Published: Synapse 2011, Vol. 2

Ventilator-Associated Pneumonia (VAP) occurs in about 15% of all patients who are on ventilators, a machine designed to mechanically pump more breathable air in and out of the lungs. According to the Centers for Disease Control, it may account for up to 60% of all deaths from healthcare-associated infections in the US and can increase the mortality rate of vented patients. VAP is also associated with prolonged length of stay for patients (6.1 days) in our Intensive Care Unit (ICU), and greatly increases the cost of care.

To prevent the development of VAP in our ICU patients, the Hospital relies on its taskforce of intensivists, pulmonologists, critical care nurse practitioners, critical care nursing staff, respiratory therapists and infection prevention to research and introduce new protocols of care.

This team has seen tremendous success since its inception and is now celebrating more than four years without an incidence of VAP in the ICU.

The Hospital's success is the result of efforts dating back to the mid-2000's when it...

• joined the national 100,000 Lives Campaign, a voluntary effort to prevent 100,000 incidents of medical harm, including vent pneumonia;
• re-emphasized the use of the ventilator bundle, a series of interventions designed to reduce the risk of complications;
• expanded its onsite intensivist program, hiring additional board-certified physicians who specialize in critical care medicine.

In more recent years, the Hospital introduced new methods of sedation; began using a special endotracheal tube to minimize secretions; started a different variety of tube feeding for therapeutic nutrition; implemented the use of a new technique for tube feeding to help reduce reflux; and established its own weaning method, known as the SSSh! Protocol.

Driven by nursing and respiratory therapy, the SSSh! Protocol is a three-part weaning process for patients in the ICU to lessen the amount of time they are on ventilators:

1. The team provides the patient with four-hour periods of dedicated Sleep;
2. The team conducts awakening tests where Sedatives are reduced to determine if the patient is mentally alert enough to be weaned from the vent;
3. The team performs Spontaneous breathing trials to determine whether the patient is physiologically ready to be weaned from the vent and ultimately extubated.

To maintain our zero-incident success in the ICU, the Hospital investigates new opportunities to prevent VAP , monitors the progress of its current strategies, and continues the implementation of the SSSh! Protocol, making adjustments based on measurable data.

Last Updated: 11/22/2011