Chest
Volume 125, Issue 6, June 2004, Pages 2224-2231
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Clinical Investigations in Critical Care
An Educational Intervention to Reduce Ventilator-Associated Pneumonia in an Integrated Health System: A Comparison of Effects

https://doi.org/10.1378/chest.125.6.2224Get rights and content

Study objectives

To determine whether an educational initiative could decrease rates of ventilator-associated pneumonia in a regional health-care system.

Setting

Two teaching hospitals (one adult, one pediatric) and two community hospitals in an integrated health system.

Design

Preintervention and postintervention observational study.

Patients

Patients admitted to the four participating hospitals between January 1, 1999, and June 30, 2002, who acquired ventilator-associated pneumonia.

Intervention

An educational program for respiratory care practitioners and ICU nurses emphasizing correct practices for the prevention of ventilator-associated pneumonia. The program included a self-study module on risk factors for, and strategies to prevent, ventilator-associated pneumonia and education-based in-services. Fact sheets and posters reinforcing the information were posted throughout the ICU and respiratory care departments.

Measurements and results

Completion rates for the module were calculated by job title at each hospital. Rates of ventilator-associated pneumonia per 1,000 ventilator days were calculated for all hospitals combined and for each hospital separately. Overall 635 of 792 ICU nurses (80.1%) and 215 of 239 respiratory therapists (89.9%) completed the study module. There were 874 episodes of ventilator-associated pneumonia at the four hospitals during the 3.5-year study period out of 129,527 ventilator days. Ventilator-associated pneumonia rates for all four hospitals combined dropped by 46%, from 8.75/1,000 ventilator days in the year prior to the intervention to 4.74/1,000 ventilator days in the 18 months following the intervention (p < 0.001). Statistically significant decreased rates were observed at the pediatric hospital and at two of the three adult hospitals. No change in rates was seen at the community hospital with the lowest rate of study module completion among respiratory therapists (56%).

Conclusions

Educational interventions can be associated with decreased rates of ventilator-associated pneumonia in the ICU setting. The involvement of respiratory therapy staff in addition to ICU nurses is important for the success of educational programs aimed at the prevention of ventilator-associated pneumonia.

Section snippets

Intervention

A multidisciplinary task force consisting of two physicians (M.H.K. and V.J.F.) and members of the Barnes-Jewish Hospital Infection Control Team was formed in February 1999 to develop a policy for the prevention of ventilator-associated pneumonia. This policy was derived in large part from two literature reviews authored by one of the task force members.7, 8 The task force also compared the new policy to the Centers for Disease Control and Prevention recommendations for the prevention of

Compliance Results

The intervention was introduced in the spring of 2000 at community hospital 1, summer 2000 at community hospital 2, fall 2000 at the adult teaching hospital, and winter 2000 at the pediatric hospital. All hospitals had completed the intervention by the fall of 2000, except the pediatric hospital, which completed the intervention by the end of 2000. The infection control nurse assigned to the individual ICU determined when completion of the intervention had occurred in terms of staff exposure to

DISCUSSION

This study demonstrated that an educational initiative directed at respiratory care practitioners and ICU nurses was associated with decreases in the incidence of ventilator-associated pneumonia at three of four participating hospitals. Decreases in ventilator-associated pneumonia rates ranged from 38 to 61%. Our results suggest that participation by respiratory therapy staff and incorporation of the self-study module into mandatory competency training for staff are important for reducing

ACKNOWLEDGMENT

The authors thank the infection control specialists, respiratory care practitioners, and the nursing staffs participating in this quality improvement project.

References (33)

  • J Rello et al.

    Why do physicians not follow evidence-based guidelines for preventing ventilator-associated pneumonia? A survey based on the opinions of an international panel of intensivists

    Chest

    (2002)
  • MJ Richards et al.

    Nosocomial infections in medical intensive care units in the United States: National Nosocomial Infections Surveillance System

    Crit Care Med

    (1999)
  • DE Craven et al.

    Preventing nosocomial pneumonia: state of the art and perspectives for the 1990s

    Am J Med

    (1991)
  • P Markowicz et al.

    Multicenter prospective study of ventilator-associated pneumonia during acute respiratory distress syndrome-incidence, prognosis, and risk factors

    Am J Respir Crit Care Med

    (2000)
  • MH. Kollef

    The prevention of ventilator-associated pneumonia

    N Engl J Med

    (1999)
  • GA Joiner et al.

    Utilizing quality assurance as a tool for reducing the risk of nosocomial ventilator-associated pneumonia

    Am J Med Qual

    (1996)
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    This work was supported by funding from the Centers for Disease Control and Prevention Cooperative Agreement UR8/CCU715087–01, BJC Hospital Epidemiology and Infection Control Consortium, and the National Institutes of Health (GM00709).

    The study module and self-examinations can be obtained as a CD-ROM through the Association for Professionals in Infection Control and Epidemiology.

    Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (e-mail: [email protected]).

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