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986 WHAP VAP to Zero: Implementation of an Oral Hygiene Product and Protocol

Sunday, March 21, 2010
Grand Hall (Hyatt Regency Atlanta)
Jeanne E. Zack, PhD, RN, CIC , Missouri Baptist Medical Center, Saint Louis, MO
Angela Recktenwald, MPH , BJC Infection Prevention and Epidemiology Consortium, Saint Louis, MO
Beth Schneiderhahn, MSN, ACNS-BC , Missouri Baptist Medical Center, Saint Louis, MO
Barb Lamb, RN, BSN , Missouri Baptist Medical Center, Saint Louis, MO
Diane Spence, RN, BSN, CCRN , Missouri Baptist Medical Center, Saint Louis, MO
Robert S. Martin, MD , Missouri Baptist Medical Center, Saint Louis, MO
David A. Striker, MD, FCCP , Missouri Baptist Medical Center, Saint Louis, MO
John E. Krettek, MD, PhD , Missouri Baptist Medical Center, Saint Louis, MO
Erik R. Dubberke, MD, MSPH , Missouri Baptist Medical Center, Saint Louis, MO
Background: The most common hospital-acquired infection (HAI) among patients requiring mechanical ventilation is ventilator-associated pneumonia (VAP), contributing to increased mortality, increased hospital stay and excess medical costs. At Missouri Baptist Medical Center (MBMC) the Medical –Surgical Intensive Care Unit (MSICU) had conducted multidisciplinary rounding on each patient, sedation vacations and weaning protocols, staff education using the WHAP VAP Module, and 30 degree head of bed elevation. Hospital leadership considered opportunities to decrease the VAP rate in the MSICU and decided to use a commercial oral hygiene product and protocol.

Objective: The objectives were to reduce VAP by implementing an oral hygiene product and protocol and to estimate the cost savings of the intervention.

Methods: A retrospective quasi-experimental intervention study was conducted. The pre-intervention period was from 1/04 to 6/05. The post-intervention period was from 7/05 to 9/09. An oral hygiene product and protocol was implemented on every MSICU ventilated patient. The oral hygiene product (Sage Oral Care Kits-Sage® Products INC) was administered every four hours and was documented in the patient's medical record. Chi-square for significant changes in VAP rates was conducted on pre and post-intervention data.

Results: The mean pre-intervention VAP rate was 3.8/1000 ventilator days (1/04 to 6/05) and the mean post-intervention rate was 0.39/1000 ventilator days (07/05 to 09/09), (p<0.001), an 88% reduction in VAP. The last VAP identified in the MSICU was 5/06. Assuming consistent VAP rates over time, MBMC would have expected to identify 42 VAP infections between 7/05 and 9/09. After introducing the oral hygiene product and protocol 5 VAP infections were identified during this time period. The estimated cost of VAP is $40,000.00 per episode. Cost avoided 07/05 to 9/09 totaled $1,480,000.00. The cost of the commercial oral hygiene product in the post-intervention period was $430,000.00. Therefore, after implementation of the oral hygiene product and protocol $1,058,000.00 in healthcare costs were avoided.
Conclusions: The oral hygiene product and protocol was easy to implement and associated with a significant reduction in VAP. The product was cost effective.