title: Adoption of a ventilator-associated pneumonia clinical practice guideline.
abstract: METHODS
  The Academic Center for Evidence-based Practice (ACE) Star Model was used to implement an evidence-based clinical practice guideline (CPG) in order to decrease ventilator-associated pneumonia (VAP) incidence rates and ventilator days. The goal was to interrupt person-to-person transmission of bacteria and bacterial colonization using low-cost, evidence-based strategies to prevent VAP. DISCOVERY: Two geographically proximate medical centers, inclusive of five intensive care units located in the southwestern region of the United States had significant variations in their VAP rates.
  
  
  METHODS
  Using the U.S. Preventive Services Task Force grading criteria, the results of 69 studies were used to establish a clinical practice guideline to prevent ventilator-associated pneumonia. TRANSLATION: A clinical practice guideline was developed for the prevention of VAP and included five nursing activities: (a) head-of-bed elevation; (b) oral care; (c) ventilator tubing condensate removal; (d) hand hygiene; and (e) glove use. The effect of the CPG, inclusive of an educational intervention, was measured using an observational, prospective, quasi-experimental design. INTEGRATION: A multidisciplinary education team developed a self-learning packet, educational materials, and storyboards for the staff as dissemination strategies. Strategies also included e-mail, one-on-one teaching with clinicians, and feedback on guideline adoption and VAP rate reports.
  
  
  RESULTS
  Observation data were collected to evaluate adoption of the CPG while caring for 106 ventilated patients. VAP rates changed at both hospitals although the change was not statistically significant. Additionally, the ICU length of stay declined at both facilities, causing cost savings.
  
  
  CONCLUSIONS
  These results support the idea that adoption of evidence-based practices contributes to decreased VAP rates. For a successful program, ICU leaders should emphasize strategies that routinize adoption of evidence-based CPGs.
authors.affiliation: Center for AMEDD Strategic Studies, USA.
authors.forename: Cynthia A
authors.initials: CA
authors.lastname: Abbott
authors.forename: Theresa
authors.initials: T
authors.lastname: Dremsa
authors.forename: Della W
authors.initials: DW
authors.lastname: Stewart
authors.forename: Debra D
authors.initials: DD
authors.lastname: Mark
authors.forename: Caren C
authors.initials: CC
authors.lastname: Swift
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003428:Cross Infection / Q000453:epidemiology / Q000517:prevention & control*; D004059:Diffusion of Innovation; D004509:Education, Nursing, Continuing / Q000458:organization & administration; D019317:Evidence-Based Medicine / Q000193:education / Q000458:organization & administration; D005260:Female; D006801:Humans; D015994:Incidence; D017053:Infection Control / Q000458:organization & administration; D007318:Inservice Training / Q000458:organization & administration; D008297:Male; D008875:Middle Aged; D017145:Models, Educational; D024802:Nurse's Role; D015403:Nursing Evaluation Research; D009741:Nursing Staff, Hospital / Q000193:education* / Q000458:organization & administration; D053717:Pneumonia, Ventilator-Associated / Q000453:epidemiology / Q000517:prevention & control*; D017410:Practice Guidelines as Topic / Q000592:standards; D015397:Program Evaluation; D012121:Respiration, Artificial / Q000009:adverse effects / Q000451:nursing; D015206:Southwestern United States / Q000453:epidemiology