We seem to be having a bit of VAP in our unit. We have done tons of education, and we're really good about all the different oral care and elevation of patients, but we still have VAP. Heard that the hilo evac tube might help, so I was wondering if anyone has any experience using them in their unit. Did they actually decrease VAP?
May 7, '12
It's part of the VAP bundle in my hospital. Whenever a patient gets intubated in the ICU they get an ETT with subglottic secretion drainage. Only thing we won't do is reintubate them if they have an ETT without subglottic secretion drainage. As far as I know having SSD is an integral and scientifically proven part of the VAP bundle. And our VAP incidence has gone down, but it's hard to tell exactly what part SSD plays in it because of confounding factors like increased awareness to the VAP bundle and rigorous nazi politics on head of bed issues by our very mean looking VAP study nurse.
Without SSD you'd still have micro-aspiration despite all other measures you take. The only problem with SSD is that often times it takes some energy to keep it draining because it has the tendency to clog up.
May 7, '12
Thanks Belgian RN. The rest of the typical VAP bundle is in place, HOB, and 4 gazillion mouth hygiene things... I'm noting that lately we have a tendency to throw 5 things in to try to reduce something and then we don't know what actually did work, so we have to keep all 5! Looks like we need a mean looking VAP nurse champion and these tubes. I'd like to put them in place in the ICU and Emergency where a lot of pts are tubed.
We are very aware of our VAP bundle. You say the word VAP and everyone kind of cringes. 2 problems we do not have the hilo tubes, and also lately we have had a lot of pts lingering on the ventilator without being trached....Mostly due to family issue or anatomy problems. (our docs are good...) I am starting to think an enterprising dentist and hygenist could set up a practice in our ICU....
May 8, '12
We hypothesized for our hospital that if the ICU was to supply the SSD-ETT's for the ED out of the ICU budget it would most likely still cut overall hospital costs for VAP. It's a major struggle between ICU and ER here to get the same materials working.
After we finished the entire discussion about getting Foleys with temperature probe in the standard outfitting of our ER we are now looking to motivate the use of ETTs with SSD. But ER management is reluctant since the tubes with SSD are 10x more expensive than the ones without... And VAP really isn't their problem since it is only used an index of quality for the ICU ^^.
May 8, '12
Frustratingly, None of the Big 4 infections are the ED problem. THis is because the ED is considered an outpatient unit, and thus any issues created by them are then credited to the unit the patient goes to.
thankfully our hospital is a smaller community hospital and the acuity of our patients does not demand the temp probe foleys, so we can probably focus on the SSD ETT. I am looking for a "fix". We have all been working so hard on the VAP bundle that when we hear that we have another VAP everyone gets really depressed and feels like what they are doing doesn't matter....