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Discussion

VAP precautions and PRI

This question goes out to the IUC staff. Our unit has adopted the VAP precautions and practice changes recommended by the various quality improvement movements in health care.

I am wondering from any of the other units that have adopted these practices if they have seen an increase in pressure related injuries - specifically coccyx injuries since the implementation of sitting ventilated patients up at 30-45 degrees?

We have been involved with this project for a year now and while we didn't have a good tracking of PRI prior to the initiative, we have a sense that they are increased and are now tracking the incidence of PRI.

I would like to find out if it is unique to our unit or if others are experincing the same thing. We have also made use of speciality bed surfaces and frequent turning, but still some patients develop injuries.

What's your sense?

and because it is so frequently about the numbers - what's your data?

thanks so much

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I am not familiar with any statistics or hard facts on this issue. And the whole time I have worked in the ICU, we have been told to keep the HOB 30 degrees. But, I have not heard of this before. My unit now actually has air mattresses on all beds, and the beds can turn the patient. Perhaps turning is not being done frequently enough? Although, there are certain patients who are going to get skin breakdown no matter what you do. Does your unit use "flexiseals" for rectal tubes with patients with loose stool? Those are the greatest invention ever, and I bet they help prevent skin breakdown.

No VAP in 2 years. GOOD oral care q2h with sage perox-a-mint and brushes as well as frequent suctioning and keeping the HOB elevated. We also use aggressive weaning protocols and most are on PPIs.

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