1232. The Morbidity and Preventability of Ventilator-Associated Conditions
Session: Oral Abstract Session: Impact of National Policy on HAI Reporting and Prevention
Friday, October 19, 2012: 3:15 PM
Room: SDCC 32 AB
Background: Little is known regarding the morbidity and preventability of ventilator-associated conditions (VAC), the new surveillance paradigm proposed by CDC for ventilated patients. We evaluated these using data from a large, multicenter quality improvement initiative. 

Methods: We retrospectively applied CDC’s VAC definition to data from a 2 year, prospective time series study implementing clinical practice guidelines for ventilator associated pneumonia (VAP) in 11 North American intensive care units (ICUs).  Recommended interventions included endotracheal tubes with subglottic secretion drainage, semi-recumbent positioning, oral care with chlorhexidine, and best practices for ventilator maintenance.  Each ICU enrolled 30 consecutive patients ventilated >48 hours in each of 4 study periods: baseline, 6, 15, and 24 months.  Clinical outcomes, antibiotic utilization, and concordance with VAP preventive measures were collected.  We measured the change in VAC rates over time and sought independent risk factors using regression models.

Results: Of 1320 patients, 139 (10.5%) developed VAC.  These patients had significantly more ventilator days, hospital days, antibiotic days, and higher hospital mortality compared to VAC negative patients (see Table).  Aggregate concordance with all VAP prevention measures rose during the study from 51% to 59%.   The VAC rate decreased significantly (P=.048) from 45/330 (13.6%) patients at baseline (14.7 per 1000 ventilator-days) to 32/330 (9.7%) patients at 24 months (12.1 per 1000 ventilator-days). The only measures potentially protective against VAC were spontaneous awakening trials (OR 0.93, 95% CI 0.87-1.00, P=.05) and spontaneous breathing trials (OR 0.97, 95% CI 0.94-1.01, P=.10). 

 

VAC Positive

VAC Negative

P

Median ventilator days [IQR]

33.5 [12.3, und]

7.7 [4.3, 20.1]

<.0001

Median hospital days [IQR]

365.0 [49.1, und]

45.3 [19.1, und]

<.0001

Mean antibiotic days [SD]

15.5 ± 7.3

9.0 ± 6.5

<.0001

Hospital mortality

49.6%

31.7%

<.0001

Conclusion: VAC is associated with significant morbidity and mortality. A moderate rise in VAP guideline concordance was associated with lower VAC rates.  Spontaneous awakening and breathing trials may be protective but further study is needed

.

Michael Klompas, MD, MPH, FRCPC1,2, Tasnim Sinuff, MD, PhD, FRCPC3,4, Xuran Jiang, MSc5, Andrew Day, MSc5 and John Muscedere, MD, FRCPC5,6, (1)Brigham and Women's Hospital, Boston, MA, (2)Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, (3)Department of Critical Care Medicine, Sunnybrook Health Sciences Center, Toronto, ON, Canada, (4)Interdepartmental Department of Critical Care Medicine, University of Toronto, Toronto, ON, Canada, (5)Clinical Evaluation Research Unit, Kingston General Hospital, Kingston, ON, Canada, (6)Department of Medicine, Queen's University, Kingston, ON, Canada

Disclosures:

M. Klompas, None

T. Sinuff, None

X. Jiang, None

A. Day, None

J. Muscedere, None

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