1. Carlson, Glenn MSN, RN, CCRN

Article Content


The purpose of this presentation was to review literature regarding the prevention of ventilator-associated pneumonia (VAP) and integrate the literature into a continuous quality improvement program.



Ventilator-associated pneumonia is one of the most common infections in the critical care unit. Prevention of VAP requires implementation of strategies that bedside nurses can use easily.



Our institution's VAP rates were higher than the multidisciplinary team expected or wanted. In 2003, Bronson Methodist Hospital convened a group of staff nurses, respiratory therapists, and clinical nurse specialists (CNSs) to look at the literature and to use simple strategies that could impact VAP prevention. The team used the PDCA outcomes improvement model to enact and evaluate change.



The strategies chosen were head-of-bed (HOB) elevation, use of oral gastric tubes, protocolized oral care hygiene, and equipment management strategies, such as weekly ventilator tubing changes. Nurses and respiratory therapists took the lead in implementing these strategies. The CNSs developed a protocol in booklet form to distribute to all nurses, respiratory therapists, and physicians. In addition, the CNSs used a data-tracking tool that at the same time served as a self-audit form.



Adherence to HOB elevation and oral care was greater than 90%. Overall, the prevention strategies had a profound effect on VAP prevention. The MICU went 20 months without a VAP, and the SICU deceased the VAP rate by more than half (2003 VAP rate of 22.7 and 2006 VAP rate of 6.37). However, the SICU wanted to decrease the rate even more. After analyzing each VAP patient, new strategies were developed to further improve the VAP prevention guidelines from 2003. Those strategies, implemented in January of 2008, were HOB elevation during transport, subglottic suctioning before lying flat for greater than 30 minutes, and use of chlorhexidine oral rinse after subglottic suctioning.



Institution of a continuous quality improvement program has been instrumental in decreasing VAP.


Implications for Practice:

The participant can use similar strategies to assist in improving patient outcomes.


Section Description

The 2009 NACNS National Conference will be held in St Louis, Missouri, on March 5 to 7. More than 350 clinical nurse specialists (CNSs), graduate faculty, nurse administrators, nurse researchers, and graduate students are registered. This year's theme, "Clinical Nurse Specialists: Vision, Value, Voice," demonstrates the essential leadership skills of the CNS as well as the CNS role in implementing evidence-based practice.


Seventy abstracts were selected for either podium or poster presentations. Again, this year, there is a CNS student poster session. The abstracts addressed CNS practice in 3 practice domains (spheres of influence), emphasizing patient safety and quality care outcomes, leadership, evidence-based practice, and new ways to shape CNS practice. Topics include CNS work activities incorporated into 3 spheres of influence-patients, nursing practice, organization/system-including the development of clinical inquiry skills among staff nurses, use of simulation technology, strategies to maintain clinical excellence, CNS practice in end-of-life care decisions, and many new and thoughtful ideas to support CNS education, practice, and research. Collectively, the abstracts represent the breadth, depth, and richness of the CNSs' contribution to the well-being of individuals, families, communities, as well as to the advancement of the nursing profession.


The conference abstracts were published here to facilitate sharing this emerging new knowledge with those who were unable to attend the conference. As you read each abstract, appreciate the intellectual talent and clinical scholarship of your CNS colleagues who are advancing the practice of nursing and contributing to the health of society through improved outcomes for patients and healthcare organizations. We encourage you to contact individual presenters to network, collaborate, consult, or share your thoughts and ideas on the conference topics. Watch out for next year's call for abstracts and consider submitting for presentation at NACNS' next annual conference in Portland, Oregon, on March 4 to 6, 2010.