Kimberly Simon, RN, BSN, CIC, Manager, Infection Control
Judy Surko, MSN, RN, CCRN, CNA, Manager, Critical Care Center
Dennis Harrison, CRTT, RTT, Manager, Respiratory Therapy
Michael Cammarano, Manager, Radiology
Anthony Cava, Vice President, Strategic Planning
Barbara Coffey, RN, Critical Care Assistant Nurse Manager
Gerard Crosbie, Materials Management
Viktoriya Fridman, PharmD
Karen Goedeke, Laboratory Manager
Mary Ellen Strozak, MSN, RN, CCRN, Critical Care Nurse Educator
Maureen Syno, RN, Quality Improvement/Outcomes
Pat Unterstein, RN, Supervisor, Case Management
Jennifer White, RN, Nurse Manager, Complex Care Unit
Dr. John Royall, Pulmonologist
Dr. Frank Arlinghaus, Pulmonologist
Dr. Adrien Pristas, Pulmonologist

Number of healthcare-acquired ventilator-associated pneumonia infections per 1,000 ventilator days

• Developed standing orders for ventilated patients in critical care based on Ventilator Bundle, including PUD and DVT prophylaxis.
• Implemented protocols for early tracheotomy and PEG tube placement within 24 hours of intubation.
• Changed timing of morning chest x-ray and ABGs so that physician would have results early and could evaluate readiness for patient extubation.
• Implemented yellow “priority” labeling for critical care labs to expedite results.
• Analyzed physician-specific practices to identify intubation to tracheotomy time.
• Implemented an oral care regimen in critical care with a nurse “champion” leading process.
• Educated emergency department with regard to use of BIPAP vs. intubation when appropriate.
• Educated anesthesia department with regard to larger sized ET tubing to expedite and ease process of weaning from ventilator.
• Implemented of sedation rounds in critical care.
• Implemented weaning protocol for intubated patients in critical care.

Our team was successful in not only achieving our target rate of 2.5 infections per 1,000 ventilator days, but also exceeding this goal as evidenced by having no VAP infections for an eight month period. Implementation of this project would not have been successful without a multidisciplinary team and a consistent cycle of planning, implementing, checking results and acting upon those results until desired outcomes were achieved.

Lessons Learned:

• Include the medical staff. It can be tempting to work around them in the beginning to capture the “low hanging fruit,” but they are truly a necessary part of the improvement project and brought a lot of expertise and ideas to our group.
• Don’t be afraid to borrow good ideas. So many other facilities were implementing the IHI project before we were and it was okay to use their ideas and experience to guide us.
• Have key members from leadership either on your team or at your team meetings. Leadership can bring the authority to the table that may be necessary to change behaviors and outdated practices.
• Communication is essential. When we started the project, our team was meeting weekly. Even after our target rate was achieved, we continued to meet weekly, only recently cutting down meetings to every two weeks.

Kimberly Simon
Manager of Infection Control
Riverview Medical Center

ksimon@meridianhealth.com