RESUMO
Pseudomonas aeruginosa infection causes high morbidity and mortality, especially in immunocompromised patients. Pseudomonas can develop multidrug resistance. As a result, it can cause serious outbreaks in hospital and intensive care unit (ICU) settings, increasing both length of stay and costs. In the second quarter of 2020, in a community hospital's 15-bed ICU, the P. aeruginosa-positive sputum culture rate was unacceptably high, with a trend of increasing prevalence over the previous 3 quarters. We performed a multidisciplinary quality improvement (QI) initiative to decrease the P. aeruginosa-positive rate in our ICU. We used the Define, Measure, Analyze, Improve, and Control model of Lean Six Sigma for our QI initiative to decrease the P. aeruginosa-positive sputum culture rate by 50% over the following year without affecting the baseline environmental services cleaning time. A Plan-Do-Study-Act approach was used for key interventions, which included use of sterile water for nasogastric and orogastric tubes, adherence to procedure for inline tubing and canister exchanges, replacement of faucet aerators, addition of hopper covers, and periodic water testing. We analyzed and compared positive sputum culture rates quarterly from pre-intervention to post-intervention. The initial P. aeruginosa-positive culture rate of 10.98 infections per 1,000 patient-days in a baseline sample of 820 patients decreased to 3.44 and 2.72 per 1,000 patient-days in the following 2 post-intervention measurements. Environmental services cleaning time remained stable at 34 minutes. Multiple steps involving all stakeholders were implemented to maintain this progress. A combination of multidisciplinary efforts and QI methods was able to prevent a possible ICU P. aeruginosa outbreak.
RESUMO
BACKGROUND: Mechanical ventilation is lifesaving therapy in intensive care units but can increase patients' risk for ventilator-associated events. These events are associated with longer intensive care unit and hospital stays, more ventilator days, and increased mortality rates. LOCAL PROBLEM: To meet internal and national benchmarks, the number of ventilator-associated events in a 15-bed intensive care unit needed to be decreased. METHODS: A multidisciplinary team used the define, measure, analyze, improve, and control framework in this quality improvement project at a community hospital. Evidence-based guidelines for preventing ventilator-associated events were incorporated into interventions, which included discussion of ventilator settings in daily rounds, additional evening rounds, and staff education. The team reinforced education, defined roles in the care of patients receiving mechanical ventilation, and implemented communication strategies between departments. Preimplementation data from the calendar year 2018 were compared with postimplementation data from the calendar year 2019. RESULTS: The ventilator-associated event incidence rate decreased from 25.58 per 1000 ventilator days in 2018 to 5.29 per 1000 ventilator days in the third quarter of 2019. The goal rate (≤ 18.00 events per 1000 ventilator days) was sustained for the year 2019. DISCUSSION: The lower rates of ventilator-associated events met internal and national benchmarks after the implementation of interventions. Safety was enhanced for patients who may have had unexpected outcomes related to a ventilator-associated event. CONCLUSIONS: The creation and implementation of clear, specific communication and processes for successfully managing patients receiving mechanical ventilation decreased the rate of ventilator-associated events.
