title: Collaborative cohort study of an intervention to reduce ventilator-associated pneumonia in the intensive care unit.
abstract: OBJECTIVE
  To evaluate the impact of a multifaceted intervention on compliance with evidence-based therapies and ventilator-associated pneumonia (VAP) rates.
  
  
  METHODS
  Collaborative cohort before-after study.
  
  
  METHODS
  Intensive care units (ICUs) predominantly in Michigan.
  
  
  METHODS
  We implemented a multifaceted intervention to improve compliance with 5 evidence-based recommendations for mechanically ventilated patients and to prevent VAP. A standardized CDC definition of VAP was used and maintained at each site, and data on the number of VAPs and ventilator-days were obtained from the hospital's infection preventionists. Baseline data were reported and postimplementation data were reported for 30 months. VAP rates (in cases per 1,000 ventilator-days) were calculated as the proportion of ventilator-days per quarter in which patients received all 5 therapies in the ventilator care bundle. Two interventions to improve safety culture and communication were implemented first.
  
  
  RESULTS
  One hundred twelve ICUs reporting 3,228 ICU-months and 550,800 ventilator-days were included. The overall median VAP rate decreased from 5.5 cases (mean, 6.9 cases) per 1,000 ventilator-days at baseline to 0 cases (mean, 3.4 cases) at 16-18 months after implementation (P < .001) and 0 cases (mean, 2.4 cases) at 28-30 months after implementation (P < .001). Compared to baseline, VAP rates decreased during all observation periods, with incidence rate ratios of 0.51 (95% confidence interval, 0.41-0.64) at 16-18 months after implementation and 0.29 (95% confidence interval, 0.24-0.34) at 28-30 months after implementation. Compliance with evidence-based therapies increased from 32% at baseline to 75% at 16-18 months after implementation (P < .001) and 84% at 28-30 months after implementation (P < .001).
  
  
  CONCLUSIONS
  A multifaceted intervention was associated with an increased use of evidence-based therapies and a substantial (up to 71%) and sustained (up to 2.5 years) decrease in VAP rates.
authors: Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. sberenho@jhmi.edu
authors: Sean M
authors: SM
authors: Berenholtz
authors: Julius C
authors: JC
authors: Pham
authors: David A
authors: DA
authors: Thompson
authors: Dale M
authors: DM
authors: Needham
authors: Lisa H
authors: LH
authors: Lubomski
authors: Robert C
authors: RC
authors: Hyzy
authors: Robert
authors: R
authors: Welsh
authors: Sara E
authors: SE
authors: Cosgrove
authors: J Bryan
authors: JB
authors: Sexton
authors: Elizabeth
authors: E
authors: Colantuoni
authors: Sam R
authors: SR
authors: Watson
authors: Christine A
authors: CA
authors: Goeschel
authors: Peter J
authors: PJ
authors: Pronovost
mesh_terms: D015331:Cohort Studies; D019317:Evidence-Based Medicine; D019983:Guideline Adherence; D006801:Humans; D015994:Incidence; D017053:Infection Control / Q000379:methods / Q000706:statistics & numerical data; D007362:Intensive Care Units / Q000458:organization & administration / Q000706:statistics & numerical data; D053717:Pneumonia, Ventilator-Associated / Q000453:epidemiology / Q000517:prevention & control*; D016012:Poisson Distribution; D012044:Regression Analysis; D012121:Respiration, Artificial / Q000009:adverse effects