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A multifaceted program to prevent ventilator-associated pneumonia: Impact on compliance with preventive measures*

Bouadma, Lila MD; Mourvillier, Bruno MD; Deiler, Véronique RN; Le Corre, Bertrand RN; Lolom, Isabelle BS; Régnier, Bernard MD; Wolff, Michel MD; Lucet, Jean-Christophe MD, PhD

doi: 10.1097/CCM.0b013e3181ce21af
Clinical Investigations

Objective: To determine the effect of a 2-yr multifaceted program aimed at preventing ventilator-acquired pneumonia on compliance with eight targeted preventive measures.

Design: Pre- and postintervention observational study.

Setting: A 20-bed medical intensive care unit in a teaching hospital.

Patients: A total of 1649 ventilator-days were observed.

Interventions: The program involved all healthcare workers and included a multidisciplinary task force, an educational session, direct observations with performance feedback, technical improvements, and reminders. It focused on eight targeted measures based on well-recognized published guidelines, easily and precisely defined acts, and directly concerned healthcare workers' bedside behavior. Compliance assessment consisted of five 4-wk periods (before the intervention and 1 month, 6 months, 12 months, and 24 months thereafter).

Measurements and Main Results: Hand-hygiene and glove-and-gown use compliances were initially high (68% and 80%) and remained stable over time. Compliance with all other preventive measures was initially low and increased steadily over time (before 2-yr level, p < .0001): backrest elevation (5% to 58%) and tracheal cuff pressure maintenance (40% to 89%), which improved after simple technical equipment implementation; orogastric tube use (52% to 96%); gastric overdistension avoidance (20% to 68%); good oral hygiene (47% to 90%); and nonessential tracheal suction elimination (41% to 92%). To assess overall performance of the last six preventive measures, using ventilator-days as the unit of analysis, a composite score for preventive measures applied (range, 0–6) was developed. The median (interquartile range) composite scores for the five successive assessments were 2 (1–3), 4 (3–5), 4 (4–5), 5 (4–6), and 5 (4–6) points; they increased significantly over time (p < .0001). Ventilator-acquired pneumonia prevalence rate decreased by 51% after intervention (p < .0001).

Conclusions: Our active, long-lasting program for preventing ventilator-acquired pneumonia successfully increased compliance with preventive measures directly dependent on healthcare workers' bedside performance. The multidimensional framework was critical for this marked, progressive, and sustained change.

From the Service de Réanimation Médicale et des Maladies Infectieuses (LB, BM, VD, BR, MW), Direction de la Qualité et Gestion des Risques (BLC), and Unité Hospitalière de Lutte contre l'Infection Nosocomiale (IL, J-CL), Hôpital Bichat–Claude-Bernard, Assistance Publique-Hôpitaux de Paris, Université Paris 7-Denis Diderot, Paris, France.

Dr. Wolff has consulted for Gilead and has received honoraria from MSD. The remaining authors have not disclosed any potential conflicts of interest.

For information regarding this article, E-mail: lila.bouadma@bch.ap-hop-paris.fr

© 2010 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins