Deadly Healthcare-Associated Infection Preventable Using Evidence-based Practices

Every year in the United States about 800,000 hospital patients go on a ventilator; for some of these patients, ventilator assistance can mean the difference between life and death.

Although mechanical ventilators can save lives—providing needed oxygen to those who are unable to breathe on their own—there are several risk factors associated with these machines, and these risks can result in serious complications, commonly referred to as ventilator-associated events (VAE). Patients undergoing mechanical ventilation can experience blood clots, lung damage, and, “one of the most common and deadly hospital-acquired infections” in the intensive care unit (ICU): ventilator-associated pneumonia.

However, there may be hope for these patients.

A study conducted by researchers from the Johns Hopkins Armstrong Institute of Patient Safety and Quality has shown that VAEs, are, in fact, preventable if healthcare providers take the proper steps.

VAEs have been linked with “increased mortality, prolonged mechanical ventilation,” and thus, more time in the ICU. Not only can these events be fatal, but they are also a financial burden.

“When patients are sick, complications can happen, and, in some cases, healthcare-associated infections are thought to be inevitable,” Sean Berenholtz, MD, professor of anesthesiology and critical care medicine at the Johns Hopkins University School of Medicine and faculty member at the Armstrong Institute said in a recent press release. “This is the largest study to date to show that these complications of mechanical ventilation, or ventilator-associated events, are also preventable.”

The study was conducted from October 2012 to March 2015, in 56 ICUs in 28 different hospitals located throughout Maryland and Pennsylvania. The central aim of the study? “To improve adherence with evidence-based practices, unit teamwork, and safety culture.”

Multidisciplinary “quality improvement teams” at the selected hospitals included in the study were trained by the research team on several interventions that are recommended by the Society for Healthcare Epidemiology of America as well as the Society of Critical Care Medicine, for patients undergoing mechanical ventilation.

According to the press release, some of these interventions included:

• Elevating the head of the patients’ beds
• Suctioning the patients’ mouth tubes
• Brushing patients’ teeth
• Using chlorhexidine to reduce dental plaque and treat gingivitis
• Performing spontaneous awakening and breathing trials by reducing narcotics and sedatives
• Screening patients for improvement

In addition, the quality improvement teams were also coached on the implementation of the Agency for Healthcare Research and Quality’s (AHRQ) Comprehensive Unit-based Safety Program, also known as CUSP, in their units, a toolkit that provides training tools that works on engaging staff members while assisting them in targeting any safety issues that need to be addressed in their facilities through the combination of “clinical best practices and the science of safety.”

The results? After 24 months, the number of VAEs in the designated ICUs witnessed a decrease of about 38%, going from 7.34 cases per 1,000 patient ventilator days to 4.58 cases. Furthermore, the number of ventilator-associated infections was essentially cut in half, going from 3.15 to 1.56 cases. Arguably, the biggest finding yielded by this study is the whopping 78% reduction that was seen in the number of ventilator-associated pneumonia cases (possible and probable), going from 1.41 to .31 cases.

“These complications prolong the duration of mechanical ventilation, and they keep patients in the hospital longer. This, in turn, leads to higher complications, higher mortality, higher lengths of stay, and higher costs,” Dr. Berenholtz said. “So, decreasing these complications is a national priority and helps our patients recover sooner.”

The research team has since expanded their study to include hospitals from all 50 states.