education for staff members. This project was launched as a result of identifying patient-centered risk reduction activities  which reflected that intent of the Patient Safety Plan.

• Performed an extensive literature search to obtain best practice information related to the care of the ventilated patient
• Performed review of current policies and procedures within the facility related to the care of the ventilated patient to identify opportunities for improvement within the facility
• Began utilization of sterile solution for irrigation of drains and catheters for ventilated patient
• Initiated standing order for pneumococcal and influenza vaccines housewide to reduce risk of pneumonia
• Updated Adult Admission History form to include screening questions for vaccines
• Provided education for staff, residents and physicians in a variety of formats, including written modules, one on one, and oral lecture
• Developed computer-assisted educational program for all staff, which was mandatory for nurses and respiratory therapy staff detailing ventilator-associated pneumonia reduction measures
• Developed signage for the head of patients’ bed, placed as a reminder of best practice measures for pneumonia prevention including
  • Hand hygiene
  • HOB elevated
  • Sterile water for irrigation
  • Tube feeds held for high residuals
  • Oral care every two hours
  • Patient repositioning every two hours
  • Secure endotrachial tube
  • Drain circuit condensate before repositioning patient
  • Give vaccines
  • Keep ambu bags clean
• Installed waterless hand sanitizer dispensers throughout the facility and educated all staff and physicians on usage
• Placed signs instructing visitors to please utilize hand sanitizer
• Implemented daily rounds on ventilated patients by Infection Control Practitioner, Respiratory Therapist, on ventilator-associated pneumonia best practice measures as outlined above
• Reported quarterly measure to Infection Control Committee, unit staff, leadership team, and Multidisciplinary Quality Committee, then to Board of Trustees

As a result of implementing specific changes in care for ventilator patients, we experienced a reduction in ventilator associated pneumonia. Reduction strategies have been shared with hospitals within the regional health system interested in achieving the same results.

• Build the case for change by utilizing the literature, infection control professionals, staff and physicians to help the multidisciplinary team gain understanding of current thinking and practice related to the care of the ventilated patient.
• Talk to anyone who will listen about what you are trying to accomplish and why, emphasizing best practice, patient safety and excellence.
• Reinforce the message and provide education in a variety of formats.
• Share results with all members of the organization. Make graphs, charts easy to understand and read.
• Celebrate successes.
• Send thank-you notes and let people know that you appreciate the hard work. This is increase commitment and support for the project.
• Round on the patient care units frequently and ask the staff how you can help. Then follow-up as necessary.

Charla Ulrich RN, BSN, MOD
CIC Director, Quality/Infection Control
St. Vincent Mercy Medical Center
Charla_Ulrich@mhsnr.org

[Storyboard presentation at IHI's National Forum, December 2004]