感染症と治療ジャーナル

抽象的な

Six sigma project on hospital acquired ventilator associated pneumonia at tertiary care hospital

Riffat Shaheen

Ventilator associated pneumonia (VAP) is the most common hospital acquired infection among patient in intensive care unit and is associated with significant mortality rate and rising the cost of care by increasing a patient’s stay (Babcock, 2004).

Purpose: 1. The 1^st purpose of all exercise, to implement a HAI surveillance system in a right manner    with described time frame.

The 2^nd purpose was that, 50% reduction of hospital acquired VAP rate and patient stay with ventilator by the end of December 2017.

Methodology: Setting: Observation was conducted in all intensive care units including medical, surgical and pediatric, consist of 51 beds, at tertiary care hospital.

Population: All patients who are connected to a ventilator after admission. All register nurses and attending doctor are assigned on patient with ventilator.

Inclusion Criteria: All patients who developed a VAP, connected to ventilator for more than 48hours and within 48hours after disconnection of ventilator. Exclusion Criteria: None.

Selection Criteria: High risk, high cost, high volume, problem prone and requirement of standard such as IPC and ISO.

Data Collection: Collected by making a daily round in all intensive care units, reviewed patient’s clinical condition, and their medical records and reviewed all investigation reports such as x-ray, sputum C/S, CBC. 

Results: Initially as a base line, just observed the current practices and knowledge of the healthcare workers and surveillance systems conducted by IPC team from July to August 2017. During baseline phase, it was observed no coordination among ICU’s stakeholder, IPC team, purchase and bio-medical department. All healthcare worker involved in care on ventilated patient, were educated on VAP bundle, hand hygiene and appropriate using of PPE. VAP committee was established with including of purchase manager and bio-medical manager to purchase right items for use and appropriate cleaning, PPM and calibration.

Conclusion: Conduction of HAI surveillance system is a first necessary step for IPC team there for it is essential that HAI surveillance system must be perform with a right direction to get a correct rate of hospital acquired infection as it will reflect on IPC’s work competency.

Limitations: Initially, implementation of surveillance system with modification was very tough for IPC team as they were not habitual, nor they had a detail concept so there was a possibility to have under reporting system as it been a new for IPC team.