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Collaborative Cohort Study of an Intervention to Reduce Ventilator-Associated Pneumonia in the Intensive Care Unit

Published online by Cambridge University Press:  02 January 2015

Sean M. Berenholtz
Affiliation:
Johns Hopkins University School of Medicine, Baltimore, Maryland Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
Julius C. Pham
Affiliation:
Johns Hopkins University School of Medicine, Baltimore, Maryland
David A. Thompson
Affiliation:
Johns Hopkins University School of Medicine, Baltimore, Maryland
Dale M. Needham
Affiliation:
Johns Hopkins University School of Medicine, Baltimore, Maryland
Lisa H. Lubomski
Affiliation:
Johns Hopkins University School of Medicine, Baltimore, Maryland
Robert C. Hyzy
Affiliation:
University of Michigan, Ann Arbor, Michigan
Robert Welsh
Affiliation:
William Beaumont Hospital, Royal Oak, Michigan
Sara E. Cosgrove
Affiliation:
Johns Hopkins University School of Medicine, Baltimore, Maryland
J. Bryan Sexton
Affiliation:
Johns Hopkins University School of Medicine, Baltimore, Maryland
Elizabeth Colantuoni
Affiliation:
Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
Sam R. Watson
Affiliation:
Michigan Health and Hospital Association Keystone Center, Lansing, Michigan
Christine A. Goeschel
Affiliation:
Johns Hopkins University School of Medicine, Baltimore, Maryland Johns Hopkins University School of Nursing, Baltimore, Maryland Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
Peter J. Pronovost
Affiliation:
Johns Hopkins University School of Medicine, Baltimore, Maryland Johns Hopkins University School of Nursing, Baltimore, Maryland Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
Corresponding
E-mail address:

Abstract

Objective.

To evaluate the impact of a multifaceted intervention on compliance with evidence-based therapies and ventilator-associated pneumonia (VAP) rates.

Design.

Collaborative cohort before-after study.

Setting.

Intensive care units (ICUs) predominantly in Michigan.

Interventions.

We 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.

Results.

One 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).

Conclusions.

A 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.

Type
Original Article
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2011

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Footnotes

a.

Duke University School of Medicine, Department of Psychiatry, Raleigh, North Carolina

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