Impact and feasibility of an emergency department-based ventilator-associated pneumonia bundle for patients intubated in an academic emergency department

Lawrence A. DeLuca, Paul Walsh, Donald D. Davidson, Lisa R. Stoneking, Laurel M. Yang, Kristi J H Grall, M. Jessica Gonzaga, Wanda J. Larson, Uwe Stolz, Dylan M. Sabb, Kurt R. Denninghoff

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Background: Ventilator-associated pneumonia (VAP) has been linked to emergency department (ED) intubation and length of stay (LOS). We assessed VAP prevalence in ED intubated patients, feasibility of ED VAP prevention, and effect on VAP rates. Methods: This was a quality improvement initiative using a pre/post design. Phase 1 (PRE1) comprised patients before intensive care unit (ICU) bundle deployment. Phase 2 (PRE2) occurred after ICU but before ED deployment. Phase 3 (POST) included patients received VAP prevention starting at ED intubation. Log-rank test for equality and Cox regression using a Breslow method for ties were performed. Bundle compliance was reported as percentages. Number needed to treat (NNT) was calculated by ventilator day. Results: PRE1, PRE2, and POST groups were composed of 195, 192, and 153 patients, respectively, with VAP rates of 22 (11.3%), 11 (5.7%), and 6 (3.9%). Log-rank test showed significant reduction in VAP (χ2 = 9.16, P = .0103). The Cox regression hazard ratio was 1.38 for the Clinical Pulmonary Infection Score (P = .001), and the hazard ratio was 0.26 for the VAP bundle (P = .005). Bundle compliance >50% for head-of-bed elevation, oral care, subglottic suctioning, and titrated sedation improved significantly with introduction of a registered nurse champion. NNT varied from 7 to 11. Conclusions: VAP was common for ED intubated patients. ED-based VAP prevention is feasible. We demonstrate significant reduction in VAP rates, which should be replicated in a multicenter study.

Original languageEnglish (US)
JournalAmerican Journal of Infection Control
DOIs
StateAccepted/In press - 2016
Externally publishedYes

Fingerprint

Ventilator-Associated Pneumonia
Hospital Emergency Service
Numbers Needed To Treat
Intubation
Compliance
Intensive Care Units
Patient Care Bundles
Mechanical Ventilators
Quality Improvement
Multicenter Studies
Length of Stay
Nurses
Head

Keywords

  • Acute respiratory failure
  • Emergency medicine
  • Hospital-acquired infection
  • Infection prevention
  • Ventilator-associated pneumonia

ASJC Scopus subject areas

  • Epidemiology
  • Health Policy
  • Public Health, Environmental and Occupational Health
  • Infectious Diseases

Cite this

Impact and feasibility of an emergency department-based ventilator-associated pneumonia bundle for patients intubated in an academic emergency department. / DeLuca, Lawrence A.; Walsh, Paul; Davidson, Donald D.; Stoneking, Lisa R.; Yang, Laurel M.; Grall, Kristi J H; Gonzaga, M. Jessica; Larson, Wanda J.; Stolz, Uwe; Sabb, Dylan M.; Denninghoff, Kurt R.

In: American Journal of Infection Control, 2016.

Research output: Contribution to journalArticle

DeLuca, Lawrence A. ; Walsh, Paul ; Davidson, Donald D. ; Stoneking, Lisa R. ; Yang, Laurel M. ; Grall, Kristi J H ; Gonzaga, M. Jessica ; Larson, Wanda J. ; Stolz, Uwe ; Sabb, Dylan M. ; Denninghoff, Kurt R. / Impact and feasibility of an emergency department-based ventilator-associated pneumonia bundle for patients intubated in an academic emergency department. In: American Journal of Infection Control. 2016.
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abstract = "Background: Ventilator-associated pneumonia (VAP) has been linked to emergency department (ED) intubation and length of stay (LOS). We assessed VAP prevalence in ED intubated patients, feasibility of ED VAP prevention, and effect on VAP rates. Methods: This was a quality improvement initiative using a pre/post design. Phase 1 (PRE1) comprised patients before intensive care unit (ICU) bundle deployment. Phase 2 (PRE2) occurred after ICU but before ED deployment. Phase 3 (POST) included patients received VAP prevention starting at ED intubation. Log-rank test for equality and Cox regression using a Breslow method for ties were performed. Bundle compliance was reported as percentages. Number needed to treat (NNT) was calculated by ventilator day. Results: PRE1, PRE2, and POST groups were composed of 195, 192, and 153 patients, respectively, with VAP rates of 22 (11.3{\%}), 11 (5.7{\%}), and 6 (3.9{\%}). Log-rank test showed significant reduction in VAP (χ2 = 9.16, P = .0103). The Cox regression hazard ratio was 1.38 for the Clinical Pulmonary Infection Score (P = .001), and the hazard ratio was 0.26 for the VAP bundle (P = .005). Bundle compliance >50{\%} for head-of-bed elevation, oral care, subglottic suctioning, and titrated sedation improved significantly with introduction of a registered nurse champion. NNT varied from 7 to 11. Conclusions: VAP was common for ED intubated patients. ED-based VAP prevention is feasible. We demonstrate significant reduction in VAP rates, which should be replicated in a multicenter study.",
keywords = "Acute respiratory failure, Emergency medicine, Hospital-acquired infection, Infection prevention, Ventilator-associated pneumonia",
author = "DeLuca, {Lawrence A.} and Paul Walsh and Davidson, {Donald D.} and Stoneking, {Lisa R.} and Yang, {Laurel M.} and Grall, {Kristi J H} and Gonzaga, {M. Jessica} and Larson, {Wanda J.} and Uwe Stolz and Sabb, {Dylan M.} and Denninghoff, {Kurt R.}",
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T1 - Impact and feasibility of an emergency department-based ventilator-associated pneumonia bundle for patients intubated in an academic emergency department

AU - DeLuca, Lawrence A.

AU - Walsh, Paul

AU - Davidson, Donald D.

AU - Stoneking, Lisa R.

AU - Yang, Laurel M.

AU - Grall, Kristi J H

AU - Gonzaga, M. Jessica

AU - Larson, Wanda J.

AU - Stolz, Uwe

AU - Sabb, Dylan M.

AU - Denninghoff, Kurt R.

PY - 2016

Y1 - 2016

N2 - Background: Ventilator-associated pneumonia (VAP) has been linked to emergency department (ED) intubation and length of stay (LOS). We assessed VAP prevalence in ED intubated patients, feasibility of ED VAP prevention, and effect on VAP rates. Methods: This was a quality improvement initiative using a pre/post design. Phase 1 (PRE1) comprised patients before intensive care unit (ICU) bundle deployment. Phase 2 (PRE2) occurred after ICU but before ED deployment. Phase 3 (POST) included patients received VAP prevention starting at ED intubation. Log-rank test for equality and Cox regression using a Breslow method for ties were performed. Bundle compliance was reported as percentages. Number needed to treat (NNT) was calculated by ventilator day. Results: PRE1, PRE2, and POST groups were composed of 195, 192, and 153 patients, respectively, with VAP rates of 22 (11.3%), 11 (5.7%), and 6 (3.9%). Log-rank test showed significant reduction in VAP (χ2 = 9.16, P = .0103). The Cox regression hazard ratio was 1.38 for the Clinical Pulmonary Infection Score (P = .001), and the hazard ratio was 0.26 for the VAP bundle (P = .005). Bundle compliance >50% for head-of-bed elevation, oral care, subglottic suctioning, and titrated sedation improved significantly with introduction of a registered nurse champion. NNT varied from 7 to 11. Conclusions: VAP was common for ED intubated patients. ED-based VAP prevention is feasible. We demonstrate significant reduction in VAP rates, which should be replicated in a multicenter study.

AB - Background: Ventilator-associated pneumonia (VAP) has been linked to emergency department (ED) intubation and length of stay (LOS). We assessed VAP prevalence in ED intubated patients, feasibility of ED VAP prevention, and effect on VAP rates. Methods: This was a quality improvement initiative using a pre/post design. Phase 1 (PRE1) comprised patients before intensive care unit (ICU) bundle deployment. Phase 2 (PRE2) occurred after ICU but before ED deployment. Phase 3 (POST) included patients received VAP prevention starting at ED intubation. Log-rank test for equality and Cox regression using a Breslow method for ties were performed. Bundle compliance was reported as percentages. Number needed to treat (NNT) was calculated by ventilator day. Results: PRE1, PRE2, and POST groups were composed of 195, 192, and 153 patients, respectively, with VAP rates of 22 (11.3%), 11 (5.7%), and 6 (3.9%). Log-rank test showed significant reduction in VAP (χ2 = 9.16, P = .0103). The Cox regression hazard ratio was 1.38 for the Clinical Pulmonary Infection Score (P = .001), and the hazard ratio was 0.26 for the VAP bundle (P = .005). Bundle compliance >50% for head-of-bed elevation, oral care, subglottic suctioning, and titrated sedation improved significantly with introduction of a registered nurse champion. NNT varied from 7 to 11. Conclusions: VAP was common for ED intubated patients. ED-based VAP prevention is feasible. We demonstrate significant reduction in VAP rates, which should be replicated in a multicenter study.

KW - Acute respiratory failure

KW - Emergency medicine

KW - Hospital-acquired infection

KW - Infection prevention

KW - Ventilator-associated pneumonia

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U2 - 10.1016/j.ajic.2016.05.037

DO - 10.1016/j.ajic.2016.05.037

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JO - American Journal of Infection Control

JF - American Journal of Infection Control

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