title: Reduction in the incidence of ventilator-associated pneumonia: a multidisciplinary approach.
abstract: BACKGROUND
  We report the process implemented in our institution by a task force focused on the reduction of ventilator-associated pneumonia (VAP).
  
  
  METHODS
  Retrospective cohort study of all adults admitted to one of our 4 adult ICUs, intubated on invasive mechanical ventilation. We  implemented a ventilator bundle in April of 2007; we report the incidence of VAP in 2008, and, after adjustment in the process (oral care performed by respiratory therapists), the incidence in 2009. The primary outcome was reduction of the microbiologically confirmed VAP rate over a 2 year  period. Other outcomes were duration of mechanical ventilation, antibiotic days, ICU and hospital stay, and mortality.
  
  
  RESULTS
  During the study period, 2,588 patients received invasive mechanical ventilation in the adult ICUs. The VAP rate during 2008 was 4.3/1,000 ventilator days, and the  2009 rate was 1.2/1,000 ventilator days. The 2008 to 2009 VAP rate ratio was significantly greater than 1 (rate ratio 3.6, 95% CI 1.8-8.0, P < .001). Antibiotic days were less in 2009 versus 2008 (Hodges-Lehmann estimate of difference between 2008 and 2009, 1.0, 95% CI 0.0-1.0,  P = .002). The median stay in the ICU was unchanged, and in the hospital was decreased in 2009 (Hodges-Lehmann estimate of difference between 2008 and 2009, 1.0, 95% CI 0.0-1.0, P < .001). The hospital mortality was 26.1%, and there was no difference between the 2 years.  Adherence with the ventilator bundle was above 92% during the study period, but the oral care adherence improved from 33% to 97% after respiratory therapists assumed oral care.
  
  
  CONCLUSIONS
  Reduction of the incidence of VAP occurred with an intervention that included respiratory therapists  doing oral care in patients receiving invasive mechanical ventilation. Oral care done by respiratory therapists may be associated with reduction of VAP.
authors.affiliation: Division of Pulmonary and Critical Care, Department of Medicine, Scott and White Memorial Hospital, Temple, Texas 76508, USA. aarroliga@swmail.sw.org
authors.forename: Alejandro C
authors.initials: AC
authors.lastname: Arroliga
authors.forename: Claire L
authors.initials: CL
authors.lastname: Pollard
authors.forename: Callie D
authors.initials: CD
authors.lastname: Wilde
authors.forename: Shad J
authors.initials: SJ
authors.lastname: Pellizzari
authors.forename: Ahmad
authors.initials: A
authors.lastname: Chebbo
authors.forename: Juhee
authors.initials: J
authors.lastname: Song
authors.forename: Joann
authors.initials: J
authors.lastname: Ordner
authors.forename: Stacy
authors.initials: S
authors.lastname: Cormier
authors.forename: Tricia
authors.initials: T
authors.lastname: Meyer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003422:Critical Care; D005260:Female; D006801:Humans; D015994:Incidence; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team / Q000458:organization & administration*; D053717:Pneumonia, Ventilator-Associated / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D012121:Respiration, Artificial; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents