Selected Abstracts of the Critical Care Canada Forum 201, November 9 to 12, 2013, Toronto, Ontario

IntroductIon:The Hospital for Sick Children has previously implemented Ventilator Associated Pneumonia (VAP) bundle preventative practices with good compliance such as: head of bed elevation, mouth Care Q2-4 hourly, ventilator tubing condensation draining away from patient, and daily assessment for extubation readiness.Despite these bundle prevention strategies, VAP rates remained high in our CCU, i.e. average approximately 3 VAP's per month during 2011 between the PICU and CCCU (VAP rate of 5.19 per 1000 ventilator days).Hospital-acquired pneumonias (HAPs) often start in the oral cavity.Bacteria, including dental plaque, can colonize in the oropharyngeal area, and these pathogens can be aspirated into the lungs.With VAP mortality rates of 29.3%, increased length of stay of 23 days, and at a cost of $14,000 per occurrence demonstrated in the literature, the clinical and financial impact is substantial.The estimated treatment cost of VAP in 2011 was $504,000 for the PICU and CCCU (36 cases at $14,000 per VAP).Focusing on our oral care practices could have a significant impact on the incidence of VAP.Prior to introducing a comprehensive oral care kit in our CCU there were three practices for oral care utilized by our nurses depending upon the patient's age.Implementing one consistent practice for oral care for all patients and having the appropriate supplies imediately avaiable to staff may increase the compliance to providing regular and effective mouthcare objectIves: Implement the Sage Q4 comprehensive oral care kit to address keys factors for VAP in PICU and CCCU.Monitor the impact on the incidence of VAP in the CCU.Maintain and track compliance to Q4 oral care protocol through education, in-servicing staff and by providing supplies directly at the bed side for staff.Validate clinically and finacially the Q4 oral care kit manufactured by Sage Products by tracking our incidence of VAP in the CCU compared with the products utilization.Methods: Replaced oral care practices with the Sage Q4 comprehesive oral care kit.This kit is utilized with all patient populations.Compared CCU ventilator days with the number of Q4 kits used to track compliance to mouth care protocols.Provided education and training on protocol and use of the Q4 system to all CCU bed side staff involved with oral care practices.Monitored the incidence of VAP and the utilization of the product to determine the clinical and financial outcome post implementation results: Average of 75% utilization of the product throughout the evaluation period observed.46%VAP reduction (average 1.63 per month over 8 months) from pre-implementation average of 3 VAPs per month.Cost of the product over the evaluation period of Oct 2012 until May 2013, $54,391.Estimated treatment saving: $154,000 as a result of decreased incidence of VAP.Eight month return on investment: $94,609.References: 1. John G Muscedere, Claudio M Martin, Daren K. Heyland.The impact of ventilator-associated pneumonia on the Canadian health care system.Journal of Critical Care (2008)23, 5-10.2. Adapted from Safer Health Care Now Getting Started Kit. 3. Schleder B., Stott K., Lloyd R. "The effect of a comprehensive oral care protocol on patients at risk for ventilator-associated-pneumonia" The Journal of Advocate Health Care (2002) 4, 27-30.

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