title: Adherence to simple and effective measures reduces the incidence of ventilator-associated pneumonia.
abstract: OBJECTIVE
  Several modalities have been shown to be individually effective in reducing the incidence (and hence associated morbidity, mortality, and costs) of ventilator-associated pneumonia, but their implementation into clinical practice is inconsistent. We introduced an intensive care unit protocol and measured its effect on ventilator-associated pneumonia.
  
  
  METHODS
  A multidisciplinary team constructed a multifaceted protocol incorporating low risk and low cost strategies, many of which had independent advantages of their own. Some components were already in use, and their importance was emphasized to improve compliance. New strategies included elevation of the head of the bed, transpyloric enteral feeding, and antiseptic mouthwash. The approach to implementation and maintenance included education, monitoring, audits and feedback to encourage compliance with the protocol.
  
  
  RESULTS
  The implementation of this prevention protocol reduced the incidence of ventilator-associated pneumonia from a baseline of 94 cases per year or 26.7 per 1,000 ventilator days to 51.3 per year or 12.5 per 1,000 ventilator days, i.e., about 50% of the pre-protocol rate (P < 0.0001).
  
  
  CONCLUSIONS
  Adherence to simple and effective measures can reduce the incidence of ventilator-associated pneumonia. The protocol described was inexpensive and effective, and estimated savings are large. Implementation and maintenance of gains require a multidisciplinary approach, with buy-in from all team members, and ongoing monitoring, education, and feedback to the participants.
authors.affiliation: Department of Critical Care, The Ottawa Hospital, General Campus, 501 Smyth Road, Ottawa, Ontario K1H 8L6, Canada. abaxter@ottawahospital.on.ca
authors.forename: Alan D
authors.initials: AD
authors.lastname: Baxter
authors.forename: Jill
authors.initials: J
authors.lastname: Allan
authors.forename: Johane
authors.initials: J
authors.lastname: Bedard
authors.forename: Sue
authors.initials: S
authors.lastname: Malone-Tucker
authors.forename: Sharon
authors.initials: S
authors.lastname: Slivar
authors.forename: Mike
authors.initials: M
authors.lastname: Langill
authors.forename: Marc
authors.initials: M
authors.lastname: Perreault
authors.forename: Owen
authors.initials: O
authors.lastname: Jansen
mesh_terms: D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D011014:Pneumonia / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D012122:Ventilators, Mechanical / Q000009:adverse effects*