title: Using evidence-based practice to prevent ventilator-associated pneumonia.
abstract: BACKGROUND
  Strategies are needed to help prevent ventilator-associated pneumonia.
  
  
  OBJECTIVE
  To develop a ventilator bundle and care practices for nurses in critical care units to reduce the rate of ventilator-associated pneumonia.
  
  
  METHODS
  The ventilator bundle developed by the Institute for Healthcare Improvement was expanded to include protocols for mouth care and hand washing, head-of-bed alarms, subglottic suctioning, and use of an electronic compliance feedback tool. Compliance audits were used to provide immediate electronic feedback.
  
  
  RESULTS
  Adherence to practices included in the bundle increased. Compliance rates were greater than 98% for prophylaxis for peptic ulcer disease and deep-vein thrombosis, interruption of sedation, and elevation of the head of the bed. The compliance rate for the oral care protocol increased from 76% to 96.8%. Readiness for extubation reached at least 92.4%. Rates of ventilator-associated pneumonia decreased from 9.47 to 1.9 cases per 1000 ventilator days. The decrease in rates produced an estimated savings of approximately $1.5 million.
  
  
  CONCLUSIONS
  Strict adherence to bundled practices for preventing ventilator-associated pneumonia, enhanced accountability for initiating protocols, use of a feedback system, and interdisciplinary collaboration improved patients' outcomes and produced marked savings in costs.
authors.affiliation: Lankenau Medical Center, Main Line Health System, Wynnewood, Pennsylvania 19096, USA. sedwickm@mlhs.org
authors.forename: Mary Beth
authors.initials: MB
authors.lastname: Sedwick
authors.forename: Mary
authors.initials: M
authors.lastname: Lance-Smith
authors.forename: Sara J
authors.initials: SJ
authors.lastname: Reeder
authors.forename: Jessica
authors.initials: J
authors.lastname: Nardi
mesh_terms: D003422:Critical Care / Q000592:standards*; D055317:Evidence-Based Practice; D019983:Guideline Adherence; D006801:Humans; D017053:Infection Control / Q000592:standards; D009910:Oral Hygiene; D053717:Pneumonia, Ventilator-Associated / Q000451:nursing* / Q000517:prevention & control*