{"@context":{"@vocab":"https://cir.nii.ac.jp/schema/1.0/","rdfs":"http://www.w3.org/2000/01/rdf-schema#","dc":"http://purl.org/dc/elements/1.1/","dcterms":"http://purl.org/dc/terms/","foaf":"http://xmlns.com/foaf/0.1/","prism":"http://prismstandard.org/namespaces/basic/2.0/","cinii":"http://ci.nii.ac.jp/ns/1.0/","datacite":"https://schema.datacite.org/meta/kernel-4/","ndl":"http://ndl.go.jp/dcndl/terms/","jpcoar":"https://github.com/JPCOAR/schema/blob/master/2.0/"},"@id":"https://cir.nii.ac.jp/crid/1361418521016840192.json","@type":"Article","productIdentifier":[{"identifier":{"@type":"DOI","@value":"10.1086/658938"}},{"identifier":{"@type":"URI","@value":"https://www.cambridge.org/core/services/aop-cambridge-core/content/view/S0195941700040224"}}],"dc:title":[{"@value":"Collaborative Cohort Study of an Intervention to Reduce Ventilator-Associated Pneumonia in the Intensive Care Unit"}],"description":[{"type":"abstract","notation":[{"@value":"<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>"}]}],"creator":[{"@id":"https://cir.nii.ac.jp/crid/1381418521016840071","@type":"Researcher","foaf:name":[{"@value":"Sean M. Berenholtz"}]},{"@id":"https://cir.nii.ac.jp/crid/1381418521016840076","@type":"Researcher","foaf:name":[{"@value":"Julius C. Pham"}]},{"@id":"https://cir.nii.ac.jp/crid/1381418521016840068","@type":"Researcher","foaf:name":[{"@value":"David A. Thompson"}]},{"@id":"https://cir.nii.ac.jp/crid/1381418521016840066","@type":"Researcher","foaf:name":[{"@value":"Dale M. Needham"}]},{"@id":"https://cir.nii.ac.jp/crid/1381418521016840073","@type":"Researcher","foaf:name":[{"@value":"Lisa H. Lubomski"}]},{"@id":"https://cir.nii.ac.jp/crid/1381418521016840070","@type":"Researcher","foaf:name":[{"@value":"Robert C. Hyzy"}]},{"@id":"https://cir.nii.ac.jp/crid/1381418521016840069","@type":"Researcher","foaf:name":[{"@value":"Robert Welsh"}]},{"@id":"https://cir.nii.ac.jp/crid/1381418521016840072","@type":"Researcher","foaf:name":[{"@value":"Sara E. Cosgrove"}]},{"@id":"https://cir.nii.ac.jp/crid/1381418521016840065","@type":"Researcher","foaf:name":[{"@value":"J. Bryan Sexton"}]},{"@id":"https://cir.nii.ac.jp/crid/1381418521016840067","@type":"Researcher","foaf:name":[{"@value":"Elizabeth Colantuoni"}]},{"@id":"https://cir.nii.ac.jp/crid/1381418521016840074","@type":"Researcher","foaf:name":[{"@value":"Sam R. Watson"}]},{"@id":"https://cir.nii.ac.jp/crid/1381418521016840075","@type":"Researcher","foaf:name":[{"@value":"Christine A. Goeschel"}]},{"@id":"https://cir.nii.ac.jp/crid/1381418521016840064","@type":"Researcher","foaf:name":[{"@value":"Peter J. Pronovost"}]}],"publication":{"publicationIdentifier":[{"@type":"PISSN","@value":"0899823X"},{"@type":"EISSN","@value":"15596834"}],"prism:publicationName":[{"@value":"Infection Control & Hospital Epidemiology"}],"dc:publisher":[{"@value":"Cambridge University Press (CUP)"}],"prism:publicationDate":"2011-04","prism:volume":"32","prism:number":"4","prism:startingPage":"305","prism:endingPage":"314"},"reviewed":"false","dc:rights":["https://www.cambridge.org/core/terms"],"url":[{"@id":"https://www.cambridge.org/core/services/aop-cambridge-core/content/view/S0195941700040224"}],"createdAt":"2011-03-08","modifiedAt":"2019-04-27","relatedProduct":[{"@id":"https://cir.nii.ac.jp/crid/1360004236349196288","@type":"Article","resourceType":"学術雑誌論文(journal article)","relationType":["isReferencedBy"],"jpcoar:relatedTitle":[{"@value":"Novel Closing Method Using Subcutaneous Continuous Drain for Preventing Surgical Site Infections in Radical Cystectomy"}]}],"dataSourceIdentifier":[{"@type":"CROSSREF","@value":"10.1086/658938"},{"@type":"CROSSREF","@value":"10.1155/2014/897451_references_DOI_3gTvV3ODrSFYYeW6dhRhncdQEAd"}]}