Our Lady of Lourdes Hospital's Intensive Care Unit participated in IHI's Breakthrough Series Collaborative on Reducing Complications from Ventilators and Central Lines in the ICU.

To become a patient-centered, safe, efficient, quality care unit by the end of the Collaborative. 

The team planned to reduce the complications from mechanical ventilation and central lines by:

• Reducing ventilator-associated pneumonia (VAP) to > 180 days between infections
• Reducing central line-related bloodstream infections (CLBSI) to > 90 days between infections
• Achieving 100 percent compliance with the Ventilator Bundle within 3 months from the start of the Collaborative
• Achieving 100 percent compliance with the Central Line Bundle within 3 months from the start of the Collaborative

• Ventilator-associated pneumonia rate per 1,000 ventilator days
• Ventilator Bundle compliance
• Central line bloodstream infection rate per 1,000 central line days
• Central Line Bundle compliance

• Educated the ICU Team and ICU staff on Ventilator Bundle and rationale for implementing it
• Developed a Ventilator Bundle monitoring tool
• Incorporated Ventilator Bundle into pre-printed physician orders for mechanical ventilation
• Incorporated Ventilator Bundle into ICU nursing flow sheet
• Began small tests, made changes as appropriate, and continued to test until entire ventilator patient population was included
• ICU staff monitored compliance with Ventilator Bundle every shift
• In the event of a VAP, ICU Team performed case review
• ICU Team reviewed the CDC Guidelines
• ICU Team developed a Central Line Bundle checklist
• Placed a designated central line cart in ICU
• Letter sent from ICU Medical Director and Infectious Disease Physician to all medical staff advising that central lines must be inserted according to the CDC Guidelines
• Began testing with one patient in ICU, gradually adding more, until entire ICU was included
• ICU staff informed physicians if they were non-compliant
• Over time, ICU staff became empowered to stop procedure (unless emergent) if bundle not followed
• Spread Central Line Bundle housewide
• Tested Central Line Bundle checklist without the “No” option in ICU

• The team achieved 100 percent Ventilator Bundle compliance and went 290 days without a ventilator-associated pneumonia in the ICU, dropping from a VAP rate of 5.53 per 1,000 ventilator days to a rate of 1.85. 
• A 100 percent compliance with the Central Line Bundle was also achieved and the ICU went 166 days without a central line bloodstream infection, dropping from a CLBSI rate of 15.3 per 1,000 central line days to 5.8.
• A slip in Central Line Bundle compliance (and, at the same time, the first CLBSI in 166 days) led the team to determine that the Central Line Insertion Checklist was not always being completed, and the focus during multidisciplinary rounds was waning. The team worked on increasing reliability for both of these issues and achieved success again. They noted what a change it represented in their culture to feel devastated by one central line infection, something that previously would have just been taken for granted.

03/06/2006