Wednesday, December 03, 2008

Great progress to the west

OK, so not really that far west, but in Northampton, MA, at Cooley Dickinson Hospital. The press release follows. Congratulations to the entire group for a job well done!

NORTHAMPTON, Mass – It’s been one year and 28 days since a Cooley Dickinson Hospital ICU patient has become sick with ventilator-associated pneumonia, a serious infection that can occur in people who rely on ventilator machines to breathe.

“As of Nov. 29, that’s 393 days since the last ventilator-associated pneumonia infection,” Daniel J. Barrieau, director of respiratory care services says of an infection that in October topped a list of the most costly and common hospital-acquired infections.

According to the Centers for Disease Control’s National Healthcare Safety Network Report, Cooley Dickinson’s accomplishment of preventing Ventilator-Associated Pneumonia or VAP ranks the hospital’s performance in the top 10 percent of the nation’s medical/surgical intensive care units (ICUs).

VAP can occur in patients who, because of severity of illness or condition, require mechanical ventilation. When the ventilator tube that pumps life-saving air into vulnerable lungs becomes contaminated, the tube can act as a pathway for bacteria or secretions to enter the respiratory tract, paving the way for VAP. According to the Institute for Healthcare Improvement’s (IHI) website, VAP typically “afflicts up to 15 percent of those in ICUs so weakened by illness or trauma that they need mechanical help to breathe.”

Physicians and staff at Cooley Dickinson are working to eliminate VAP and have adopted a zero-VAP philosophy. Says Barrieau, “We are being aggressive about eliminating VAP, and our track record demonstrates our commitment to delivering the highest possible care to our patients.”

This aggressive approach is paying off. Barrieau says VAP infections in Cooley Dickinson’s intensive care unit have gone from 5 in 2007 to zero as of Nov. 29.

“Besides searching for clinical solutions to the VAP problem, we asked ourselves, ‘what could we change about our culture and our systems to improve our outcomes?’” says Barrieau.

This culture change began in 2005 when team of respiratory therapists, physicians, nurses, quality improvement staff and infection prevention specialists adopted a set of instructions from the Institute for Healthcare Improvement known as the IHI ventilator bundle. The IHI bundle offers a series of interventions determined to be the best evidence-based practices related to reducing the risk of VAP to patients.

Then, Barrieau explains, staff began to “push beyond the bundle of strategies to look for other ways to reduce the risk to patients and eliminate VAP altogether.”

They scrutinized the VAP cases to identify patterns and trends. For example, their analysis indicated that patients on ventilators for more than 19 days, those with difficult intubations and those who required transportation within the hospital were the most vulnerable.

Using an approach called clinical Microsystems, where front-line teams are empowered to make improvement decisions based on scientific data and best practices the team evaluated how each clinician relates their daily work and actions to VAP.

“Doing the minimum is not enough to achieve our zero-VAP philosophy,” states Barrieau. He says clinicians in a culture of zero VAP understand how their actions matter and that acting to reduce risk is part of the clinician’s standard practice.

In addition to preventing VAP infections in patients and providing best-practice care, there is a significant cost savings to the hospital. In 2007, based on Cooley Dickinson’s VAP prevention measures, the organization saved $200,000 by reducing or eliminating the occurrence of the infection and reducing the patient’s length of stay in the intensive care unit.

In 2006, the Institute for Healthcare Improvement named Cooley Dickinson a mentor hospital in three clinical areas including VAP. Since then, Barrieau and his colleagues have presented Cooley Dickinson’s VAP elimination strategies at professional conferences, and he has served on the Mass. Department of Public Health’s Healthcare Associated Infection Task Force.

In December 2007, Cooley Dickinson was one of three hospitals in Massachusetts to receive the Betsy Lehman Patient Safety Award for the organization’s work to eliminate hospital-associated infections including VAP.

In October 2008, Cooley Dickinson was featured in the Joint Commission Journal on Quality on Patient Safety and lauded for breaking new ground in quality improvement.

The five healthcare groups that contributed to the guide include the Healthcare Infection Control Practices Advisory Committee (HICPAC), the Society for Healthcare Epidemiology of American (SHEA), the American Hospital Association (AHA), the Association for Professionals in Infection Control and Epidemiology, Inc. (APIC) and The Joint Commission.


Anonymous said...

Great example of what can and should be done. The pressure is on for measurable performance improvement. Those who invest determination and resources will see the payoff. Others will suffer when regulation requires it.

Anonymous said...

What did you use as your definition of VAP?

Anonymous said...

We use the CDC NHSN definition. The detail of the definition can be found at:

The algorithm is on page 20 of the document.

Thanks for your interest.

Dan Barrieau
Cooley Dickinson Hospital

Anonymous said...

For those interested, we are at 428 days (and counting) as of 1/3/08

Dan Barrieau
Cooley Dickinson Hospital