Impact of a program of intensive surveillance and interventions targeting ventilated patients in the reduction of ventilator-associated pneumonia and its cost-effectiveness.
OBJECTIVE
We hypothesized that a program of prospective intensive surveillance for ventilator-associated pneumonia (VAP) and concomitant implementations of multimodal, multidisciplinary preventive and intervention strategies would result in a reduction in the incidence of VAP and would be cost-effective.


METHODS
Medical and surgical intensive care units (ICUs) in a university teaching hospital.


METHODS
All ventilated patients in the medical and surgical ICUs were monitored for VAP from January 1997 through December 1998. Interventions including elevation of the head of the bed, use of sterile water and replacement of stopcocks with enteral valves for nasogastric feeding tubes, and prolongation of changing of in-line suction catheters from 24 hours to as needed were implemented.


RESULTS
The rates of VAP decreased by 10.8/1,000 ventilator-days in the medical ICU (CI95, 4.65-16.91) and by 17.2/1,000 ventilator-days in the surgical ICU (CI95, 2.85-31.56) when they were compared for 1997 and 1998. With the use of the estimated cost of a VAP of dollars 4,947 from the literature, the reduction resulted in cost savings of dollars 178,092 and dollars 148,410 in the medical and surgical ICUs, respectively, for a total of dollars 326,482. In addition, dollars 25,497 was saved due to the lengthening of the time for the change of in-line suction catheters, resulting in a cost savings of dollars 351,979. This total cost savings of dollars 351,979 minus the cost of enteral valves of dollars 2,100 resulted in total net savings of dollars 349,899.


CONCLUSIONS
Intensive surveillance and interventions targeted at ventilated patients resulted in reduction of VAP and appeared to be cost-effective.
Lai
Kwan Kew
KK
Department of Medicine, Division of Infectious Diseases, University of Massachusetts Medical School, University of Massachusetts Medical Center, Worcester, MA 01655, USA.
Baker
Stephen P
SP
Fontecchio
Sally A
SA
D003362:Cost-Benefit Analysis; D003428:Cross Infection / Q000191:economics / Q000382:microbiology / Q000517:prevention & control*; D004866:Equipment Contamination; D006745:Hospital Bed Capacity, 300 to 499; D006785:Hospitals, University; D006801:Humans; D017053:Infection Control / Q000191:economics / Q000379:methods*; D016357:Infection Control Practitioners; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008404:Massachusetts / Q000453:epidemiology; D011014:Pneumonia / Q000191:economics / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*; D018571:Sentinel Surveillance; D012122:Ventilators, Mechanical / Q000382:microbiology*