POTSDAM - Canton-Potsdam Hospital reached an important milestone on July 10, marking the hospitals 12th consecutive month during which there were zero cases of ventilator-associated pneumonia (VAP) occurring in patients of the hospitals Critical Care Unit, also known as intensive care.
VAP is one of the most common hospital-acquired infections (HAI), affecting 10-20 percent of patients undergoing ventilation, with death due to VAP occurring in over 10 percent of patients, according to the U.S. Centers for Disease Control (CDC). It also comes with a high economic cost to patients, families, and to the healthcare system overall due to extended hospitalizations, excess use of antimicrobial medications, and increased direct medical costs.
VAP is an infection that develops in the lungs of people who need to breathe with the aid of a mechanical ventilator because they cannot breathe on their own. The ventilator helps a patient breathe through a tube placed in the nose or mouth, or through a surgical opening in the neck. Germs may enter the tube and get into the patients lungs, resulting in an infection.
Reducing VAP is very challenging for hospitals, because it involves so many different aspects of care, said Amy R. Nugent, MSN, RN, NE-BC, director of the Critical Care Unit at CPH.
Staff who order equipment, clean the room and the equipment, and those who are involved in managing documentation need to know about special procedures, and patients and their families need to understand these procedures as well, she said. While the patients practitioner, nurses, and respiratory technologists are centrally involved in the care, prevention extends well beyond the purely clinical aspects of care, said Nugent.
Its been an intensive effort to bring several departments together and have them working as a team to prevent infections for 12 straight months on a challenging safety initiative, said Nancy A. Wood, RN, infection prevention specialist.
We followed best practices based on the latest research and recommendations, Nugent added, which include use of noninvasive ventilation wherever possible and minimizing the duration of mechanical ventilation, keeping the patients head elevated between 30 and 45 degrees, performing daily evaluations of the patients readiness to breathe without a ventilator, regularly swabbing the patients mouth with an antiseptic solution, rigorously adhering to proper hand hygiene for all who come in contact with the patient, and educating staff, volunteers, patients, and visitors about these preventive steps, said Nugent.
Medical protocols were also adjusted: Timothy K. Atkinson, MD, and Imré K. Rainey-Spence, MD, both hospitalists (practitioners whose medical specialty is the care of patients who have been hospitalized), and Andrew Williams, MD, internal medicine specialist, led the effort to introduce consistent ventilator order sets and use of the Adult Respiratory Distress Syndrome (ARDS-net) protocol.
Patients may not be able to communicate well with staff, so the involvement of families and visitors was very important in achieving our goals for this program, Nugent said. Families and visitors are encouraged to ask questions, learn about the procedures, and even challenge a caregiver if they see something that isnt right. Safety and quality are our highest priority, and we need patients and their families to be partners in monitoring safe practices.
The Critical Care Unit is an advanced care unit that handles approximately 180 visits annually. It is staffed by nurses with education in critical care, and is overseen by Magendra Thakur, MD, board-certified internal medicine and sleep medicine specialist with a subspecialty in pulmonology, and medical director of the unit, and Alexandru (Andre) Stoian, MD, board-certified cardiologist with subspecialties in adult echocardiology and nuclear cardiology, who is the medical staff chair of the Department of Internal Medicine, encompassing critical care.
Patients on the unit have been determined to have life-threatening injuries or illnesses such as complications from surgery, accidents, and severe breathing problems that have been temporarily stabilized but need constant, continuous attention by a team of specially trained healthcare providers.
For more information about CPH services, including critical care, interested individuals should call 315-265-3300 or visit www.cphospital.org.