title: Impact of availability of guidelines and active surveillance in reducing the incidence of ventilator-associated pneumonia in Europe and worldwide.
abstract: BACKGROUND
  To analyse whether the availability of written standards for management of mechanically ventilated patients and/or the existence of a surveillance system for cases of ventilation-associated pneumonia (VAP) are positively associated with compliance with 6 well-established VAP prevention measures.
  
  
  METHODS
  Ecological study based on responses to an online-questionnaire completed by 1730 critical care physicians. Replies were received from 77 different countries, of which the majority, i.e. 1351, came from 36 European countries.
  
  
  RESULTS
  On a cross-country level, compliance with VAP prevention measures is higher in countries with a large number of prevention standards and/or VAP surveillance systems in place at ICU level., Likewise, implementation of standards and VAP surveillance systems has a significant impact on self-reported total compliance with VAP prevention measures (both p < 0.001). Moreover, predictions of overall prevention measure compliance show the effect size of the availability of written standards and existence of surveillance system. For instance, a female physician with 10 years of experience in critical care working in a 15-bed ICU in France has a predicted baseline level of VAP prevention measure compliance of 63 per cent. This baseline level increases by 9.5 percentage points (p < 0.001) if a written clinical VAP prevention standard is available in the ICU, and by another 4 percentage points (p < 0.001) if complemented by a VAP surveillance system.
  
  
  CONCLUSIONS
  The existence of written standards for management of mechanically ventilated patients in an ICU and the availability of VAP surveillance systems have shown to be positively associated with compliance with VAP prevention measures and should be fostered on a policy level.
authors.affiliation: Institute of Medical Biometry and Medical Informatics, University Medical Center, Freiburg, Germany. kaier@imbi.uni-freiburg.de.
authors.forename: Klaus
authors.initials: K
authors.lastname: Kaier
authors.forename: Marie-Laurence
authors.initials: ML
authors.lastname: Lambert
authors.forename: Uwe K
authors.initials: UK
authors.lastname: Frank
authors.forename: Werner
authors.initials: W
authors.lastname: Vach
authors.forename: Martin
authors.initials: M
authors.lastname: Wolkewitz
authors.forename: Evelina
authors.initials: E
authors.lastname: Tacconelli
authors.forename: Jordi
authors.initials: J
authors.lastname: Rello
authors.forename: Ursula
authors.initials: U
authors.lastname: Theuretzbacher
authors.forename: Maria
authors.initials: M
authors.lastname: Martin
mesh_terms: D005060:Europe / Q000453:epidemiology; D005260:Female; D014943:Global Health; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D019538:Health Care Surveys; D006801:Humans; D015994:Incidence; D008297:Male; D053717:Pneumonia, Ventilator-Associated / Q000453:epidemiology / Q000517:prevention & control*; D011159:Population Surveillance; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires
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