The Effects of Standardized Suction and Ventilator Management Protocol on Ventilator Associated Pneumonia in the Intensive Care Unit

Song, Kyung Ja; Yoo, Cheong Suk; Kwon, Eun Ok; Jung, Eun Ja; Shin, Hyeon Ju; Park, Ock Hyang; Ok, Sun Ok; Yu, Mi; Yun, Sun Hee; Lee, Bok Nam; Choi, Jin Ah; Hwang, Jeong Hae; Oh, Hyang Soon

Journal of Korean Society Quality Assurance Health Care 2001;8(1): 44.
Published online June 30, 2001.

중환자실 흡인간호 및 인공호흡기관리 표준화를 통한 인공호흡기 관련 폐렴발생 감소효과에 관한 연구

송경자¹, 유정숙¹, 권은옥¹, 정은자¹, 신현주¹, 박옥향¹, 옥순옥¹, 유미¹, 윤선희¹, 이복남¹, 최진아¹, 황정해², 오향순³

¹서울대학교병원 간호부
²서울대학교병원 QA전담반
³서울대학교병원 감염관리실

The Effects of Standardized Suction and Ventilator Management Protocol on Ventilator Associated Pneumonia in the Intensive Care Unit

Kyung Ja Song¹, Cheong Suk Yoo¹, Eun Ok Kwon¹, Eun Ja Jung¹, Hyeon Ju Shin¹, Ock Hyang Park¹, Sun Ok Ok¹, Mi Yu¹, Sun Hee Yun¹, Bok Nam Lee¹, Jin Ah Choi¹, Jeong Hae Hwang², Hyang Soon Oh³

¹Nursing Department, Seoul National University Hospital
²QA team, Seoul National University Hospital
³Infection Control Service, Seoul National University Hospital

Abstract

Background
This study aimed at identifying the effect of the standardized protocol on lowering the incidence of the ventilator associated pneumonia(VAP).
Methods
The standard protocol focusing on decreasing VAP was made and applied at 5 ICUs (Medical ICU, surgical ICU, Respiratory ICU, Neonatal ICU, Pediatric ICU) in a university affiliated tertiary hospital, from April 1, 2000 to Oct 31, 2000. The protocol involved 3 parts : hand washing, the suctioning method and ventilator circuit management. All the nursing personnel received intensive education which was consisted of lecture, video film and demonstration. 176 nurses reported the performance of handwashing pre and post intervention. And randomly selected 15 nurses were observed by charge nurse and the handwashing practice was analyzed pre and post intervention. The incidence of VAP was compared with the former year incidence.
Results
The self reported frequency of hand washing increased. In the direct observation of handwashing, the frequency, time, thoroughness of hand washing during 8 hours day duty was found to be improved. The frequency was increased from 1.1 time to 4.1 times; the time was improved from 1.7 seconds to 5.7 seconds and the thoroughness of the washing practice was from 0.2 times to 3.0 times respectively (p<0.001). The incidence of VAP decreased from at a rate of 15.63 number of case per 1,000 ventilator-day (April 1~August 31, 1999) to 7.23 number of case per 1,000 ventilator-days(April 1~Oct 31, 2000)(P<0.001).
Conclusion
We developed the protocols which included hand washing, the suctioning method, and ventilator circuit management. Through the implementation of the protocol, the performance of hand washing improved and the VAP incidence rate in ICU was decreased.

Key words Ventilator associated pneumonia;Handwashing;Suction;Ventilator;