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Ventilator Associated Pneumonia Reduced Through Subglottic Secretion Removal In an effort to further patient safety and decrease hospital costs, Deborah Heart and Lung Center has become a national leader among hospitals in its fight to reduce incidence of Ventilator Associated Pneumonia (VAP). By conducting significant research, assisting in the development of a product designed to reduce VAP, and becoming the first hospital in the nation to use that product, Deborah’s physicians, Respiratory Care practitioners and Pneumonia Task Force members are receiving national attention for their success. In recent years, reducing rates of VAP, a healthcare-acquired pneumonia acquired by patients after intubation and initiation of mechanical ventilation, has been targeted by healthcare institutions. The concern is largely due to several factors, including: patient ambulation and mortality (patients who develop VAP are likely to have longer hospital stays, as well as a 22 percent higher risk of death than those who don’t); infection control (VAP patients are likely to develop drug resistant infections); and cost (costs of caring for these patients can be significant). Traditionally, in their efforts to fight VAP, hospitals have focused largely on the treatment of patients who acquired the illness, rather than VAP prevention. In 2001, Deborah Heart and Lung Center formed its Pneumonia Task Force to investigate VAP, in hopes of reducing acquisition rates within the Center. The Task Force conducted a literature review to determine the risk factors that seemed to lead to an increase in VAP, and discovered four: “Current literature supports that the secretions that form above the cuff, if allowed to migrate into the lower airways, will exacerbate the development of Ventilator Associated Pneumonia,” explained John Hill, RRT, Co-Technical Director, Respiratory Care Services. “Based on its research, Deborah’s Pneumonia Task Force strongly recommended the removal of subglottic secretions as a measure to reduce VAP incidence within the hospital; the theory is that secretion removal will prevent aspiration of the secretions, thus reducing the risk of Ventilator Associated Pneumonia.” |
The double lumen endotracheal tube used at Deborah (HI-LO EVAC, Mallinckrodt) has a second lumen integrated within the wall of the tube with an opening above the cuff, and a suction connection next to the pilot balloon. This suction connection allows for easier secretion removal, requiring only insertion of a syringe into suction connection. “Once the use of the double lumen endotracheal tube was implemented, data were tracked to evaluate the difference in VAP incidence,” stated Hill. “A significant decrease - 42 percent - in VAP has been recorded between the establishment of the Task Force (2001) and now.” Contributing to that decrease in VAP incidence was the use of the Model 3720 CASS Suction Regulator, designed by Boehringer Laboratories, Inc. This regulator, designed to complement the double lumen endotracheal tube, allows care providers to remove tenacious subglottic secretions with the push of a button, rather than by syringe. The CASS Suction Regulator also provides continuous secretion removal. In recognition of its extensive efforts to reduce VAP, and its extensive use of the double lumen endotracheal tube, Deborah Heart and Lung Center was selected as a research site for the CASS Suction Regulator; Deborah was the only hospital involved in the development of the product, the first to use it after its FDA approval and wide-market release, and remains its most active user, with over 50 CASS Regulators in use at the Center. To assist other healthcare institutions in their own efforts to reduce VAP, Deborah has engaged in several educational initiatives. In addition to publishing several articles on the Task Force’s success, an abstract has been accepted for presentation at the Amercian College of Chest Physicians 2004 Congress. On a regional scale, Deborah’s Respiratory Care practitioners invited outside healthcare providers to a symposium held at the Center entitled “Zap Your VAP,” which examined Deborah’s successful strategies to reduce hospital-acquired pneumonia. The symposium was so well attended that more are currently being planned. “Deborah Heart and Lung Center has been extremely progressive in its efforts to combat Ventilator Associated Pneumonia, and, as a result, has seen a 42 percent decrease in VAP incidence in the past three years,” stated David Murphy, MD, Chair, Department of Pulmonary Medicine, Deborah Heart and Lung Center. “Prevention through removal of subglottic secretions is a relatively new idea in the literature; we’re proud to have played a role in supporting this theory, as well as in developing products that will help prevent acquisition of this disease in hospital patients across the country.”™ |
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