Vap

[WSH-RN]

I would like to know how you guys are handling VAP in your units? What is your pro-active approach to VAP. Do you have many/any occurrences?

Thanks!!

WSH

[BBFRN, BSN, PhD]

We use the Hi-Lo ETTs. I absolutely love them!

[criticalHP, MSN, RN]

We are using Sage oral care products but have considered going to chlorhex. Some of the staff are resistant because of staining of the teeth can be a problem with chlorhexadine. Have any of you experienced a problem with this?

[cardiacRN2006, ADN, RN]

With agresssive use of the ventilator bundle, we have completely eliminated VAP from our unit. We've not had a case of VAP in 21 months.

Same here, we're going on 3 years with no VAP, using the bundle...

[ChelleChelle]

As at other institutions we use the IHI Ventilator Bundle

1. HOB up 30 to 45 degrees unless medically contraindicated

2. Sedation Vacation or Daily Awakening

3. Peptic Ulcer Prophylaxis

5. DVT Prophylaxis

Other initiatives

* Use of a CASS (continuous airway sub-glottal suction) tube to intubate on any patient going to the ICU or any re-intubation

* No break in the ventilator circuit during transportation (or any other time for that matter)

*Squirting NS down the tube it is a "no-no"!!!

* Vent tubing is no longer changed frequently (remember when we used to change it every 24 hours??)

* Religious oral care or "interventional" hygiene as we like to call it

* Pushing patients to early extubation. Our theory is, if we don't have to reintubate a few of them............then we are not getting them off the vent soon enough

*Handwashing, handwashing, handwashing!

*Changing the Yankauer every 24 hours and keeping it covered

*Maintaining separate suction canisters (the CASS tube separate from oral suction separate from CT suction separate from rectal tube suction, etc.)

* We also use an acronym......"WHAP the VAP"

Wean Early

Hand Hygiene

Aspiration Precautions

Prevent Cross Contamination

I'm sure there are a few more that I have forgotten.

We are by no means perfect and the VAP rate varies between our cardiac ICU, medical ICU, surgical ICU, and neuro ICU............but many of the units have sustained a zero VAP rate for quite some time.

[Meteam1]

Hi,

The hospital that I work at is participating in a VAP study (sorry but I can't remember the name of the study).. Up until now we have not done much to prevent VAP but now have adopted the VAP bundle as in an earlier post. I did not see comment on use of the EVAC tube which is now common practice in our unit.

I think is is great that we are providing care that is evidenced based now and not doing things because "that's just the way we do things" with no rationale behind it.

Time will tell the effectiveness of our new adapted ways as our VAP rate was very high.

D in ON