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Impact of a Program of Intensive Surveillance and Interventions Targeting Ventilated Patients in the Reduction of Ventilator-Associated Pneumonia and Its Cost-Effectiveness

Published online by Cambridge University Press:  02 January 2015

Kwan Kew Lai*
Affiliation:
Department of Medicine, Division of Infectious Diseases, University of Massachusetts Medical School, University of Massachusetts Medical Center, Worcester, Massachusetts
Stephen P. Baker
Affiliation:
Graduate School of Biomedical Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
Sally A. Fontecchio
Affiliation:
Department of Infection Control, University of Massachusetts Medical Center, Worcester, Massachusetts
*Corresponding
Division of Infectious Diseases, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655

Abstract

Objective:

We hypothesized that a program of prospective intensive surveillance for ventilator-associated pneumonia (VAP) and concomitant implementations of multimodal, multidisciplinary preventive and intervention strategies would result in a reduction in the incidence of VAP and would be cost-effective.

Setting:

Medical and surgical intensive care units (ICUs) in a university teaching hospital.

Interventions:

All ventilated patients in the medical and surgical ICUs were monitored for VAP from January 1997 through December 1998. Interventions including elevation of the head of the bed, use of sterile water and replacement of stopcocks with enteral valves for nasogastric feeding tubes, and prolongation of changing of in-line suction catheters from 24 hours to as needed were implemented.

Results:

The rates of VAP decreased by 10.8/1,000 ventilator-days in the medical ICU (CI95, 4.65-16.91) and by 17.2/1,000 ventilator-days in the surgical ICU (CI95> 2.85-31.56) when they were compared for 1997 and 1998. With the use of the estimated cost of a VAP of $4,947 from the literature, the reduction resulted in cost savings of $178,092 and $148,410 in the medical and surgical ICUs, respectively, for a total of $326,482. In addition, $25,497 was saved due to the lengthening of the time for the change of in-line suction catheters, resulting in a cost savings of $351,979. This total cost savings of $351,979 minus the cost of enteral valves of $2,100 resulted in total net savings of $349,899.

Conclusion:

Intensive surveillance and interventions targeted at ventilated patients resulted in reduction of VAP and appeared to be cost-effective.

Type
Original Articles
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2003

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Impact of a Program of Intensive Surveillance and Interventions Targeting Ventilated Patients in the Reduction of Ventilator-Associated Pneumonia and Its Cost-Effectiveness
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