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Effect of an education program aimed at reducing the occurrence of ventilator-associated pneumonia*

Zack, Jeanne E. BSN; Garrison, Teresa MSN; Trovillion, Ellen BSN; Clinkscale, Darnetta RRT; Coopersmith, Craig M. MD; Fraser, Victoria J. MD; Kollef, Marin H. MD

FEATURE ARTICLES

Objective The purpose of the study was to determine whether an education initiative could decrease the hospital rate of ventilator-associated pneumonia.

Design Pre- and postintervention observational study.

Setting Five intensive care units in Barnes-Jewish Hospital, an urban teaching hospital.

Patients Patients requiring mechanical ventilation who developed ventilator-associated pneumonia between October 1, 1999, and September 30, 2001.

Interventions An education program directed toward respiratory care practitioners and intensive care unit nurses was developed by a multidisciplinary task force to highlight correct practices for the prevention of ventilator-associated pneumonia. The program consisted of a ten-page self-study module on risk factors and practice modifications involved in ventilator-associated pneumonia, inservices at staff meetings, and formal didactic lectures. Each participant was required to take a preintervention test before the study module and identical postintervention tests following completion of the study module. Fact sheets and posters reinforcing the information in the study module were also posted throughout the intensive care units and the Department of Respiratory Care Services.

Measurements and Main Results One hundred ninety-one episodes of ventilator-associated pneumonia occurred in 15,094 ventilator days (12.6 per 1,000 ventilator days) in the 12 months before the intervention. Following implementation of the education module, the rate of ventilator-associated pneumonia decreased to 81 episodes in 14,171 ventilator days (5.7 per 1,000 ventilator days), a decrease of 57.6% (p < .001). The estimated cost savings secondary to the decreased rate of ventilator-associated pneumonia for the 12 months following the intervention were between $425,606 and $4.05 million.

Conclusions A focused education intervention can dramatically decrease the incidence of ventilator-associated pneumonia. Education programs should be more widely employed for infection control in the intensive care unit setting and can lead to substantial decreases in cost and patient morbidity attributed to hospital-acquired infections.

From the Pulmonary and Critical Care Division (MHK), Division of Infectious Diseases (VJF), and Department of Surgery (CMC), Washington University School of Medicine, St. Louis, MO; and the Departments of Hospital Epidemiology and Infection Control (JEZ, TG, ET) and Department of Respiratory Care Services (DC, MHK), Barnes-Jewish Hospital, St. Louis, MO.

* See also p. 2593.

Supported, in part, 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).

Address requests for reprints to: Marin H. Kollef, MD, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8052, St. Louis, MO 63110. E-mail: kollefm@msnotes.wustl.edu

By instituting a simple, risk-free education module, we decreased our infection rate by more than 50% and saved anywhere between $425,606 and $4.05 million.

© 2002 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins