title: An educational intervention to reduce ventilator-associated pneumonia in an integrated health system: a comparison of effects.
abstract: OBJECTIVE
  To determine whether an educational initiative could decrease rates of ventilator-associated pneumonia in a regional health-care system.
  
  
  METHODS
  Two teaching hospitals (one adult, one pediatric) and two community hospitals in an integrated health system.
  
  
  METHODS
  Preintervention and postintervention observational study.
  
  
  METHODS
  Patients admitted to the four participating hospitals between January 1, 1999, and June 30, 2002, who acquired ventilator-associated pneumonia.
  
  
  METHODS
  An educational program for respiratory care practitioners and ICU nurses emphasizing correct practices for the prevention of ventilator-associated pneumonia. The program included a self-study module on risk factors for, and strategies to prevent, ventilator-associated pneumonia and education-based in-services. Fact sheets and posters reinforcing the information were posted throughout the ICU and respiratory care departments.
  
  
  RESULTS
  Completion rates for the module were calculated by job title at each hospital. Rates of ventilator-associated pneumonia per 1,000 ventilator days were calculated for all hospitals combined and for each hospital separately. Overall 635 of 792 ICU nurses (80.1%) and 215 of 239 respiratory therapists (89.9%) completed the study module. There were 874 episodes of ventilator-associated pneumonia at the four hospitals during the 3.5-year study period out of 129,527 ventilator days. Ventilator-associated pneumonia rates for all four hospitals combined dropped by 46%, from 8.75/1,000 ventilator days in the year prior to the intervention to 4.74/1,000 ventilator days in the 18 months following the intervention (p < 0.001). Statistically significant decreased rates were observed at the pediatric hospital and at two of the three adult hospitals. No change in rates was seen at the community hospital with the lowest rate of study module completion among respiratory therapists (56%).
  
  
  CONCLUSIONS
  Educational interventions can be associated with decreased rates of ventilator-associated pneumonia in the ICU setting. The involvement of respiratory therapy staff in addition to ICU nurses is important for the success of educational programs aimed at the prevention of ventilator-associated pneumonia.
authors.affiliation: Division of Infectious Diseases, Washington University School of Medicine, St Louis, MO, USA. hbabcock@im.wustl.edu
authors.forename: Hilary M
authors.initials: HM
authors.lastname: Babcock
authors.forename: Jeanne E
authors.initials: JE
authors.lastname: Zack
authors.forename: Teresa
authors.initials: T
authors.lastname: Garrison
authors.forename: Ellen
authors.initials: E
authors.lastname: Trovillion
authors.forename: Marilyn
authors.initials: M
authors.lastname: Jones
authors.forename: Victoria J
authors.initials: VJ
authors.lastname: Fraser
authors.forename: Marin H
authors.initials: MH
authors.lastname: Kollef
mesh_terms: D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003428:Cross Infection / Q000209:etiology / Q000517:prevention & control; D019033:Delivery of Health Care, Integrated; D005260:Female; D006266:Health Education; D006784:Hospitals, Teaching; D006801:Humans; D017053:Infection Control / Q000379:methods*; D007318:Inservice Training; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D018410:Pneumonia, Bacterial / Q000453:epidemiology* / Q000209:etiology* / Q000517:prevention & control; D011322:Primary Prevention / Q000379:methods; D012121:Respiration, Artificial / Q000009:adverse effects* / Q000379:methods; D012189:Retrospective Studies; D012680:Sensitivity and Specificity