Ventilator Associated Pneumonia
Ventilator Associated Pneumonia (VAP) is defined as a pneumonia (lung infection) occurring in patients in an Intensive Care Unit who require external mechanical breathing support (a ventilator) intermittently or continuously, through a breathing tube for more than 48 hours. VAP can develop in patients for many reasons. Because they are relying on an external machine to breathe, their normal coughing, yawning, and deep breath reflexes are suppressed. Furthermore, they may have a depressed immune system, making them more vulnerable to infection.
ICU teams have many ways to try to assist patients with these normal breathing reflexes, but despite this, patients are still at risk for developing pneumonia. In keeping with best practices with Safer Healthcare Now, at the NHS we are using new protocols to prevent VAP, such as: elevating the head of the patient's bed 30 degrees; a daily assessment to determine if the patient is ready to come off the ventilator; decreasing sedation where possible; and placing a feeding tube in the mouth instead of the nose, to decrease sinus infection and resulting mucus build-up.
Baseline data was collected in March 2009 and we are pleased to report that there were no cases of Ventilator associated pneumonia in our three ICUs.
Baseline data was collected in March 2009 and we are pleased to report that there were no Central-Line Infections in our three ICUs.
VAP incidents diagnosed after day 2 of admission for adult patients greater than 18 years of age:
| Site | Jan-Mar 2009 | Apr-Jun 2009 | Jul-Sep 2009 | Oct-Dec 2009 | Jan-Mar 2010 | Apr-Jun 2010 | ||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Number of VAP Incidents | VAP Rate / 1,000 Mech. Vent. days | Number of VAP Incidents | VAP Rate / 1,000 Mech. Vent. days | Number of VAP Incidents | VAP Rate / 1,000 Mech. Vent. days | Number of VAP Incidents | VAP Rate / 1,000 Mech. Vent. days | Number of VAP Incidents | VAP Rate / 1,000 Mech. Vent. days | Number of VAP Incidents | VAP Rate / 1,000 Mech. Vent. days | |
| Douglas Memorial | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Niagara-on-the-Lake | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Port Colborne General | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Greater Niagara General | 0 | 0.00 | 0 | 0.00 | 0 | 0.00 | 0 | 0.00 | 0 | 0.00 | 0 | 0.00 |
| St. Catharines General | 0 | 0.00 | 0 | 0.00 | 0 | 0.00 | 0 | 0.00 | <5 | 4.01 | 0 | 0.00 |
| Welland Hospital Site | 0 | 0.00 | 0 | 0.00 | 0 | 0.00 | 0 | 0.00 | 0 | 0.00 | 0 | 0.00 |
* N/A - do not have designated intensive care units
All hospitals with ICUs ARE required to report into the Critical Care Information System (CCIS), a centralized data collection system where hospitals report a variety of critical care information, must publicly report the VAP indicator data. These hospitals are considered “eligible” for VAP reporting.
These Ontario hospitals are posting their quarterly VAP rate and case count for those infections acquired in their facility, using the following formula:
| total # of ICU cases of VAP after 48 hours of mechanical ventilation | x 1000 |
| total # of ventilator days for ICU patients 18 years and older |