• Infect Control Hosp Epidemiol · Apr 2011

    Collaborative cohort study of an intervention to reduce ventilator-associated pneumonia in the intensive care unit.

    • Sean M Berenholtz, Julius C Pham, David A Thompson, Dale M Needham, Lisa H Lubomski, Robert C Hyzy, Robert Welsh, Sara E Cosgrove, J Bryan Sexton, Elizabeth Colantuoni, Sam R Watson, Christine A Goeschel, and Peter J Pronovost.
    • Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. sberenho@jhmi.edu
    • Infect Control Hosp Epidemiol. 2011 Apr 1;32(4):305-14.

    ObjectiveTo evaluate the impact of a multifaceted intervention on compliance with evidence-based therapies and ventilator-associated pneumonia (VAP) rates.DesignCollaborative cohort before-after study.SettingIntensive care units (ICUs) predominantly in Michigan.InterventionsWe implemented a multifaceted intervention to improve compliance with 5 evidence-based recommendations for mechanically ventilated patients and to prevent VAP. A standardized CDC definition of VAP was used and maintained at each site, and data on the number of VAPs and ventilator-days were obtained from the hospital's infection preventionists. Baseline data were reported and postimplementation data were reported for 30 months. VAP rates (in cases per 1,000 ventilator-days) were calculated as the proportion of ventilator-days per quarter in which patients received all 5 therapies in the ventilator care bundle. Two interventions to improve safety culture and communication were implemented first.ResultsOne hundred twelve ICUs reporting 3,228 ICU-months and 550,800 ventilator-days were included. The overall median VAP rate decreased from 5.5 cases (mean, 6.9 cases) per 1,000 ventilator-days at baseline to 0 cases (mean, 3.4 cases) at 16-18 months after implementation (P < .001) and 0 cases (mean, 2.4 cases) at 28-30 months after implementation (P < .001). Compared to baseline, VAP rates decreased during all observation periods, with incidence rate ratios of 0.51 (95% confidence interval, 0.41-0.64) at 16-18 months after implementation and 0.29 (95% confidence interval, 0.24-0.34) at 28-30 months after implementation. Compliance with evidence-based therapies increased from 32% at baseline to 75% at 16-18 months after implementation (P < .001) and 84% at 28-30 months after implementation (P < .001).ConclusionsA multifaceted intervention was associated with an increased use of evidence-based therapies and a substantial (up to 71%) and sustained (up to 2.5 years) decrease in VAP rates.

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