Can We Reduce Ventilator-Associated Pneumonia Incidence After Cardiac Surgery? : 12-Year Experience of a Teaching Hospital in Chile

Background:

Ventilator-associated pneumonia (VAP) is the most common infection acquired by adults after cardiac surgery and it is well known that increases morbidity, mortality and healthcare costs.  Active surveillance is one of the most important strategies for VAP prevention. Our hospital is a reference center for cardiac surgery, and we have a large VAP surveillance experience in order to prevent this complication.

Objective: To communicate the results of VAP active surveillance after cardiac surgery and the most successful interventions implemented during the last 12 years in a teaching hospital in Santiago, Chile.

Methods:

Revision of VAP rates obtained by active surveillance based on the Chilean Ministry of Health criteria for adults who underwent cardiac surgery. Comparison of the VAP rates using t-test.

Results:

From January 1998 to July 2009 we followed 4,954 patients who underwent cardiac surgery. In 2,673 (54%) surgeries the patient remained on mechanical ventilation (MV) for ≥ 24 hours, resulting in 6,433 ventilator-days. We observed a significant reduction of VAP rates, 57 per 1,000 ventilator-days in 1998 versus 4.9 per 1,000 ventilator-days in the first semester of 2009 (p<0.001). The greatest reduction was observed since 2003 (34.4 versus 14.8 per 1,000 ventilator days in 2004, p<0.001).  Since 2004, VAP rates have been under our national standard for percentile 50. Most frequent organisms isolated were: Enterobacteriaceae (32.8%), methicillin-resistant Staphylococcus aureus (19.9%) and Pseudomonas aeruginosa (17.7%). The main interventions started in 2003 including regular meetings with medical and nursing staff, continuous update and implementation of evidence-based VAP prevention recommendations, and education of healthcare workers who take care of patients undergoing MV after cardiac surgery. Since 2003 the ventilator equipment maintenance and handling are performed by certified trained nurses. In addition, hand hygiene campaigns using waterless alcohol based solutions and contact precaution for all patients colonized or infected with resistant organisms were also introduced during the same period of time.

Conclusions:

Active surveillance and a coordinated prevention program with the cardiac surgery team have been successful in reducing VAP incidence after cardiac surgery at our hospital.