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A program for sustained improvement in preventing ventilator associated pneumonia in an intensive care setting
Raquel A Caserta1, Alexandre R Marra, Marcelino S Durão
1Intensive Care Unit, Hospital Israelita Albert Einstein, Av, Albert Einstein, 627/701 - 5º Andar - Bloco B, São Paulo, CEP 05651-901, Brazil. raquel_case@eintein.br
BMC Infectious Diseases
|October 2, 2012
Summary
Implementing a comprehensive ventilator bundle, including oral decontamination and continuous aspiration of subglottic secretions, significantly reduced ventilator-associated pneumonia (VAP) rates in the ICU. Sustained VAP reduction to near zero is achievable with ongoing monitoring and multiple interventions.
Area of Science:
- Critical care medicine
- Infectious disease prevention
- Healthcare quality improvement
Background:
- Ventilator-associated pneumonia (VAP) is a frequent and often fatal infection in intensive care units (ICUs).
- Effective prevention strategies are crucial to reduce patient morbidity and mortality.
Purpose of the Study:
- To evaluate the impact of a multi-faceted intervention strategy on VAP rates.
- To assess the feasibility of achieving near-zero VAP incidence in a medical-surgical ICU.
Main Methods:
- A quasi-experimental study was conducted in a medical-surgical ICU from October 2008 to December 2010.
- Interventions included the Institute for Healthcare Improvement's (IHI) ventilator bundle, oral chlorhexidine decontamination, and continuous aspiration of subglottic secretions (CASS).
- Data on patient-days and ventilator-days were collected and analyzed.
Main Results:
- A total of 21,984 patient-days and 6,052 ventilator-days were evaluated.
- VAP rates were 1.3 and 2.0 per 1,000 ventilator days in 2009 and 2010, respectively.
- Zero VAP incidence was achieved multiple times when compliance with the VAP bundle exceeded 90%.
Conclusions:
- Near-zero rates of VAP are attainable and sustainable through a complex, multi-measure intervention process.
- Continuous monitoring and adherence to multiple performance measures are essential for maintaining low VAP incidence.
- The study highlights the effectiveness of a bundled approach in VAP prevention.
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