• Elena Righi, Gabriella Aggazzotti, Elena Ferrari, Chiara Giovanardi, Stefano Busani, Laura Rinaldi, and Massimo Girardis.
• Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy. Electronic address: elena.righi@unimore.it.
• Am J Infect Control. 2014 Dec 1; 42 (12): 1312-6.

BackgroundThe impact on ventilator-associated pneumonia (VAP) occurrence of a multifaceted program, including progressive strategies for VAP prevention, implemented in an Italian intensive care unit (ICU) is reported.MethodsAll adults admitted to the ICU in 2004-2010 with a length of stay ≥72 hours and mechanical ventilation time ≥48 hours were included in the study. Demographics, clinical information, and data on VAP were extracted from the ICU-acquired infection surveillance dataset. A standardized bundle for VAP prevention was implemented in 2004. In 2008, selective digestive tract decontamination (SDD) was added to the protocol. Changes in VAP incidence were evaluated.ResultsThere were 1,372 subjects included in the study. Overall, 156 (11.4%) developed VAP. In the second part of the study VAP incidence decreased from 15.9% to 6.7% (P < .001). Reductions both in early-onset VAP (6.6% to 1.9%; P < .001) and late-onset VAP (9.3% to 4.7%; P = .001) incidence were observed. Multivariate analysis showed a significant reduction in the risk of developing VAP from multidrug-resistant pathogens in the bundle plus SDD period as well (odds ratio, .54; 95% confidence interval, .31-.91).ConclusionThe implementation of a standardized approach to patient care, including a number of key reduction interventions, was associated with a significant reduction in the risk of developing VAP.Copyright © 2014 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

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