LEAP: Lead, Excel, Achieve, Perform: A Report on the UHC Annual Conference 2011

Cindy White, Julie Cerese, Jake Groenewold, Jim Collins, Susan Dentzer, Timothy H. Dellit, Elizabeth A. McNamara, John B. Lynch, Cathy Rodgers Ward, Edith Matesic, J. Thomas Rosenthal, David J. Cook, Jeffrey E. Thompson, Anantha Kollengode, Thoralf M. Sundt, Catherine Shipp, Phillip J. DeChristopher, Steven B. Edelstein, Jason Kang, Helen KrontirasMartin J. Heslin, Bettina Berman, William S. Cobb, Bruce A. Snyder, Cindy B. Coffey, Spence M. Taylor, Eugene M. Langan, Kathy Pawlicki, Shane Cerone, Sam Flanders, Rocco J. Perla, Karen Annis, Samuel F. Hohmann, Jodie Black, George V. Russell, Michael Baumann, Gene Beyt, Rich Graffis, Jody Hoffer Gittell, Tom Hartley, Tracy Spitzer, Suzi Tolliver, Cindy Angiulo, Donna Henderson, Katy Folk-Way, Arjun Rao, Joseph Hopkins, Kim Pardini-Keily, Barton L. Sachs, Ellen F. Robinson, Anneliese M. Schleyer, Kevin Middleton, Ken Jarman, Mark Taylor, Mark C. Zaros, Joseph Cuschieri, J. Richard Goss, Glenn K. Geeting, Christopher J. DeFlitch, Kerri Anne Scanlon, Karen Nelson, Sheldon Newman, Kelly Cifu-Tursellino, Susanne Schultz, Bela Patel, Ruth Siska, Tammy Campos, Pratik Doshi, Brandy McKelvy, Khalid Almoosa, Rex Mathew, Andrew Storer, Linda Davis-Moon, Michael Carey, Laura Kneale, Jonathan Stegner, Jenny Lanier, Anika T. Bell-Gray, Kathy Boyle, Pat Tillapaugh, Jeff Pelot, Coletta Danneker, Charles Willson, Gerald Strope, Ronald Perkin, Judy Schueler, Linda May, Tom Gilmore, Joshua Medow, Carin Bouchard, Michael Sheinberg, Francis A. Fullam, Dale Shaller, Gladys J. Epting, Brenda Ohta, Donna L. Kaye, Jeff Strickler, C. Scott Hultman, Lilian Chukwuma, Zachary Mufson, Nathan Levitan, Eric Bieber, Cathy Koppelman, Susan Madden, Dennis Kaldenberg, Richard Siegrist, Madeline Bell, Anna Spraycar, Colleen Swartz, Paul DePriest, Martha J. Radford, Lynn E. Webb, Maureen Slade, Nita Kulkarni, Cahren Cruz, John Brumsted, Randall Messier, Melissa Holman, Carolyn L. Sanders, Lorna Prutzman

Research output: Contribution to journalArticlepeer-review

Abstract

Background. Ventilator-associated pneumonia (VAP) has been a challenge for our burn, trauma, and neurosurgical population because of their underlying injuries, prolonged mechanical ventilation, need for spinal clearance prior to head-of-bed elevation, and risk for multidrug-resistant organisms, resulting in a total of 266 cases of VAPs in 2007. Intervention detail. We developed a multidisciplinary team, involving critical care, infection control, antimicrobial stewardship, clinical education, and information technology (IT), focused on prevention, diagnosis, and management with detailed surveillance of VAP cases and rates, microbiology, and antimicrobial resistance. Each VAP case is reviewed at the unit level with the multidisciplinary care team for VAP risk factors as well as bundle compliance. IT has facilitated electronic surveillance of bundle compliance in all ventilated patients as well as an automated daily list of all patients on spine precautions and time to head of bed >30°. Results. Improved antimicrobial use along with infection control initiatives such as hand hygiene, active surveillance cultures of all intensive care unit patients for MRSA and carbapenem-resistant Acinetobacter, use of contact precautions, daily chlorhexidine baths, and improved environmental cleaning with monthly audits have led to dramatic reductions in VAP caused by MRSA and Acinetobacter. Changes in local microbiology resulted in modification of empirical antimicrobial therapy and reduced use of imipenem for late-onset VAP (mechanical ventilation or hospitalization >5 days). In addition, active surveillance cultures have a 99% negative predictive value for the development of MRSA VAP, allowing more judicial use of empirical vancomycin. More appropriate use of vancomycin and imipenem are estimated to reduce pharmacy costs by $130 000 per year. These measures have led to a sustained reduction in the number of VAP cases from 266 in 2007 to 98 in 2010, reflecting a 63% reduction in the absolute number of VAP cases, and our management has been improved through appropriate antimicrobial therapy based on local microbiology and resistance patterns.

Original languageEnglish (US)
Pages (from-to)S3-S33
JournalAmerican Journal of Medical Quality
Volume27
Issue number1 SUPPL.
DOIs
StatePublished - 2012

All Science Journal Classification (ASJC) codes

  • Health Policy

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