Executive Summary Checklist

In order to establish a program to reduce ventilator-associated pneumonia (VAP) the following implementation plan will   require   these   actionable   steps.   The   following   checklist   was   adapted   from   the   prevention   strategies recommended by the California Department of Public Health (CDPH) \cite{00001}, American Association of Critical Care Nursing \cite{adults}, the American Thoracic Society and Infectious Disease Societies of America \cite{2005}

The Performance Gap

Ventilator-associated pneumonia (VAP) is an infection that appears in the lungs when a patient is mechanically ventilated. Mechanically ventilated hospital patients are typically critically ill and treated in an intensive care unit (ICU). The infection develops after 48 hours or more of mechanical ventilation and is caused when bacteria reaches the lower respiratory tract via the endotracheal tube or tracheostomy; in addition, when airways are not properly maintained intubation may allow oral and gastric secretions to enter the lower airways \cite{00002a}.
VAP is the leading cause of death associated with healthcare-associated infections (HAIs) \cite{00003}. In the US, a multi-state prevalence survey estimated the incidence of VAP in the US at 49,900 cases annually \cite{2014}. As  many  as  28%  of  all  patients  who  receive mechanical ventilation in the hospital will develop VAP and the incidence increases with the duration of mechanical ventilation.  The  crude  mortality  rate  for  VAP  is  between  20%  and  60%; and incidence  ranges  from  4% to  48% \cite{9735080}\cite{10194173}. Depending  on the  type  of  pneumonia the  mortality  rate  may vary; Pseudomonas and Acinetobacter are  associated with higher  mortality  rates  than  other  strains  of  bacteria \cite{Fagon_1996}. It  is  believed  that  when  antibiotic  therapy  is  delayed  or improperly dosed, mortality also increases. These factors are largely preventable.
Patients who acquire VAP have significantly longer durations of mechanical ventilation, length of ICU stay as well as hospital stay \cite{Rello_2002}. In addition,  the  development  of  VAP  is  associated  with significant increase  in hospital  costs  and poor economic outcomes. VAP is associated with greater than $40,000 in mean hospital charges per patient.
It is estimated that the use of process change and technology to reduce VAP can save up to $1.5 billion per year while significantly improving quality and safety \cite{00006}. Closing the performance gap will require hospitals and healthcare systems to commit to action in the form of specific leadership, practice, and technology plans, examples of which are delineated below for utilization or reference. This is provided to assist hospitals in prioritizing their efforts at designing and implementing evidence-based bundles for VAP reduction.

Leadership Plan