Reduction of ventilator-associated pneumonia: active versus passive guideline implementation

Purpose Ventilator-associated pneumonia (VAP) is associated with increased morbidity, mortality and costs. We describe an active, multifaceted implementation of a VAP prevention bundle designed to improve staff compliance with evidence-based actions and reduce the incidence of VAP. Method A ‘VAP pre...

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Bibliographic Details
Published in:Intensive care medicine 2009-07, Vol.35 (7), p.1180-1186
Main Authors: Hawe, Caroline S., Ellis, Kirsteen S., Cairns, Chris J. S., Longmate, Andrew
Format: Article
Language:English
Subjects:
Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
Anesthesiology
Biological and medical sciences
Catheters
Clinical Protocols
Compliance
Critical care
Critical Care Medicine
Disease control
Education
Emergency and intensive respiratory care
Emergency Medicine
Evidence-Based Medicine
Feedback
Female
Guideline Adherence
Humans
Intensive
Intensive care
Intensive care medicine
Intensive Care Units
Intervention
Length of Stay
Male
Medical sciences
Medicine
Medicine & Public Health
Mortality
Nosocomial infections
Original
Pain Medicine
Patients
Pediatrics
Pneumology/Respiratory System
Pneumonia
Pneumonia, Ventilator-Associated - epidemiology
Pneumonia, Ventilator-Associated - prevention & control
Prevention
Severity of Illness Index
Surveillance
United Kingdom - epidemiology
Ventilators
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Summary:Purpose Ventilator-associated pneumonia (VAP) is associated with increased morbidity, mortality and costs. We describe an active, multifaceted implementation of a VAP prevention bundle designed to improve staff compliance with evidence-based actions and reduce the incidence of VAP. Method A ‘VAP prevention bundle’ was designed then implemented, first passively, then actively, as defined by a multimodal programme incorporating staff education, process measurement and outcome measurement and feedback to staff and organisational change. Results Compliance with the VAP prevention bundle increased after active implementation. VAP incidence fell significantly from 19.2 to 7.5 per 1,000 ventilator days. Rate difference (99% CI) = 11.6 (2.3–21.0) per 1,000 ventilator days; rate ratio (99% CI) = 0.39 (0.16, 0.96). Conclusions An active implementation programme increased staff compliance with evidence-based interventions and was associated with a significant reduction in VAP acquisition.
ISSN:0342-4642
1432-1238
DOI:10.1007/s00134-009-1461-0