An evaluation of ventilator-associated pneumonia process measure sampling strategies in a surgical ICU.
Ventilator-associated pneumonia (VAP) is common, lethal, and expensive. Little is known about optimal strategies to evaluate process measures for VAP prevention. The authors conducted a prospective study of different sampling strategies for evaluating head of bed (HOB) elevation and oral care. There was no significant difference between morning and evening shift HOB elevation compliance rates (P = .47). If oral care was performed at least once during a 12-hour shift, there was an 87% probability that it also was performed at least twice. If oral care was performed at least twice during a 12-hour shift, then there was a 93% probability that chlorhexidine oral care was performed at least once. The results of this study suggest that sampling HOB elevation twice as compared with once daily is unlikely to change the estimate of performance, oral care need not be frequently sampled, and high oral care compliance may predict chlorhexidine oral care compliance.
Johns Hopkins Community Physicians, Columbia, MD Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, MD Department of Anesthesia and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD nrawat1@jhmi.edu.
Nishi
N
Rawat
Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, MD Department of Anesthesia and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
Ting
T
Yang
Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, MD Department of Anesthesia and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
Kathleen
K
Speck
Johns Hopkins Hospital, Baltimore, MD.
Jennifer
J
Helzer
Johns Hopkins Hospital, Baltimore, MD.
Cathleen
C
Barenski
Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, MD Department of Anesthesia and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
Sean
S
Berenholtz
D002710:Chlorhexidine / Q000627:therapeutic use; D003422:Critical Care / Q000379:methods*; D004202:Disinfectants / Q000627:therapeutic use; D006801:Humans; D007362:Intensive Care Units; D053717:Pneumonia, Ventilator-Associated / Q000517:prevention & control*; D017064:Process Assessment, Health Care / Q000379:methods; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000379:methods
D004202:Disinfectants; D002710:Chlorhexidine
critical care; process assessment; quality of health care; ventilator-associated pneumonia