BABCOCK HM, ZACK J, TROVILLIAN E, GARRISON T, KOLLEF M, FRASER V; Interscience Conference on Antimicrobial Agents and Chemotherapy (42nd : 2002 : San Diego, Calif.).

Abstr Intersci Conf Antimicrob Agents Chemother Intersci Conf Antimicrob Agents Chemother. 2002 Sep 27-30; 42: abstract no. K-654.

Washington University School of Medicine, St. Louis, MO.

BACKGROUND: Ventilator-associated pneumonia (VAP) is the most common nosocomial infection among patients (pts) requiring mechanical ventilation and results in excess mortality, hospital length of stay and cost. METHODS: Infection control practitioners (ICPs) designed an intervention ("WHAP VAP") with a pre-test, educational module and post-test for intensive care (ICU) nurses and respiratory therapists (RTs) to decrease VAP in a multi-hospital system. ICPs at each hospital report all VAPs, with available microbiologic data, to a centralized database. The intervention was implemented in fall 2000. We reviewed VAP data from 4 hospitals (3 adult, 1 pediatric) for microbiology patterns and for changes in VAP rates from 1998-2001. RESULTS: 970 episodes of VAP occurred among 910 pts. 769 pts had culture data. The most common organism for all hospitals combined was S. aureus (SA, 21.3%), followed by P. aeruginosa (PA, 20.5%). 75 (8.2%) pts had a secondary bloodstream infection associated with the VAP. Rates for specific VAP organisms varied by hospital: the pediatric hospital had higher rates of E. coli (5.4% vs. 1.7%, p=.001), E. cloacae (9.7% vs. 1.9%, p=.001) and K. pneumoniae (7.5% vs.2.6%, p=.001) than adult hospitals. Rates also varied within hospitals: the pediatric ICU had higher PA rates than the neonatal ICU (22% vs. 12%, p=.02), the neurologic ICU had higher SA rates (32% vs.18.5%, p=.003) and the cardiothoracic ICU had higher PA rates (32% vs. 18%, p=.011) than other adult ICUs. VAP rates for all 4 hospitals combined dropped after the WHAP VAP intervention (8.1 vs. 5.1/1000 ventilator days, p=.0001). Rates dropped at the pediatric hospital and 2 of 3 adult hospitals. CONCLUSIONS: Educational interventions can have a significant impact on VAP rates. Microbiologic etiologies of VAP may vary between and within hospitals. Understanding etiologic agents for specific settings may help target interventions and antimicrobial use.

Publication Types:

• Meeting Abstracts

Keywords:

• Adult
• Child
• Cross Infection
• Hospitals, Pediatric
• Humans
• Infection Control Practitioners
• Intensive Care
• Intensive Care Units
• Pneumonia
• Respiration, Artificial
• Ventilators, Mechanical
• education

Other ID:

• GWAIDS0028320

UI: 102267944

From Meeting Abstracts