title: Reduction of ventilator-associated pneumonia: active versus passive guideline implementation.
abstract: OBJECTIVE
  Ventilator-associated pneumonia (VAP) is associated with increased morbidity, mortality and costs. We describe an active, multifaceted implementation of a VAP prevention bundle designed to improve staff compliance with evidence-based actions and reduce the incidence of VAP.
  
  
  METHODS
  A 'VAP prevention bundle' was designed then implemented, first passively, then actively, as defined by a multimodal programme incorporating staff education, process measurement and outcome measurement and feedback to staff and organisational change.
  
  
  RESULTS
  Compliance with the VAP prevention bundle increased after active implementation. VAP incidence fell significantly from 19.2 to 7.5 per 1,000 ventilator days. Rate difference (99% CI) = 11.6 (2.3-21.0) per 1,000 ventilator days; rate ratio (99% CI) = 0.39 (0.16, 0.96).
  
  
  CONCLUSIONS
  An active implementation programme increased staff compliance with evidence-based interventions and was associated with a significant reduction in VAP acquisition.
authors.affiliation: Department of Anaesthesia and Intensive Care Medicine, Stirling Royal Infirmary, Livilands Stirling, FK8 2AU, UK. hawecaroline@hotmail.com
authors.forename: Caroline S
authors.initials: CS
authors.lastname: Hawe
authors.forename: Kirsteen S
authors.initials: KS
authors.lastname: Ellis
authors.forename: Chris J S
authors.initials: CJ
authors.lastname: Cairns
authors.forename: Andrew
authors.initials: A
authors.lastname: Longmate
mesh_terms: D002985:Clinical Protocols; D019317:Evidence-Based Medicine; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D053717:Pneumonia, Ventilator-Associated / Q000453:epidemiology / Q000517:prevention & control*; D012720:Severity of Illness Index; D006113:United Kingdom / Q000453:epidemiology