title: Trends in ventilator-associated pneumonia: impact of a ventilator care bundle in an Italian tertiary care hospital intensive care unit.
abstract: BACKGROUND
  The impact on ventilator-associated pneumonia (VAP) occurrence of a multifaceted program, including progressive strategies for VAP prevention, implemented in an Italian intensive care unit (ICU) is reported.
  
  
  METHODS
  All adults admitted to the ICU in 2004-2010 with a length of stay ≥72 hours and mechanical ventilation time ≥48 hours were included in the study. Demographics, clinical information, and data on VAP were extracted from the ICU-acquired infection surveillance dataset. A standardized bundle for VAP prevention was implemented in 2004. In 2008, selective digestive tract decontamination (SDD) was added to the protocol. Changes in VAP incidence were evaluated.
  
  
  RESULTS
  There were 1,372 subjects included in the study. Overall, 156 (11.4%) developed VAP. In the second part of the study VAP incidence decreased from 15.9% to 6.7% (P < .001). Reductions both in early-onset VAP (6.6% to 1.9%; P < .001) and late-onset VAP (9.3% to 4.7%; P = .001) incidence were observed. Multivariate analysis showed a significant reduction in the risk of developing VAP from multidrug-resistant pathogens in the bundle plus SDD period as well (odds ratio, .54; 95% confidence interval, .31-.91).
  
  
  CONCLUSIONS
  The implementation of a standardized approach to patient care, including a number of key reduction interventions, was associated with a significant reduction in the risk of developing VAP.
authors.affiliation: Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy. Electronic address: elena.righi@unimore.it.
authors.forename: Elena
authors.initials: E
authors.lastname: Righi
authors.affiliation: Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy.
authors.forename: Gabriella
authors.initials: G
authors.lastname: Aggazzotti
authors.affiliation: Department of Anesthesia and Intensive Care, University Hospital of Modena, Modena, Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: Ferrari
authors.affiliation: Department of Anesthesia and Intensive Care, University Hospital of Modena, Modena, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Giovanardi
authors.affiliation: Department of Anesthesia and Intensive Care, University Hospital of Modena, Modena, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Busani
authors.affiliation: Department of Anesthesia and Intensive Care, University Hospital of Modena, Modena, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Rinaldi
authors.affiliation: Department of Anesthesia and Intensive Care, University Hospital of Modena, Modena, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Girardis
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015994:Incidence; D017053:Infection Control / Q000379:methods*; D007362:Intensive Care Units; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D064872:Patient Care Bundles; D053717:Pneumonia, Ventilator-Associated / Q000453:epidemiology* / Q000517:prevention & control; D012121:Respiration, Artificial / Q000009:adverse effects*; D063128:Tertiary Health Care; D012122:Ventilators, Mechanical / Q000009:adverse effects*
keywords: Intensive care unit; Prevention; Surveillance; Ventilator care bundle; Ventilator-associated pneumonia