An intensive care unit quality improvement collaborative in nine Department of Veterans Affairs hospitals: reducing ventilator-associated pneumonia and catheter-related bloodstream infection rates.
BACKGROUND
Measured adherence to evidence-based best practice in the intensive care unit (ICU) setting, as in all of health care, remains unacceptably low. In 2005 to 2006, the VA Midwest Health Care Network used a quality improvement collaborative (QIC) model to improve adherence with ICU best practices in widely varying ICU and hospital settings in nine Department of Veterans Affairs (VA) hospitals.


METHODS
Interdisciplinary performance improvement teams at each of the participating sites implemented evidence-based ventilator and central line insertion bundles, interdisciplinary team rounds, and use of a daily patient ICU bedside checklist.


RESULTS
Adherence with all five elements of the ventilator bundle improved from 50% in the first three months to 82% in the final three months of the intervention. Mean ventilator-associated pneumonia (VAP) rates decreased by 41% over the same time frame. Use of a central line insertion checklist to monitor adherence with the central line bundle increased from 58% in the first three months to 74% in the final three months of the intervention. Mean catheter-related bloodstream infection (CRBSI) rates decreased by 48% over the same time frame. Following completion of the collaborative, eight of the nine sites continued to report on adherence with the ventilator and central line bundles, the practice of interdisciplinary team rounds, and the use of an ICU patient checklist. The incidence of VAP and CRBSI in these eight sites declined in the 12-month period following the collaborative's completion, compared with the previous 12-month period.


CONCLUSIONS
Implementing the ventilator and central line bundles was associated with a reduction in rates of VAPs and CRBSIs.
Bonello
Robert S
RS
Medical Intensive Unit, Pulmonary and Critical Care Section, Minneapolis VA Medical Center, Minneapolis, USA. Robert.Bonello@va.gov
Fletcher
Carol E
CE
Becker
William K
WK
Clutter
Kay L
KL
Arjes
Shelley L
SL
Cook
Jennifer J
JJ
Petzel
Robert A
RA
D055499:Catheter-Related Infections / Q000097:blood* / Q000453:epidemiology / Q000517:prevention & control*; D003299:Cooperative Behavior; D006787:Hospitals, Veterans; D006801:Humans; D053717:Pneumonia, Ventilator-Associated / Q000453:epidemiology / Q000517:prevention & control*; D011785:Quality Assurance, Health Care / Q000458:organization & administration*; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs