Improving Quality. Saving Lives.

MD Anderson Cancer Center Receives Statewide Award for Quality

(AUSTIN - Feb. 1, 2011) – For its efforts to reduce the incidence of ventilator-associated pneumonia in the ICU to zero, the Texas Hospital Association has honored The University of Texas MD Anderson Cancer Center with the inaugural Bill Aston Award for Quality. Established in 2010, the award recognizes a hospital’s measurable success in improving quality and patient outcomes through the sustained implementation of a national and/or state evidence-based patient care initiative. It will be presented Feb. 3 at the THA Annual Conference in Austin.

When Joseph L. Nates, M.D., joined MD Anderson Cancer Center in Houston in 2002, he learned that the intensive care unit ventilator-associated pneumonia rate was 34.2 cases per 1,000 ventilator days, double the national average for trauma ICUs (used as the benchmark).

Nates was concerned; VAP increases ICU stay by up to 22 days and hospital stay by up to 25 days, and it has the highest mortality of health care-associated infections. The following year, Nates and his colleagues implemented aggressive multidisciplinary strategies to reduce the VAP rate. By 2009 that rate had dropped to zero, and it has stayed at zero for the past year.
“When we started, a lot of people were skeptical that we could reduce that rate. Our ventilated cancer patients are very sick, and many of them are immunosuppressed from chemotherapy,” said Nates, who serves as medical director of the ICU.

“Many of the techniques we are using today had not even been published when we started eight years ago. That’s why you have to keep learning and working on the problem. We haven’t eliminated the causes. If we don’t continue to work on the factors that lead to VAP, the infections will come back,” Nates said. “The main reason for achieving a rate of zero VAPs for the past year is that we have been persistent. We have a cohesive and aggressive multidisciplinary team that consists of physicians, nurses, respiratory therapists and infection control specialists who work together toward this common goal.”

Thomas Burke, M.D., executive vice president and physician-in-chief at MD Anderson, points to the impassioned leadership Nates provided.

“Quality projects require a champion, and he’s the guy that drove this team,” Burke said. “To be successful, you have to be relentless.”

Another important driver of success was the impact on patient lives. VAP is a deadly complication. In 2005, the American Thoracic Society published data that showed a 30-40 percent death rate for VAP cases occurring in the general population. Other more conservative estimates put the death rate at 25 percent of all VAP patients. For the MD Anderson ICU, which averaged more than six cases per month in 2002, a drop to zero represents dozens of lives saved during the past eight years.

The drop in VAP rates also saves an enormous amount of money and helps patients recover more quickly and leave the hospital sooner, freeing up critically needed hospital beds. The average cost of treating a VAP infection is about $57,000. With at least six cases per month, MD Anderson’s cost for treating VAPs in 2002 was more than $4.1 million per year.

Burke said the ICU team has inspired the work of other quality improvement projects at MD Anderson.

“This is a classic quality improvement project,” he said. “There isn’t one thing that made all the difference – there was a series of things that got the team members part-way there. They didn’t abandon their gains, and they didn’t settle for their initial gains. They kept working.”


About MD Anderson
The University of Texas MD Anderson Cancer Center in Houston ranks as one of the world’s most respected centers focused on cancer patient care, research, education and prevention. MD Anderson is one of only 40 comprehensive cancer centers designated by the National Cancer Institute. For seven of the past nine years, including 2010, MD Anderson has ranked No. 1 in cancer care in “America’s Best Hospitals,” a survey published annually in U.S. News & World Report.

About Texas Hospital Association
Founded in 1930, the Texas Hospital Association is the leadership organization and principal advocate for the state’s hospitals and health care systems. Based in Austin, THA enhances its members’ abilities to improve accessibility, quality and cost-effectiveness of health care for all Texans. One of the largest hospital associations in the country, THA represents more than 85 percent of the state’s acute-care hospitals and health care systems, which employ some 365,000 health care professionals statewide. Learn more about THA at or follow THA on Twitter at

The Bill Aston Award for Quality
In 2010, the Texas Hospital Association established the Bill Aston Award for Quality through an endowment of the Baylor Health Care System. The award is named for the late Baylor Health Care System Board Member and Texas Healthcare Trustees Chairman Bill Aston, a longtime leader in and champion for quality and patient safety. All THA active institutional members are eligible for the award. Nominated projects must demonstrate improved outcomes in patient care and be related to a national or state standard for improved patient care.