Oral Care Protocol Combined with Ventilator Bundle Reduces VAP Rates

By Nancy M. Case, BSN, RN; Terri Townsend, RN, MA, CCRN, BC, CVN-II; Renee Samples Twibell, DNS, RN, CNE; Shelia Simons, BSN, RN; Karrie Osborne, BSN, RN; Debra S. Hurst, BSN, RN, CIC; Carolyn Sanders, MS, MT (ASCP), CIC; Debra Siela, PhD, RN, CCNS, APRN, BC, CCRN, RRT

Note: Tables and figures available in the July 2008 issue of ICT.

Introduction

Ventilator-associated pneumonia (VAP) is a common complication of mechanical ventilation. Between 10 percent and 20 percent of patients who are intubated and receive mechanical ventilation develop VAP.¹ The incidence is related to the duration of mechanical ventilation, with patients who are intubated more than 72 hours demonstrating incidence rates near 20 percent.² This high incidence rate is of particular concern because the mortality rate is doubled in critically ill patients who develop VAP.¹ In ICU patients of a private community teaching hospital, ventilated patients with VAP had mortality rates of 45.⁵ percent compared with 32.² percent in ventilated patients without VAP.³

Economic Impact of VAP

The economic costs associated with VAP care are high, and as reimbursement for hospital-acquired conditions declines, hospitals and healthcare providers will shoulder more of the cost burden. Rello et al.⁴ found that the development of VAP was associated with an additional mean hospital cost exceeding $40,000 per patient. In a cost comparison of community-acquired pneumonia of patients with VAP, Kollef et al.⁵ found costs of community-acquired pneumonia ranged from $25,218 to $40,577, whereas VAP costs ranged from $150,841 to $151,155.

Pathogens Associated with VAP

The most common pathogens isolated in patients with VAP are Pseudomonas aeruginosa, Escherichia coli, Klebsiella pneumoniae, Staphylococcus species, and Acinetobacter species.⁶ In a study of patients who had been intubated for more than 72 hours, 57 percent were infected with strains of bacteria that were resistant to multiple antibiotics,² which would likely add to the cost of care.