title: Procedural and educational interventions to reduce ventilator-associated pneumonia rate and central line-associated blood stream infection rate.
abstract: BACKGROUND
  Implementing best practice guidelines for ventilator-associated pneumonia (VAP) and central line-associated blood stream infection (CLA-BSI) has variable success. Our institution was concerned with high rates of VAP and CLA-BSI. This retrospective study was undertaken to see whether implementation of the below practices would reduce the rates of VAP and CLA-BSI without resorting to more expensive interventions such as subglottic endotracheal (ET) tube suctioning or silver-impregnated ET tubes. We utilized easily collectable data (standardized infection ratios [SIRs]) to rapidly assess whether interventions already in place were successful. This avoided cumbersome data collection and review.
  
  
  METHODS
  Retrospective data review calculated SIRs using National Healthcare Safety Network benchmarks. Rates and SIRs were compared using z tests with P values <.05 considered statistically significant. This data review attempted to examine the impact of education campaigns, staff meetings, in-services, physician checklist, nurse checklist, charge nurse checklist implementation, and chlorhexidine gluconate oral care addition to the VAP bundle. Additionally, central line insertion required nursing supervision, a checklist, and physician signature.
  
  
  RESULTS
  The incidence rate of VAP went from 9.88 occurrences/1000 vent days in 2009 to 0 occurrences/1000 vent days in 2010 (P < .001). The CLA-BSI occurrences/1000 line days were 2.86 in 2009 and 0.97 in 2010 (P = .0187). The SIR for VAP was 4.12 in 2009 and 0 in 2010 (P < .001). For CLA-BSI, the SIR was 1.1 in 2009 and 0.37 in 2010 (P = .04).
  
  
  CONCLUSIONS
  Efforts to improve physician, patient, and staff education, and checklist implementation resulted in a decrease in VAP and CLA-BSI. This study confirms the applicability of best practice guidelines and suggests a benefit to the use of checklists. We utilize a practical approach for examining the success of these changes.
authors.affiliation: Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, University of Louisville, Louisville, KY, U.
authors.forename: Scott P
authors.initials: SP
authors.lastname: Kellie
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Scott
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Cavallazzi
authors.forename: Tim L
authors.initials: TL
authors.lastname: Wiemken
authors.forename: Linda
authors.initials: L
authors.lastname: Goss
authors.forename: Deanna
authors.initials: D
authors.lastname: Parker
authors.forename: Mohamed
authors.initials: M
authors.lastname: Saad
mesh_terms: D055499:Catheter-Related Infections / Q000517:prevention & control*; D002405:Catheterization, Central Venous / Q000009:adverse effects* / Q000379:methods; D057189:Checklist; D002710:Chlorhexidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D003428:Cross Infection / Q000517:prevention & control; D006282:Health Personnel / Q000193:education*; D006801:Humans; D017063:Outcome Assessment, Health Care; D053717:Pneumonia, Ventilator-Associated / Q000453:epidemiology / Q000517:prevention & control*; D012189:Retrospective Studies; D018805:Sepsis / Q000453:epidemiology / Q000517:prevention & control*; D012122:Ventilators, Mechanical / Q000009:adverse effects*
chemical_list: C010882:chlorhexidine gluconate; D002710:Chlorhexidine
keywords: blood stream infection (BSI); central line-associated blood stream infection (CLA-BSI); educational intervention; hospital-acquired infections; procedural intervention; standardized infection ratio (SIR); ventilator-associated pneumonia (VAP)