The impact of implementing multifaceted interventions on the prevention of ventilator-associated pneumonia

Raymond Khan; Hasan M Al-Dorzi; Khalid Al-Attas; Faisal Wali Ahmed; Abdellatif M Marini; Shihab Mundekkadan; Hanan H Balkhy; Joseph Tannous; Adel Almesnad; Dianne Mannion; Hani M Tamim; Yaseen M Arabi

doi:10.1016/j.ajic.2015.09.025

The impact of implementing multifaceted interventions on the prevention of ventilator-associated pneumonia

Raymond Khan, Hasan M Al-Dorzi, Khalid Al-Attas, Faisal Wali Ahmed, Abdellatif M Marini, Shihab Mundekkadan, Hanan H Balkhy, Joseph Tannous, Adel Almesnad, Dianne Mannion, Hani M Tamim, Yaseen M Arabi

Research output: Contribution to journal › Article › peer-review

55 Citations (Scopus)

Abstract

BACKGROUND: Ventilator-associated pneumonia (VAP) is a frequent hospital acquired infections among intensive care unit patients. The Institute for Healthcare Improvement has suggested a "care bundle" approach for the prevention of VAP. This report describes the effects of implementing this strategy on VAP rates.

METHODS: All mechanically ventilated patients admitted to the intensive care unit between 2008 and 2013 were prospectively followed for VAP development according to the National Healthcare Safety Network criteria. In 2011, a 7-element care bundle was implemented, including head-of-bed elevation 30°-45°, daily sedation vacation and assessment for extubation, peptic ulcer disease prophylaxis, deep vein thrombosis prophylaxis, oral care with chlorhexidine, endotracheal intubation with in-line suction and subglottic suctioning, and maintenance of endotracheal tube cuff pressure at 20-30 mmHg. The bundle compliance and VAP rates were then followed.

RESULTS: A total of 3665 patients received mechanical ventilation, and there were 9445 monitored observations for bundle compliance. The total bundle compliance before and after initiation of the VAP team was 90.7% and 94.2%, respectively (P < .001). The number of VAP episodes decreased from 144 during 2008-2010 to only 14 during 2011-2013 (P < .0001). The rate of VAP decreased from 8.6 per 1000 ventilator-days to 2.0 per 1000 ventilator-days (P < .0001) after implementation of the care bundle.

CONCLUSIONS: This study suggests that systematic implementation of a multidisciplinary team approach can reduce the incidence of VAP. Further sustained improvement requires persistent vigilant inspections.

Original language	English
Pages (from-to)	320-326
Number of pages	7
Journal	American Journal of Infection Control
Volume	44
Issue number	3
DOIs	https://doi.org/10.1016/j.ajic.2015.09.025
Publication status	Published - 1 Mar 2016
Externally published	Yes

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10.1016/j.ajic.2015.09.025

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Khan, R., Al-Dorzi, H. M., Al-Attas, K., Ahmed, F. W., Marini, A. M., Mundekkadan, S., Balkhy, H. H., Tannous, J., Almesnad, A., Mannion, D., Tamim, H. M., & Arabi, Y. M. (2016). The impact of implementing multifaceted interventions on the prevention of ventilator-associated pneumonia. American Journal of Infection Control, 44(3), 320-326. https://doi.org/10.1016/j.ajic.2015.09.025

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title = "The impact of implementing multifaceted interventions on the prevention of ventilator-associated pneumonia",

abstract = "BACKGROUND: Ventilator-associated pneumonia (VAP) is a frequent hospital acquired infections among intensive care unit patients. The Institute for Healthcare Improvement has suggested a {"}care bundle{"} approach for the prevention of VAP. This report describes the effects of implementing this strategy on VAP rates.METHODS: All mechanically ventilated patients admitted to the intensive care unit between 2008 and 2013 were prospectively followed for VAP development according to the National Healthcare Safety Network criteria. In 2011, a 7-element care bundle was implemented, including head-of-bed elevation 30°-45°, daily sedation vacation and assessment for extubation, peptic ulcer disease prophylaxis, deep vein thrombosis prophylaxis, oral care with chlorhexidine, endotracheal intubation with in-line suction and subglottic suctioning, and maintenance of endotracheal tube cuff pressure at 20-30 mmHg. The bundle compliance and VAP rates were then followed.RESULTS: A total of 3665 patients received mechanical ventilation, and there were 9445 monitored observations for bundle compliance. The total bundle compliance before and after initiation of the VAP team was 90.7% and 94.2%, respectively (P < .001). The number of VAP episodes decreased from 144 during 2008-2010 to only 14 during 2011-2013 (P < .0001). The rate of VAP decreased from 8.6 per 1000 ventilator-days to 2.0 per 1000 ventilator-days (P < .0001) after implementation of the care bundle.CONCLUSIONS: This study suggests that systematic implementation of a multidisciplinary team approach can reduce the incidence of VAP. Further sustained improvement requires persistent vigilant inspections.",

keywords = "Adult, Aged, Aged, 80 and over, Female, Humans, Incidence, Infection Control/methods, Intensive Care Units, Male, Middle Aged, Patient Care Bundles, Pneumonia, Ventilator-Associated/epidemiology",

author = "Raymond Khan and Al-Dorzi, {Hasan M} and Khalid Al-Attas and Ahmed, {Faisal Wali} and Marini, {Abdellatif M} and Shihab Mundekkadan and Balkhy, {Hanan H} and Joseph Tannous and Adel Almesnad and Dianne Mannion and Tamim, {Hani M} and Arabi, {Yaseen M}",

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doi = "10.1016/j.ajic.2015.09.025",

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Khan, R, Al-Dorzi, HM, Al-Attas, K, Ahmed, FW, Marini, AM, Mundekkadan, S, Balkhy, HH, Tannous, J, Almesnad, A, Mannion, D, Tamim, HM & Arabi, YM 2016, 'The impact of implementing multifaceted interventions on the prevention of ventilator-associated pneumonia', American Journal of Infection Control, vol. 44, no. 3, pp. 320-326. https://doi.org/10.1016/j.ajic.2015.09.025

TY - JOUR

T1 - The impact of implementing multifaceted interventions on the prevention of ventilator-associated pneumonia

AU - Khan, Raymond

AU - Al-Dorzi, Hasan M

AU - Al-Attas, Khalid

AU - Ahmed, Faisal Wali

AU - Marini, Abdellatif M

AU - Mundekkadan, Shihab

AU - Balkhy, Hanan H

AU - Tannous, Joseph

AU - Almesnad, Adel

AU - Mannion, Dianne

AU - Tamim, Hani M

AU - Arabi, Yaseen M

PY - 2016/3/1

Y1 - 2016/3/1

N2 - BACKGROUND: Ventilator-associated pneumonia (VAP) is a frequent hospital acquired infections among intensive care unit patients. The Institute for Healthcare Improvement has suggested a "care bundle" approach for the prevention of VAP. This report describes the effects of implementing this strategy on VAP rates.METHODS: All mechanically ventilated patients admitted to the intensive care unit between 2008 and 2013 were prospectively followed for VAP development according to the National Healthcare Safety Network criteria. In 2011, a 7-element care bundle was implemented, including head-of-bed elevation 30°-45°, daily sedation vacation and assessment for extubation, peptic ulcer disease prophylaxis, deep vein thrombosis prophylaxis, oral care with chlorhexidine, endotracheal intubation with in-line suction and subglottic suctioning, and maintenance of endotracheal tube cuff pressure at 20-30 mmHg. The bundle compliance and VAP rates were then followed.RESULTS: A total of 3665 patients received mechanical ventilation, and there were 9445 monitored observations for bundle compliance. The total bundle compliance before and after initiation of the VAP team was 90.7% and 94.2%, respectively (P < .001). The number of VAP episodes decreased from 144 during 2008-2010 to only 14 during 2011-2013 (P < .0001). The rate of VAP decreased from 8.6 per 1000 ventilator-days to 2.0 per 1000 ventilator-days (P < .0001) after implementation of the care bundle.CONCLUSIONS: This study suggests that systematic implementation of a multidisciplinary team approach can reduce the incidence of VAP. Further sustained improvement requires persistent vigilant inspections.

AB - BACKGROUND: Ventilator-associated pneumonia (VAP) is a frequent hospital acquired infections among intensive care unit patients. The Institute for Healthcare Improvement has suggested a "care bundle" approach for the prevention of VAP. This report describes the effects of implementing this strategy on VAP rates.METHODS: All mechanically ventilated patients admitted to the intensive care unit between 2008 and 2013 were prospectively followed for VAP development according to the National Healthcare Safety Network criteria. In 2011, a 7-element care bundle was implemented, including head-of-bed elevation 30°-45°, daily sedation vacation and assessment for extubation, peptic ulcer disease prophylaxis, deep vein thrombosis prophylaxis, oral care with chlorhexidine, endotracheal intubation with in-line suction and subglottic suctioning, and maintenance of endotracheal tube cuff pressure at 20-30 mmHg. The bundle compliance and VAP rates were then followed.RESULTS: A total of 3665 patients received mechanical ventilation, and there were 9445 monitored observations for bundle compliance. The total bundle compliance before and after initiation of the VAP team was 90.7% and 94.2%, respectively (P < .001). The number of VAP episodes decreased from 144 during 2008-2010 to only 14 during 2011-2013 (P < .0001). The rate of VAP decreased from 8.6 per 1000 ventilator-days to 2.0 per 1000 ventilator-days (P < .0001) after implementation of the care bundle.CONCLUSIONS: This study suggests that systematic implementation of a multidisciplinary team approach can reduce the incidence of VAP. Further sustained improvement requires persistent vigilant inspections.

KW - Adult

KW - Aged

KW - Aged, 80 and over

KW - Female

KW - Humans

KW - Incidence

KW - Infection Control/methods

KW - Intensive Care Units

KW - Male

KW - Middle Aged

KW - Patient Care Bundles

KW - Pneumonia, Ventilator-Associated/epidemiology

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U2 - 10.1016/j.ajic.2015.09.025

DO - 10.1016/j.ajic.2015.09.025

M3 - Article

C2 - 26940595

SN - 0161-6005

VL - 44

SP - 320

EP - 326

JO - American Journal of Infection Control

JF - American Journal of Infection Control

IS - 3

ER -

The impact of implementing multifaceted interventions on the prevention of ventilator-associated pneumonia

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