Evidence-based strategies substantially reduce the incidence of ventilator-associated pneumonia in ICUsVentilator-associated pneumonia (VAP) is a significant and common cause of patient sickness and death, as well as increased health care costs. A new study found that an intervention to boost the use of five evidence-based strategies to reduce VAP accomplished just that. In 112 intensive care units (ICUs), the overall median VAP rate declined from an average of 6.9 to 3.4 cases per 1,000 ventilator days at 16-18 months after implementation of the intervention. There was a further decrease from 3.4 to 2.4 cases from 16-18 months to 28-30 months. Compliance with evidence-based therapies increased from 32 percent at baseline to 75 percent at 16-18 months after implementation to 84 percent at 28-30 months.
The five evidence-based strategies were: semirecumbent positioning to decrease the risk of VAP; stress ulcer prophylaxis to decrease gastrointestinal bleeding; prophylaxis to decrease deep venous thrombosis (blood clots in the leg); adjustment of sedation until the patient can follow commands; and daily assessment of readiness to extubate, to reduce the duration of mechanical ventilation.
The intervention was implemented through an AHRQ-funded collaborative known as the Keystone Project that included 112 ICUs, mostly in Michigan, along with Johns Hopkins University and the Michigan Health and Hospital Association. Local ICU improvement teams were established that included the ICU director and nurse manager, an ICU physician and nurse, and the senior hospital executive. The teams were trained through meetings, coaching by study investigators, and conference calls.
The study demonstrated that VAP can be successfully prevented across a large and diverse cohort of ICUs. The multifaceted intervention was implemented without expensive technology or funding for the participating ICUs. This study was supported by the Agency for Healthcare Research and Quality (HS14426).
See "Collaborative cohort study of an intervention to reduce ventilator-associated pneumonia in the intensive care unit," by Sean M. Berenholtz, M.D., Julius C. Pham, M.D., Ph.D., David A. Thompson, D.Sc.N., R.N., and others in the April 2011 Infection Control and Epidemiology 32(4), pp. 305-314.
Research Activities, December 2011: Patient Safety and Quality: Evidence-based strategies substantially reduce the incidence of ventilator-associated pneumonia in ICUs