1. Eliminate Ventilator-Associated Pneumonia

2. What Is a Ventilator? A machine that supports breathing for those that have lost the ability to breathe Short term use – During surgery – During treatment Long term use

3. After surgical procedures – Lung, heart, prolonged procedures, Impaired breathing – Heart attack, stroke, trauma, head injury, drug overdose, chronic lung disease Who Needs a Ventilator?

4. What is Ventilator-Associated Pneumonia? A lung infection that develops in a person who is on a ventilator Occurs in 10-20% of ventilated patients Common healthcare-acquired infection – 250,000 infections annually Most lethal healthcare-acquired infection – Mortality likely exceeds 10% – Up to 36,000 deaths annually Cost per episode- $23,000+ Safdar CCM 2005, Kollef Chest 2005, Perencevich ICHE 2007, Public Health Rep. 2007.

5. Ineffective hand washing Agents that impair patient’s natural defense and/or increase the chance of swallowing oral secretions Prolonged antibiotic use Prolonged mechanical ventilation Lung disease Impaired mental status Excessive sedation Cigarette smoking Risk Factors for Ventilator-Associated Pneumonia

6. Eliminate Ventilator-Associated Pneumonia Led by Dr. Sean Berenholtz, of the Armstrong Institute for Patient Safety & Quality Funded by NIH/NHLBI and AHRQ Only two states invited to participate- Maryland and Pennsylvania Two year intervention period with a 1 year sustainability Based on the latest science and research Includes unit-based Technical and Adaptive components Goals: – To achieve significant reductions in VAP/VAE rates – To achieve significant improvements in safety culture

7. Benefits to Participation Improve patient outcomes – Build upon and spread efforts to date – Focused specifically on VAP prevention, including structural measures Get “a leg up” on the new CDC VAE definition – Predicted to increase current VAP rates – Aligned with public reporting of VAP Enhance performance-Health Service Cost Review Commission's quality initiatives including Maryland Hospital Acquired Conditions (MHACs) Initiatives Supports the Maryland Health Care Commission’s Healthcare- Associated Infections Prevention Plan

8. The Problem in Maryland* 583 ventilator-associated pneumonia cases in FY2011 equates to an estimated: – 130 deaths – 4,198 excess length of stay days – $47,289,462 excess cost *Source: Health Services Cost Review Commission Maryland Hospital Acquired Conditions database and VAP national estimator - http://www.hopkinsmedicine.org/quality_safety_research_group/our_projects/ventilator_associated_pheumonias/estimator.html http://www.hopkinsmedicine.org/quality_safety_research_group/our_projects/ventilator_associated_pheumonias/estimator.html

9. ‘VAP Prevention’ Bundle

10. Early Ambulation Improved return to independent functional status after discharge Shorter duration of delirum Increased ventilator-free days

11. Implementation Strategy Technical Clinical Bundle – HOB > 30° – Oral care with chlorhexidine – Subglottic suctioning – Spontaneous awakening & breathing trials Data – Outcome Measures – Process Measures – Structural Measures Adaptive Comprehensive Unit-based Safety Program (CUSP) Educate staff on science of safety Identify defects Assign executive to adopt unit Learn from one defect per quarter Implement teamwork tools

12. Maryland’s Participation Kick-off October 12 100 attendees 26 hospitals participating 36 patient care units