Collaborative Cohort Study of an Intervention to Reduce Ventilator-Associated Pneumonia in the Intensive Care Unit

被引：156

作者：

Berenholtz, Sean M. ^{[1
,6
]}

Pham, Julius C.

Thompson, David A.

Needham, Dale M.

Lubomski, Lisa H.

Hyzy, Robert C. ^{[2
]}

Welsh, Robert ^{[3
]}

Cosgrove, Sara E.

Sexton, J. Bryan

Colantuoni, Elizabeth

Watson, Sam R. ^{[4
]}

Goeschel, Christine A. ^{[5
,6
]}

Pronovost, Peter J. ^{[5
,6
]}

机构：

[1] Johns Hopkins Univ, Qual & Safety Res Grp, Sch Med, Baltimore, MD 21231 USA

[2] Univ Michigan, Ann Arbor, MI 48109 USA

[3] William Beaumont Hosp, Royal Oak, MI 48072 USA

[4] Michigan Hlth & Hosp Assoc Keystone Ctr, Lansing, MI USA

[5] Johns Hopkins Univ, Sch Nursing, Baltimore, MD 21231 USA

[6] Johns Hopkins Univ, Bloomberg Sch Publ Hlth, Baltimore, MD 21231 USA

来源：

INFECTION CONTROL AND HOSPITAL EPIDEMIOLOGY | 2011年 / 32卷 / 04期

基金：

美国国家卫生研究院; 美国医疗保健研究与质量局;

关键词：

QUALITY IMPROVEMENT; NOSOCOMIAL INFECTIONS; IMPACT; BUNDLE; SAFETY; GUIDELINE; MORTALITY; OUTCOMES; DEFECTS; PROGRAM;

D O I：

10.1086/658938

中图分类号：

R1 [预防医学、卫生学];

学科分类号：

1004 ; 120402 ;

摘要：

OBJECTIVE. To evaluate the impact of a multifaceted intervention on compliance with evidence-based therapies and ventilator-associated pneumonia (VAP) rates. DESIGN. Collaborative cohort before-after study. SETTING. Intensive care units (ICUs) predominantly in Michigan. INTERVENTIONS. We implemented a multifaceted intervention to improve compliance with 5 evidence-based recommendations for mechanically ventilated patients and to prevent VAP. A standardized CDC definition of VAP was used and maintained at each site, and data on the number of VAPs and ventilator-days were obtained from the hospital's infection preventionists. Baseline data were reported and postimplementation data were reported for 30 months. VAP rates (in cases per 1,000 ventilator-days) were calculated as the proportion of ventilator-days per quarter in which patients received all 5 therapies in the ventilator care bundle. Two interventions to improve safety culture and communication were implemented first. RESULTS. One hundred twelve ICUs reporting 3,228 ICU-months and 550,800 ventilator-days were included. The overall median VAP rate decreased from 5.5 cases (mean, 6.9 cases) per 1,000 ventilator-days at baseline to 0 cases (mean, 3.4 cases) at 16-18 months after implementation (P < .001) and 0 cases (mean, 2.4 cases) at P < .001 28-30 months after implementation (P < .001). Compared to baseline, VAP rates decreased during all observation periods, with incidence rate ratios of 0.51 (95% confidence interval, 0.41-0.64) at 16-18 months after implementation and 0.29 (95% confidence interval, 0.24-0.34) at 28-30 months after implementation. Compliance with evidence-based therapies increased from 32% at baseline to 75% at 16-18 months after implementation (P < .001) and 84% at 28-30 months after implementation (P < .001). CONCLUSIONS. A multifaceted intervention was associated with an increased use of evidence-based therapies and a substantial (up to 71%) and sustained (up to 2.5 years) decrease in VAP rates. Infect Control Hosp Epidemiol 2011; 32(4): 305-314

引用

页码：305 / 314

页数：10

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