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 journalArticlepeer-review

44 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 languageEnglish
Pages (from-to)320-326
Number of pages7
JournalAmerican Journal of Infection Control
Volume44
Issue number3
DOIs
Publication statusPublished - 1 Mar 2016
Externally publishedYes

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