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J Intensive Care Med. 2014 May-Jun;29(3):165-74. doi: 10.1177/0885066612467152. Epub 2012 Nov 15.

Procedural and educational interventions to reduce ventilator-associated pneumonia rate and central line-associated blood stream infection rate.

Author information

1
Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, University of Louisville, Louisville, KY, U.

Abstract

BACKGROUND:

Implementing best practice guidelines for ventilator-associated pneumonia (VAP) and central line-associated blood stream infection (CLA-BSI) has variable success. Our institution was concerned with high rates of VAP and CLA-BSI. This retrospective study was undertaken to see whether implementation of the below practices would reduce the rates of VAP and CLA-BSI without resorting to more expensive interventions such as subglottic endotracheal (ET) tube suctioning or silver-impregnated ET tubes. We utilized easily collectable data (standardized infection ratios [SIRs]) to rapidly assess whether interventions already in place were successful. This avoided cumbersome data collection and review.

METHODS:

Retrospective data review calculated SIRs using National Healthcare Safety Network benchmarks. Rates and SIRs were compared using z tests with P values <.05 considered statistically significant. This data review attempted to examine the impact of education campaigns, staff meetings, in-services, physician checklist, nurse checklist, charge nurse checklist implementation, and chlorhexidine gluconate oral care addition to the VAP bundle. Additionally, central line insertion required nursing supervision, a checklist, and physician signature.

RESULTS:

The incidence rate of VAP went from 9.88 occurrences/1000 vent days in 2009 to 0 occurrences/1000 vent days in 2010 (P < .001). The CLA-BSI occurrences/1000 line days were 2.86 in 2009 and 0.97 in 2010 (P = .0187). The SIR for VAP was 4.12 in 2009 and 0 in 2010 (P < .001). For CLA-BSI, the SIR was 1.1 in 2009 and 0.37 in 2010 (P = .04).

CONCLUSIONS:

Efforts to improve physician, patient, and staff education, and checklist implementation resulted in a decrease in VAP and CLA-BSI. This study confirms the applicability of best practice guidelines and suggests a benefit to the use of checklists. We utilize a practical approach for examining the success of these changes.

KEYWORDS:

blood stream infection (BSI); central line-associated blood stream infection (CLA-BSI); educational intervention; hospital-acquired infections; procedural intervention; standardized infection ratio (SIR); ventilator-associated pneumonia (VAP)

PMID:
23753223
DOI:
10.1177/0885066612467152
[Indexed for MEDLINE]

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