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Decreasing Ventilator-Associated Pneumonia in a Trauma ICU

Cocanour, Christine S. MD; Peninger, Michelle BSMT, CIC; Domonoske, Bradley D. Pharm D; Li, Tao MBA; Wright, Bobbie RRT; Valdivia, Alicia RN; Luther, Katharine M. RN, MPM

The Journal of Trauma: Injury, Infection, and Critical Care: July 2006 - Volume 61 - Issue 1 - p 122-130
doi: 10.1097/01.ta.0000223971.25845.b3
Original Articles

Background: The incidence of ventilator-associated pneumonia ranges from 10 to 25%, with mortality of 10 to 40%. It prolongs hospital stay and drives up hospital costs. Our Intensive Care Unit (ICU) ventilator-associated pneumonia (VAP) rates were hovering at the National Nosocomial Infection Surveillance (NNIS) 90th percentile (22.3–32.7 infections per 1,000 ventilator days from January 2002 through October 2002) necessitating a performance improvement initiative designed to decrease the incidence of VAP.

Methods: A ventilator bundle that incorporates the Center for Disease Control (CDC) Guidelines for Prevention of Nosocomial Pneumonia was instituted in June of 2002. In October 2002, an intervention that audited compliance with the ventilator bundle and provided real-time feedback to ICU staff was started. VAP rates were followed using NNIS criteria. Costs were evaluated using hospital TSI data.

Results: VAP did not decrease with institution of the ventilator bundle alone. However, VAP did significantly decrease when the compliance with the ventilator bundle was audited daily and weekly feedback was provided to the caregivers. From November 2002 through June 2003 VAP stayed between 0 and 12.8 per 1,000 ventilator days. The average cost of a VAP was $50,000.

Conclusions: Prevention of VAP requires a concerted effort on the part of hospital administration, physicians, and ICU personnel. The program must be evidence-based, maintained, and accepted by ICU personnel. Continued education and feedback are crucial to maintaining a low VAP rate.

From the University of Texas Medical School at Houston, Houston, Texas (C.S.C.); and the Memorial Hermann Hospital, Houston, Texas (D.G.; M.P.; B.D.D.; T.L.; B.W.; A.V.; K.M.L.).

Submitted for publication September 17, 2003.

Accepted for publication April 12, 2006.

Presented at the 62nd Annual Meeting of the American Association for the Surgery of Trauma, September 11–13, 2003, Minneapolis, Minnesota.

Address for Reprints: Christine S. Cocanour, MD, 6431 Fannin, MSB 4.284, Houston, TX 77030; email:

© 2006 Lippincott Williams & Wilkins, Inc.