Trends in ventilator-associated pneumonia: Impact of a ventilator care bundle in an Italian tertiary care hospital intensive care unit

doi:10.1016/j.ajic.2014.08.009

American Journal of Infection Control

Volume 42, Issue 12, December 2014, Pages 1312-1316

https://doi.org/10.1016/j.ajic.2014.08.009 Get rights and content

Highlights

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A ventilator care bundle was implemented in an Italian intensive care unit.
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Over the study years, ventilator-associated pneumonia incidence significantly decreased.
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Reductions both in early-onset and late-onset VAP incidence were observed.
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This approach to patient care had a significant impact on critically ill patients.

Background

The impact on ventilator-associated pneumonia (VAP) occurrence of a multifaceted program, including progressive strategies for VAP prevention, implemented in an Italian intensive care unit (ICU) is reported.

Methods

All adults admitted to the ICU in 2004-2010 with a length of stay ≥72 hours and mechanical ventilation time ≥48 hours were included in the study. Demographics, clinical information, and data on VAP were extracted from the ICU-acquired infection surveillance dataset. A standardized bundle for VAP prevention was implemented in 2004. In 2008, selective digestive tract decontamination (SDD) was added to the protocol. Changes in VAP incidence were evaluated.

Results

There were 1,372 subjects included in the study. Overall, 156 (11.4%) developed VAP. In the second part of the study VAP incidence decreased from 15.9% to 6.7% (P < .001). Reductions both in early-onset VAP (6.6% to 1.9%; P < .001) and late-onset VAP (9.3% to 4.7%; P = .001) incidence were observed. Multivariate analysis showed a significant reduction in the risk of developing VAP from multidrug-resistant pathogens in the bundle plus SDD period as well (odds ratio, .54; 95% confidence interval, .31-.91).

Conclusion

The implementation of a standardized approach to patient care, including a number of key reduction interventions, was associated with a significant reduction in the risk of developing VAP.

Section snippets

Patients and setting

In this retrospective observational analysis we studied all the adult patients with an ICU length of stay (LOS) ≥72 hours and receiving MV ≥48 hours admitted from January 2004-December 2010, to the ICU of the University Hospital of Modena, a 700-bed tertiary hospital in Northern Italy. The 10-bed ICU has around 800 admissions per year. During the study period the mean LOS was 3.5 days, and approximately 45% of the patients received MV.

VAP prevention protocol

In September 2003, a multidisciplinary group developed a

Results

In the study period, 1,372 patients admitted to the ICU had an ICU LOS ≥72 hours and a MV time ≥48 hours and therefore were eligible for our study. Overall, 156 subjects (11.4%) developed VAP: LVAP accounted for 62.3% of VAP cases (n = 97 cases, 7.1% of patients), whereas 59 subjects (4.3% of patients) developed EVAP (37.7% of VAP cases). The most commonly isolated organisms were Enterobacteriaceae (32.9%) followed by Pseudomonas spp, including B cepacia (30.1%), S aureus (14.1%), and

Discussion

Evidence-based guidelines for preventing VAP have been available for many years. Different bundles aimed at facilitating guideline implementation have been proposed to reduce VAP incidence in ICUs.3, 4, 5, 6, 7, 8 In this 7-year study a significant reduction in VAP risk associated with the introduction and implementation of different key VAP prevention items, which were clustered in bundles, in an Italian tertiary care hospital ICU was observed. VAP incidence decreased from 15.9% to 6.7%, and a

Conclusion

Over a 7-year period, we observed a significant reduction in the risk of developing VAP in critically ill patients. We believe that the introduction of a standardized multifaceted approach to patient care, including a number of key VAP preventive interventions, has contributed to this improved outcome.

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Major articleTrends in ventilator-associated pneumonia: Impact of a ventilator care bundle in an Italian tertiary care hospital intensive care unit

Highlights

Background

Methods

Results

Conclusion

Section snippets

Patients and setting

VAP prevention protocol

Results

Discussion

Conclusion

J Crit Care

Jt Comm J Qual Patient Saf

Am J Infect Control

Am J Infect Control

Am J Infect Control

Am J Infect Control

Chest

Lancet Infect Dis

Ventilator-associated pneumonia

Am J Respir Crit Care Med

Clinical and economic consequences of ventilator-associated pneumonia: a systematic review

Crit Care Med

Ventilator-associated pneumonia. European Task Force on ventilator-associated pneumonia

Eur Respir J

Guidelines for preventing healthcare-associated pneumonia, 2003: recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee

MMWR Recomm Rep

Guidelines for the management of adults with hospital-acquired, ventilator-associated and healthcare-associated pneumonia

Am J Respir Crit Care Med

The 100,000 lives campaign: setting a goal and a deadline for improving health care quality

JAMA

A European care bundle for prevention of ventilator-associated pneumonia

Intensive Care Med

Major article
Trends in ventilator-associated pneumonia: Impact of a ventilator care bundle in an Italian tertiary care hospital intensive care unit