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Go Lean:
Zap the VAP
5D Surgical Intensive Care Unit thinks lean and decreases infections

Staff on the 5D Surgical Intensive Care Unit are working hard to stamp out hospital- acquired infections, and the results are fabulous for patients and staff alike.

Fellow TravelersNate Bentz, R.N., and Renee Havey, R.N., were part of the lean project to implement a strenuous patient oral care program to reduce ventilator-associated pneumonia rates.

“We’ve changed what we do to prevent ventilator-associated pneumonia,” says Lena Napolitano, M.D., division chief of Acute Care Surgery and the director of Surgical Critical Care. 5D SICU is home to the General Surgery, Trauma, Endocrine, Oncology and Liver Transplant services. SICU’s patients often have multiple serious conditions, which open the door to lung infections when they are on a ventilator.

In its continuous efforts to eliminate avoidable infections, the SICU has experienced success with a patient oral care program that has dropped ventilator-associated pneumonia rates to zero for months at a time. 5D’s leadership team instituted an evidence-based, standardized protocol for oral care to combat VAP. In addition to more regular tooth brushing and regimented oral care, leadership decided to use an antimicrobial oral rinse every day on patients who are on a ventilator.

The unit standardized the protocol so it no longer requires a physician order, thus promoting optimal compliance among all staff.

Sharon Dickinson, M.S.N., clinical nurse specialist on SICU says, “We took a cookbook approach and we follow it, ingredient by ingredient.” Dickinson and Christy Zelewski, MPH, published a paper about the successful approach, and the team is often invited to present its findings at conferences across the country.

5D also has experienced a significant decrease in catheter-related bloodstream infections. “Everybody’s responsible for this success, including Environmental Services,” says Mary LaBeske, R.N., who also credits the way in which the unit includes patient families in education about hand washing and oral care as another factor in the unit’s successful control of infections.

MaryAnn Bettis, R.N., manager for the SICU, says, “No VAPS, low mortality rates—very good for us, very good for our patients and very good for the Health System in terms of decreasing costs.”

“Staff are so proud of what they do,” says Connie Rickelmann, R.N. “This is really benefiting the 1,500 plus patients who pass through 5D every year.”

“We do all this for our patients and for our families,” Napolitano agrees. “But in the end, doing this also makes for a wonderful team environment to work in.” - CM

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