Successful prevention of ventilator-associated pneumonia in an intensive care setting

Alexandre R Marra; Ruy Guilherme Rodrigues Cal; Cláudia Vallone Silva; Raquel Afonso Caserta; Ângela Tavares Paes; Denis Faria Moura; Oscar Fernando Pavão dos Santos; Michael B Edmond; Marcelino Souza Durão

doi:10.1016/j.ajic.2009.03.009

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Successful prevention of ventilator-associated pneumonia in an intensive care setting

Journal article

Peer reviewed

Successful prevention of ventilator-associated pneumonia in an intensive care setting

Alexandre R Marra, Ruy Guilherme Rodrigues Cal, Cláudia Vallone Silva, Raquel Afonso Caserta, Ângela Tavares Paes, Denis Faria Moura, Oscar Fernando Pavão dos Santos, Michael B Edmond and Marcelino Souza Durão

AJIC: American Journal of Infection Control, Vol.37(8), pp.619-625

2009

DOI: 10.1016/j.ajic.2009.03.009

PMID: 19559503

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Abstract

Ventilator-associated pneumonia (VAP) is one of the most common health care-associated infections (HAIs) in critical care settings. Our objective was to examine the effect of a series of interventions, implemented in 3 different periods to reduce the incidence of VAP in an intensive care unit (ICU). A quasiexperimental study was conducted in a medical-surgical ICU. Multiple interventions to optimize VAP prevention were performed during different phases. From March 2001 to December 2002 (phase 1: P1), some Centers for Disease Control and Prevention (CDC) evidence-based practices were implemented. From January 2003 to December 2006 (P2), we intervened in these processes at the same time that performance monitoring was occurring at the bedside, and, from January 2007 to September 2008 (P3), we continued P2 interventions and implemented the Institute for Healthcare Improvement's ventilator bundle plus oral decontamination with chlorhexidine and continuous aspiration of subglottic secretions. The incidence density of VAP in the ICU per 1000 patient-days was 16.4 in phase 1, 15.0 in phase 2, and 10.4 in phase 3, P = .05. Getting to zero VAP was possible only in P3 when compliance with all interventions exceeded 95%. These results suggest that reducing VAP rates to zero is a complex process that involves multiple performance measures and interventions.

health care associated infection

Ventilator associated pneumonia

infection control

ventilator bundle

critical care prevention

Details

Title: Subtitle: Successful prevention of ventilator-associated pneumonia in an intensive care setting
Creators: Alexandre R Marra - Intensive Care, Hospital Israelita Albert Einstein, São Paulo, Brazil
Ruy Guilherme Rodrigues Cal - Intensive Care, Hospital Israelita Albert Einstein, São Paulo, Brazil
Cláudia Vallone Silva - Infection Control Units, Hospital Israelita Albert Einstein, São Paulo, Brazil
Raquel Afonso Caserta - Intensive Care, Hospital Israelita Albert Einstein, São Paulo, Brazil
Ângela Tavares Paes - Instituto Israelita de Ensino e Pesquisa (IIEP), São Paulo, Brazil
Denis Faria Moura - Intensive Care, Hospital Israelita Albert Einstein, São Paulo, Brazil
Oscar Fernando Pavão dos Santos - Intensive Care, Hospital Israelita Albert Einstein, São Paulo, Brazil
Michael B Edmond - Department of Internal Medicine, Virginia Commonwealth University School of Medicine, Richmond, VA
Marcelino Souza Durão - Intensive Care, Hospital Israelita Albert Einstein, São Paulo, Brazil
Resource Type: Journal article
Publication Details: AJIC: American Journal of Infection Control, Vol.37(8), pp.619-625
Publisher: Mosby, Inc
DOI: 10.1016/j.ajic.2009.03.009
PMID: 19559503
ISSN: 0196-6553
eISSN: 1527-3296
Language: English
Date published: 2009
Academic Unit: Infectious Diseases; Internal Medicine
Record Identifier: 9983905531102771

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