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. 2012 Sep 29:12:234.
doi: 10.1186/1471-2334-12-234.

A program for sustained improvement in preventing ventilator associated pneumonia in an intensive care setting

Raquel A Caserta  1 , Alexandre R Marra, Marcelino S Durão, Cláudia Vallone Silva, Oscar Fernando Pavao dos Santos, Henrique Sutton de Sousa Neves, Michael B Edmond, Karina Tavares Timenetsky
Affiliations

A program for sustained improvement in preventing ventilator associated pneumonia in an intensive care setting

Raquel A Caserta et al. BMC Infect Dis. .

Abstract

Background: Ventilator-associated pneumonia (VAP) is a common infection in the intensive care unit (ICU) and associated with a high mortality.

Methods: A quasi-experimental study was conducted in a medical-surgical ICU. Multiple interventions to optimize VAP prevention were performed from October 2008 to December 2010. All of these processes, including the Institute for Healthcare Improvement's (IHI) ventilator bundle plus oral decontamination with chlorhexidine and continuous aspiration of subglottic secretions (CASS), were adopted for patients undergoing mechanical ventilation.

Results: We evaluated a total of 21,984 patient-days, and a total of 6,052 ventilator-days (ventilator utilization rate of 0.27). We found VAP rates of 1.3 and 2.0 per 1,000 ventilator days respectively in 2009 and 2010, achieving zero incidence of VAP several times during 12 months, whenever VAP bundle compliance was over 90%.

Conclusion: These results suggest that it is possible to reduce VAP rates to near zero and sustain these rates, but it requires a complex process involving multiple performance measures and interventions that must be permanently monitored.

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Figures

Figure 1
Figure 1
Study design. *Phases 1, 2 and 3 (from April 2007 to September 2008) are a consequence of our previous publication [4]. We extended data collection in this present manuscript (from October 2008 to December 2010) in phase 3.
Figure 2
Figure 2
Bundle compliance and VAP(ventilator associated pneumonia) ratefrom April 2007 toDecember 2010. This chart shows extended data from the study published in AJIC 2009 (reference number 4). Oral decontamination with chlorhexidine 0.12% (since October/2007). Continuous aspiration of subglottic secretions (CASS) endotracheal tube (since February/2008).
Figure 3
Figure 3
Segmented regression of ventilatorassociated pneumonia (VAP) rateper 1,000 ventilator daysfrom April 2007 toDecember 2010. Segmented 1: β10 = +6.08 p = 0.004; CI 95%: [(2.06 - 10.12)]. Segmented 1 (the slope): β11 = +2.59 p <0.001; CI 95%: [(1.47 - 3.71)]. Segmented 2: β20 = −11.24 p = 0.004; CI 95%: [(−18.60) - (−3.89)]. Segmented 2 (the slope): β21 = −2.30 p = 0.272; CI 95%: [(−6.48) - 1.88)]. Segmented 3: β30 = −2.67 p = 0.682; CI 95%: [(−15.83) - 10.47)]. Segmented 3 (the slope): β31 = +0.03 p = 0.610; CI 95%: [(−0.08) - 0.13)].
Figure 4
Figure 4
Secular trends of mechanicalventilation utilization rate inICU
Figure 5
Figure 5
Incidence density rate (IDR)of VAP/1000 ventilator-days from2004 to 2010 inthe ICU.
See this image and copyright information in PMC

References

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