For a long time, ventilator associated pneumonia (VAP) had been viewed as an unavoidable evil, particularly in intensive care units (ICU).
The healthcare-associated infection (HAI) was a common occurrence among patients who had been on mechanical ventilation on an endotracheal or tracheostomy tube for more than 48 hours. As with many HAIs, however, the healthcare world's view on preventability has changed. Lee Memorial Health System, a Ft. Myers, FL-based health system, targeted VAP as an HAI the organization would wipe out completely.
And the health system has succeeded, going 24 months without a case.
There were a number of reasons why Lee Memorial chose VAPs as a target for zero—part of the Association for Professionals in Infection Control and Epidemiology's (APIC) Targeting Zero campaign. First and foremost, VAPs occurring in the ICU have the highest rate of fatality of any HAI, says Stephen Streed, MS, CIC, system director of epidemiology and infection prevention with Lee Memorial. Streed is a board member with APIC.
Studies show that "14% of patients who has had VAP has had a fatal outcome," he says. "That is too much."
In the past, says Marilyn Kole, MD, medical director of system intensive care services at Gulf Coast Medical Center, part of the Lee Memorial Health System, common parlance said that if a patient was in the ICU, there was a 30% chance the patient would contract VAP.
Medical professionals "talked about them being expected," says Kole.
The historical statistics on VAP are particularly frightening: it was considered a 5% cumulative chance of contracting a VAP, meaning after 10 days in the ICU, there was a 50% chance the patient would come down with a VAP.
Matter of perspective
One reason for the hospital's success has been a dual-level approach to looking at VAPs. On one side of the coin they have the intensivist perspective—the individual patient, the individual case. But they now also incorporate an epidemiology angle to their perspective, looking at groupings, recurrences, and trends.
"The difference is looking at patients one at a time versus groups, the way an epidemiologist would look," says Streed. "An intensivist will look at the patients one at a time."
The facility now reviews each case, but also looks at long-term trends to try to evaluate if they're headed in the right direction.
This improvement process has increased awareness among staff and also built a sense of pride—particularly following the organization's extended success in combating VAP.
"They take it very personally now," says Streed. "They have ownership. If a VAP case were to occur, everyone would be distressed. Were one to happen now, we'd do an almost root-cause analysis level exploration of the individual and the case."
This ownership has taken root in everyone, not just clinical staff. And everyone is paying attention.
"That was an evolution," says Kole. "Now you get an infection and everyone wants to know what's going on, they want to know which patient it is."