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

<jats:sec id="S0195941700040224_abs1"><jats:title>Objective.</jats:title><jats:p>To evaluate the impact of a multifaceted intervention on compliance with evidence-based therapies and ventilator-associated pneumonia (VAP) rates.</jats:p></jats:sec><jats:sec id="S0195941700040224_abs2"><jats:title>Design.</jats:title><jats:p>Collaborative cohort before-after study.</jats:p></jats:sec><jats:sec id="S0195941700040224_abs3"><jats:title>Setting.</jats:title><jats:p>Intensive care units (ICUs) predominantly in Michigan.</jats:p></jats:sec><jats:sec id="S0195941700040224_abs4"><jats:title>Interventions.</jats:title><jats:p>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.</jats:p></jats:sec><jats:sec id="S0195941700040224_abs5"><jats:title>Results.</jats:title><jats:p>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 (<jats:italic>P</jats:italic> < .001) and 0 cases (mean, 2.4 cases) at 28-30 months after implementation (<jats:italic>P</jats:italic> < .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 (<jats:italic>P</jats:italic> < .001) and 84% at 28–30 months after implementation (<jats:italic>P</jats:italic> < .001).</jats:p></jats:sec><jats:sec id="S0195941700040224_abs6"><jats:title>Conclusions.</jats:title><jats:p>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.</jats:p></jats:sec>