title: A multifaceted program to prevent ventilator-associated pneumonia: impact on compliance with preventive measures.
abstract: OBJECTIVE
  To determine the effect of a 2-yr multifaceted program aimed at preventing ventilator-acquired pneumonia on compliance with eight targeted preventive measures.
  
  
  METHODS
  Pre- and postintervention observational study.
  
  
  METHODS
  A 20-bed medical intensive care unit in a teaching hospital.
  
  
  METHODS
  A total of 1649 ventilator-days were observed.
  
  
  METHODS
  The program involved all healthcare workers and included a multidisciplinary task force, an educational session, direct observations with performance feedback, technical improvements, and reminders. It focused on eight targeted measures based on well-recognized published guidelines, easily and precisely defined acts, and directly concerned healthcare workers' bedside behavior. Compliance assessment consisted of five 4-wk periods (before the intervention and 1 month, 6 months, 12 months, and 24 months thereafter).
  
  
  RESULTS
  Hand-hygiene and glove-and-gown use compliances were initially high (68% and 80%) and remained stable over time. Compliance with all other preventive measures was initially low and increased steadily over time (before 2-yr level, p < .0001): backrest elevation (5% to 58%) and tracheal cuff pressure maintenance (40% to 89%), which improved after simple technical equipment implementation; orogastric tube use (52% to 96%); gastric overdistension avoidance (20% to 68%); good oral hygiene (47% to 90%); and nonessential tracheal suction elimination (41% to 92%). To assess overall performance of the last six preventive measures, using ventilator-days as the unit of analysis, a composite score for preventive measures applied (range, 0-6) was developed. The median (interquartile range) composite scores for the five successive assessments were 2 (1-3), 4 (3-5), 4 (4-5), 5 (4-6), and 5 (4-6) points; they increased significantly over time (p < .0001). Ventilator-acquired pneumonia prevalence rate decreased by 51% after intervention (p < .0001).
  
  
  CONCLUSIONS
  Our active, long-lasting program for preventing ventilator-acquired pneumonia successfully increased compliance with preventive measures directly dependent on healthcare workers' bedside performance. The multidimensional framework was critical for this marked, progressive, and sustained change.
authors.affiliation: Service de Réanimation Médicale et des Maladies Infectieuses, Hôpital Bichat-Claude-Bernard, Assistance Publique-Hôpitaux de Paris, Université Paris 7-Denis Diderot, Paris, France. lila.bouadma@bch.ap-hop-paris.fr
authors.forename: Lila
authors.initials: L
authors.lastname: Bouadma
authors.forename: Bruno
authors.initials: B
authors.lastname: Mourvillier
authors.forename: Véronique
authors.initials: V
authors.lastname: Deiler
authors.forename: Bertrand
authors.initials: B
authors.lastname: Le Corre
authors.forename: Isabelle
authors.initials: I
authors.lastname: Lolom
authors.forename: Bernard
authors.initials: B
authors.lastname: Régnier
authors.forename: Michel
authors.initials: M
authors.lastname: Wolff
authors.forename: Jean-Christophe
authors.initials: JC
authors.lastname: Lucet
mesh_terms: D003422:Critical Care / Q000379:methods / Q000592:standards; D003430:Cross-Sectional Studies; D004650:Employee Performance Appraisal; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006235:Hand Disinfection / Q000592:standards; D006785:Hospitals, University; D006801:Humans; D007318:Inservice Training; D007362:Intensive Care Units; D007857:Leadership; D010297:Paris; D010348:Patient Care Team / Q000706:statistics & numerical data; D053717:Pneumonia, Ventilator-Associated / Q000453:epidemiology / Q000517:prevention & control*; D011446:Prospective Studies; D011481:Protective Clothing / Q000706:statistics & numerical data; D014600:Utilization Review