Oral Care Protocol Combined with Ventilator Bundle Reduces VAP Rates

Table 2: CVICU Cost Savings

IHI’s VAP Prevention Bundle

The Institute for Healthcare Improvement (IHI) initiated the 5 Million Lives Campaign in 2006 to build on the success of the 100,000 Lives Campaign launched in 2004 to prevent 100,000 avoidable deaths nationwide in hospitals.²² One of the six goals from the original 100,000 Lives Campaign was to prevent VAP, which is defined as an airway infection that develops more than 48 hours after intubation. The IHI strategy for reducing VAP is to encourage healthcare providers to adopt the use of a ventilator bundle.²³

The ventilator bundle consists of several interventions that as a group may reduce the risk of VAP if instituted with frequent audits and feedback.²⁴ The four recommendations in the IHI ventilator bundle are to elevate the head of the bed 30 degrees, to provide daily trials of lightened sedation to assess patient responsiveness and readiness for extubation, to provide prophylaxis for deep venous thrombosis, and to provide prophylaxis for peptic ulcer disease.²³

The CDC developed guidelines in 1994 for preventing VAP and published revised guidelines in 2003. The original guidelines recommend elevation of the bed to 30 degrees to 45 degrees, continuous clearance of subglottic collections of secretions, and to change the ventilation tubing no more often than every 48 hours. The updated guidelines also recommend disinfection and maintenance of equipment and devices to minimize bacterial transmission, hand hygiene (including glove use), and oropharyngeal cleaning and decontamination.¹³ The ultimate goal of these interventions is to decrease the incidence of pneumonia in the acute-care and other healthcare settings.