TY - JOUR
T1 - Collaborative cohort study of an intervention to reduce ventilator-associated pneumonia in the intensive care unit
AU - Berenholtz, Sean M.
AU - Pham, Julius C.
AU - Thompson, David A.
AU - Needham, Dale M.
AU - Lubomski, Lisa H.
AU - Hyzy, Robert C.
AU - Welsh, Robert
AU - Cosgrove, Sara E.
AU - Sexton, J. Bryan
AU - Colantuoni, Elizabeth
AU - Watson, Sam R.
AU - Goeschel, Christine A.
AU - Pronovost, Peter J.
PY - 2011/4
Y1 - 2011/4
N2 - 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.
AB - 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.
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U2 - 10.1086/658938
DO - 10.1086/658938
M3 - Article
C2 - 21460481
AN - SCOPUS:79952594691
SN - 0899-823X
VL - 32
SP - 305
EP - 314
JO - Infection control and hospital epidemiology
JF - Infection control and hospital epidemiology
IS - 4
ER -