title: Successful prevention of tracheostomy associated pneumonia in step-down units.
abstract: BACKGROUND
  Prevention of health care-associated infections is well described in critical care. However, surveillance in step-down unit (SDU) patients who need intermediate care with bilevel mechanical ventilation pressure through tracheotomy needs to be better understood. We evaluated the implementation of preventive measures in SDU over 2 different periods on device (bilevel mechanical ventilation)-associated pneumonia.
  
  
  METHODS
  A quasi-experimental, interrupted time series study was conducted in SDUs. Interventions were implemented to optimize the prevention of pneumonia associated with tracheostomy and evaluated in 2 phases. From January to October of 2007 (phase 1), some practices recommended by the Centers for Disease Control and Prevention were implemented, and the epidemiology unit carried out surveillance for pneumonia associated with tracheostomy. From November of 2007 to August of 2008 (phase 2) the same practices recommended by the Centers for Disease Control and Prevention were followed, but, in addition, the assessment of these processes as well as bedside interventions were initiated.
  
  
  RESULTS
  The mean incidence density of tracheostomy associated pneumonia per 1,000 tracheostomy-days in the SDUs was 6.0 in phase 1 and 0.7 in phase 2, P = .002.
  
  
  CONCLUSIONS
  Reducing pneumonia associated with tracheostomy is a continuous multidisciplinary process that involves the measurement of multiple performance metrics.
authors.affiliation: Intensive Care Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil. raquel_case@einstein.br
authors.forename: Raquel Caserta
authors.initials: RC
authors.lastname: Eid
authors.forename: Fernanda
authors.initials: F
authors.lastname: Domingues
authors.forename: Joyce Kelly
authors.initials: JK
authors.lastname: Silva Barreto
authors.forename: Alexandre R
authors.initials: AR
authors.lastname: Marra
authors.forename: Claudia Vallone
authors.initials: CV
authors.lastname: Silva
authors.forename: Angela Tavares
authors.initials: AT
authors.lastname: Paes
authors.forename: Oscar Fernando Pavão
authors.initials: OF
authors.lastname: Dos Santos
authors.forename: Michael B
authors.initials: MB
authors.lastname: Edmond
mesh_terms: D000368:Aged; D006302:Health Services Research; D006801:Humans; D015994:Incidence; D017053:Infection Control / Q000379:methods*; D018410:Pneumonia, Bacterial / Q000453:epidemiology* / Q000517:prevention & control*; D053717:Pneumonia, Ventilator-Associated / Q000453:epidemiology* / Q000517:prevention & control*; D014139:Tracheostomy / Q000009:adverse effects*