Focusing on a Core Measure: Reducing Hospital-Acquired Infections in Ventilator Patients

Sonya Goffney, RT, Manager Respiratory TherapyMethodist Dallas Medical Center
Nicole Higdon, RT
Tara Merchant, RT
Methodist Dallas Medical Center

Working at a tertiary care facility like Methodist Dallas Medical Center provides clinical staff with the opportunity to care for patients with medically complex conditions. Many are critically ill and require careful monitoring and higher levels of care. While challenging and rewarding, this level of acuity places added responsibility on the caregivers’ shoulders to do everything in their power to prevent costly hospital-acquired infections (HAIs) from occurring.

For respiratory therapists, a primary focus is preventing ventilator-associated pneumonias (VAPs) from occurring in critically ill patients. This common HAI has been targeted for incidence reduction by The Joint Commission and the Centers for Medicare & Medicaid Services (CMS). In fact, CMS will begin penalizing hospitals with unacceptably high rates of VAP through its value-based purchasing reimbursement model. Ventilator patients are often unable to maintain and clear their airways. Their cough can be minimal and they have trouble clearing their secretions. This causes their immune system to be compromised so they’re more susceptible to pneumonia.

Why are VAPs of such concern to The Joint Commission and CMS? In his March 2009 article, “The Direct Medical Costs of Healthcare-Associated Infections in U.S. Hospitals and the Benefits of Prevention,” R. Douglas Scott II, an economist for the Coordinating Center for Infectious Diseases for the Centers for Disease Control and Prevention (CDC), estimates that more than 52,000 VAPs occur annually with a per patient cost of between $14,806 and $28,508.

In “Strategies to Prevent Ventilator-Associated Pneumonia in Acute Care Hospitals” published in the October 2008 issue of Infection Control and Hospital Epidemiology, the incidence of VAP among ventilated patients is reported to be between 10 to 20 percent. These studies also suggest that many cases of VAP could be prevented by careful attention to the process of care.

At Methodist Dallas, reducing VAPs is a team effort. Respiratory therapists and nurses join forces to follow ventilator patient care protocols outlined by The Joint Commission, CDC, and other leading health care organizations.

  • Keep the head of the patient’s bed raised between 30 and 45 degrees unless other medical conditions do not allow this to occur.
  • Check the patient’s ability to breathe on his or her own every day so that the patient can be weaned from the ventilator as soon as possible.
  • Follow generally accepted hand-washing guidelines, cleaning hands with soap and water or an alcohol-based hand rub before and after touching the patient or the ventilator.
  • Clean the inside of the patient’s mouth on a regular basis, including suctioning the patient’s mouth to reduce germs.
  • Clean or replace equipment between use on different patients. Much of the equipment we use at Methodist Dallas is designed for one-time use, which can be more costly but safer for the patient.
  • Suction the endotracheal tube frequently.
  • Educate and involve the family on pneumonia and HAIs and encourage their participation in their loved one’s care.
  • Establish and follow ventilator bundles of care that are comprised of standing orders for ventilator care that are on the patient’s chart and serve to ensure optimal safety.

Every day we track, via unit boards, the length of time since the last VAP and every day we go without an infection is a reason to celebrate. The great thing about working as a respiratory therapist at Methodist Dallas is that you really feel like everyone is motivated to help the patient get better and go home.

If you’re a respiratory therapist who’s ready for a breath of fresh air for your career, then it’s time to choose Methodist. Learn more by visiting

©Methodist Health System