title: Prevention of ventilator-associated pneumonia: current practice in Canadian intensive care units.
abstract: OBJECTIVE
  To evaluate the current use of strategies to prevent ventilator-associated pneumonia (VAP) and to identify interventions to target for quality-improvement initiatives.
  
  
  METHODS
  Cross-sectional national survey.
  
  
  METHODS
  Canadian intensive care units (ICUs) with at least 8 beds.
  
  
  METHODS
  Seven hundred and two patients in 66 ICUs in 10 provinces in Canada.
  
  
  METHODS
  None.
  
  
  RESULTS
  The Canadian Critical Care Trials Group recently developed VAP prevention guidelines. Before these guidelines were disseminated, we documented the extent to which these recommendations were followed in practice by using 3 methods: survey of ICU directors, prospective observation of patients on one day, and retrospective review of patient charts for a 12-day period. According to ICU directors, ventilator circuits were changed only for new patients or if the circuit was soiled in 7 of 66 ICUs (10%), heat and moisture exchangers were used routinely in 53 of 66 ICUs (80%), and closed-suction catheter systems were used in 58 of 66 ICUs (88%). Neither subglottic secretion drainage tubes nor prophylactic antibiotics for VAP were used at all. Of the entire cohort of 702 patients, the average degree of elevation of the head of the bed was 29.9 degrees (range, 0 degrees -90 degrees ) and 22 of 702 (3.1%) were observed to be on a kinetic bed. Of the 459 patients receiving any form of mechanical ventilation, 56 (12.2%) were receiving noninvasive or mask ventilation, 262 (57.1%) were orally intubated, 9 (1.9%) were nasally intubated, and 132 (28.8%) had received a tracheostomy. Of the 423 patients who received nutrition support, 373 (88.2%) received enteral nutrition. Small bowel feeding tubes were used during 16.4% of study days on enteral feeds and sucralfate was prescribed for 1.7% of study days.
  
  
  CONCLUSIONS
  Significant opportunities exist to improve VAP prevention practices in Canada. These strategies include decreasing the frequency of ventilator circuit changes, and increasing the use of non-invasive ventilation, subglottic secretion drainage endotracheal tubes, kinetic bed therapy, small bowel feedings, and elevation of the head of the bed.
authors.affiliation: Department of Medicine, Queen's University, Kingston, Ontario, Canada. dkh2@post.queensu.ca
authors.forename: Daren K
authors.initials: DK
authors.lastname: Heyland
authors.forename: Deborah J
authors.initials: DJ
authors.lastname: Cook
authors.forename: Peter M
authors.initials: PM
authors.lastname: Dodek
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002170:Canada; D003422:Critical Care / Q000379:methods / Q000592:standards*; D003428:Cross Infection / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D017053:Infection Control / Q000379:methods / Q000592:standards*; D007362:Intensive Care Units; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D011014:Pneumonia / Q000209:etiology / Q000517:prevention & control*; D011446:Prospective Studies; D011785:Quality Assurance, Health Care; D012121:Respiration, Artificial / Q000009:adverse effects*; D012189:Retrospective Studies; D011795:Surveys and Questionnaires