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

Sean M. Berenholtz MD, MHS, Julius C. Pham MD, PhD, David A. Thompson DScN, RN, Dale M. Needham MD, PhD, Lisa H. Lubomski PhD, Robert C. Hyzy MD, Robert Welsh MD, Sara E. Cosgrove MD, J. Bryan Sexton PhD, Elizabeth Colantuoni PhD, Sam R. Watson MSA MT(ASCP), Christine A. Goeschel ScD, RN, MPA, MPS and Peter J. Pronovost MD, PhD
Infection Control and Hospital Epidemiology
Vol. 32, No. 4 (April 2011), pp. 305-314
DOI: 10.1086/658938
Stable URL: http://www.jstor.org/stable/10.1086/658938
Page Count: 10
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Collaborative Cohort Study of an Intervention to Reduce Ventilator-Associated Pneumonia in the Intensive Care Unit
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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 () and 0 cases (mean, 2.4 cases) at 28–30 months after implementation (). 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 () and 84% at 28–30 months after implementation ().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.

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