title: Reduction in deep vein thrombosis incidence in intensive care after a clinician education program.
abstract: BACKGROUND
  Deep vein thrombosis (DVT) is a major complication in intensive care units (ICU) but dedicated guidelines on its management are still lacking.
  
  
  OBJECTIVE
  This study investigated the effect of a 1-year educational program for the implementation of DVT prophylaxis on the incidence of inferior limb DVT in a mixed-bed ICU that admits high-risk surgical and trauma patients, investigated during a first retrospective phase [126 patients, SAPS II score 42 (28-54)] and a following prospective phase [264 patients, SAPS II score II 41 (27-55)]. The role of baseline and time-dependent DVT risk factors in DVT occurrence was also investigated during the prospective phase.
  
  
  RESULTS
  The educational program on implementation of DVT prophylaxis was associated with a significant decrease in DVT incidence from 11.9% to 4.5% (P < 0.01) and in the mean length of ICU stay (P < 0.01). Combined with pharmacological prophylaxis, the use of elastic compressive stockings significantly also increased in the prospective phase (P < 0.01). The duration of mechanical ventilation, vasopressor administration and neuromuscular block were significantly different between DVT-positive and DVT-negative patients (P < 0.01). Multivariate analysis identified neuromuscular block as the strongest independent predictor for DVT incidence.
  
  
  CONCLUSIONS
  One-year ICU-based educational programs on implementation of DVT prophylaxis were associated with a significant decrease in the incidence of DVT and also in the length of stay in ICU.
authors.affiliation: Clinica Medica Generale e Medicine Specialistiche, Dipartimento di Area Critica Medico-Chirurgica, Azienza Ospedaliera-Universitaria Careggi, Florence, Italy. m.boddi@dac.unifi.it
authors.forename: M
authors.initials: M
authors.lastname: Boddi
authors.forename: F
authors.initials: F
authors.lastname: Barbani
authors.forename: R
authors.initials: R
authors.lastname: Abbate
authors.forename: M
authors.initials: M
authors.lastname: Bonizzoli
authors.forename: S
authors.initials: S
authors.lastname: Batacchi
authors.forename: E
authors.initials: E
authors.lastname: Lucente
authors.forename: M
authors.initials: M
authors.lastname: Chiostri
authors.forename: G F
authors.initials: GF
authors.lastname: Gensini
authors.forename: A
authors.initials: A
authors.lastname: Peris
mesh_terms: D000328:Adult; D000368:Aged; D003131:Combined Modality Therapy; D003479:Curriculum; D004502:Education, Medical, Continuing; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006405:Hematology / Q000193:education*; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D048228:Intermittent Pneumatic Compression Devices; D007558:Italy / Q000453:epidemiology; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D019148:Neuromuscular Blockade / Q000009:adverse effects; D017410:Practice Guidelines as Topic; D015995:Prevalence; D015397:Program Evaluation; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000009:adverse effects; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D053828:Stockings, Compression; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography; D014662:Vasoconstrictor Agents / Q000009:adverse effects; D020246:Venous Thrombosis / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*
chemical_list: D005343:Fibrinolytic Agents; D014662:Vasoconstrictor Agents