The application of human engineering interventions reduces ventilator-associated pneumonia in trauma patients.
BACKGROUND
Ventilator-associated pneumonia (VAP) increases mortality and length of stay and escalates the cost of care. Our institution embarked on a project to eradicate VAP.


METHODS
We compared the outcome of trauma patients admitted in period 1 (P1) (January 2005 to December 2006) and period 2 (P2) (January 2006 to December 2009). Team building, culture change, and the ventilator bundle were introduced and modified during P1 and were fully implemented in P2. Outcome data were calculated for both periods. The Center for Disease Control VAP definition was used. The VAP rate was calculated as VAP/1,000 ventilator days. Chi-square and t test statistics were used as appropriate. Data were considered statistically significant if p ≤ 0.05.


RESULTS
In total, 299 trauma patients were admitted in P1 and 655 in P2. The two groups were identical in age, Injury Severity Score, mortality, and non-VAP. There was a trend toward a shorter length of stay in P2 (p = 0.06). The days on ventilator was significantly shorter in P2 compared with P1 (p = 0.05). The VAP rate dropped significantly from 7.9/1,000 in P1 to 1.0/1,000 in P2 (p = 0.04). The Appropriate Care Measure score increased from 45% in early P1 to 91% in late P2 (p = 0.0001).


CONCLUSIONS
The application of the VAP bundle, a checklist, and the multidisciplinary team approach resulted in significant improvement of VAP in all trauma patients admitted to the shock trauma unit and to the decrease in days on ventilator in the trauma patients. This intervention did not affect mortality or the rate of non-VAP in the trauma patients.


METHODS
Therapeutic study, level IV.
Crozer Chester Medical Center, Upland, Pennsylvania, USA. Riad.cachecho@crozer.org
Riad
R
Cachecho
Eric
E
Dobkin
D004867:Equipment Design; D006804:Ergonomics / Q000331:legislation & jurisprudence / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007902:Length of Stay / Q000639:trends; D008297:Male; D008875:Middle Aged; D010330:Patents as Topic; D010414:Pennsylvania / Q000453:epidemiology; D053717:Pneumonia, Ventilator-Associated / Q000453:epidemiology / Q000517:prevention & control*; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D014193:Trauma Centers; D012122:Ventilators, Mechanical; D014947:Wounds and Injuries / Q000628:therapy*