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Ranji SR, Shetty K, Posley KA, et al. Closing the Quality Gap: A Critical Analysis of Quality Improvement Strategies (Vol. 6: Prevention of Healthcare–Associated Infections). Rockville (MD): Agency for Healthcare Research and Quality (US); 2007 Jan. (Technical Reviews, No. 9.6.)
Closing the Quality Gap: A Critical Analysis of Quality Improvement Strategies (Vol. 6: Prevention of Healthcare–Associated Infections).
Show detailsTable 8cArticles addressing prevention of ventilator-associated pneumonia: simple before-after studies of poor methodologic quality
| Author | Setting and Hospital Type | Study period | Length of follow-up | Preventive Interventions | Quality improvement intervention | Results |
|---|---|---|---|---|---|---|
| *Berg 199560 | Guatemala | Not specified | 1 year | Hand hygiene | QI Strategies: Clinician education | Infection rate prior to intervention: 113 VAP per 1,000 ventilator-days |
| Tertiary care or university hospital | A multifaceted intervention was used to target nosocomial infections in the ICU, with both general measures and measures targeting VAP and CAUTI. Nurses and physicians received 15 educational sessions on aseptic technique, stressing proper hand washing. The educational sessions used lectures and demonstrations, and individual clinicians also received positive and negative feedback and reminder signs at the bedside. The VAP intervention targeted proper use of sterile rinse water and improvement in aseptic technique for suctioning. Providers received more than 15 interactive conferences on the detection, management, and prevention of nosocomial pneumonia; these included lectures, demonstrations, individual instruction and feedback, and contests. The CAUTI intervention consisted of changing open urinary drainage systems to closed systems (aseptic catheter care), with an educational session on the new catheter. The intervention did not specifically target surgical site infections, but those outcomes are reported. | Infection rate after intervention: 40 VAP per 1,000 ventilator-days | ||||
| p<0.01 | ||||||
| Adherence to protocols for hand hygiene: | ||||||
| Before intervention: 5% | ||||||
| After intervention: 63% | ||||||
| p<0.01 | ||||||
| Joiner 1996108 | United States | 5/1992–9/1992 | 2.5 years | Hand hygiene | QI Strategies: Clinician education, organizational change | Infection rate prior to intervention: 26 VAP per 1,000 ventilator-days |
| Tertiary care or university hospital | Head of bed elevation above 30 degrees | A QI team (including physicians, respiratory therapists, ICU nurses, infection control practitioners, and quality managers) brainstormed to develop practice guidelines for preventing VAP. These guidelines were developed into a standardized protocol and presented to staff in a presentation and at staff meetings. VAP rates were reviewed monthly and shared with departments. A continuous quality improvement method was used to review data and revise the intervention as needed. | Infection rate after intervention: 16 VAP per 1,000 ventilator-days | |||
| p value not reported | ||||||
| Resar 2005113 | United States | 2002-2004 | 6 months | Head of bed elevation above 30 degrees | QI Strategies: Clinician education, organizational change | For medical-surgical ICUs |
| Multiple hospitals of different types | Daily interruption of sedation | Report of 61 hospitals who participated in the IHI IMPACT network. Teams of critical care physicians from each organization attended collaborative meetings, beginning with a half-day introductory course on change concepts. | Infection rate prior to intervention: 5.5 VAP per 1,000 ventilator days | |||
| The “ventilator bundle”, consisting of PUD prophylaxis, DVT prophylaxis, HOB elevation, and sedation vacation, were the key concepts targeted for implementation, and the collaborative meetings sere devoted to implementation methods. | Infection rate after intervention: 2.7 VAP per 1,000 ventilator days | |||||
| ICU's implemented multidisciplinary rounds and daily patient goals at a minimum. | p value not reported | |||||
| Nicotra 1996112 | United States | 12/1991–5/1994 | 18 months | Hand hygiene | QI Strategies: Clinician education, organizational change | Infection rate prior to intervention: 22 VAP per 1,000 ventilator days |
| Single hospital, type not specified | A continuous quality improvement style intervention was implemented to reduce VAP. A multidisciplinary task force developed a process improvement plan consisting of implementation of a closed suction device, and changes in cleaning and maintenance of ventilator units. A survey was performed which revealed a lack of knowledge among nurses about preventive interventions for VAP. Thus, an educational program on VAP was conducted for nurses, consisting of information about hand washing, suctioning, other preventive measures (such as patient mobilization, respiratory care, maintaining hydration, assessing nutritional status, and review of drugs for stress ulceration), as well as general infection control measures. | Infection rate after intervention: 8.3 VAP per 1,000 ventilator days | ||||
| p values not reported | ||||||
| **Lam 200462 | Hong Kong | Not specified | 10 months | Hand hygiene | QI Strategies: Clinician reminder; organizational change | Infection rate prior to intervention: 16.9 VAP per 1,000 ventilator days |
| Tertiary care or university hospital | Nurses and physicians received an educational program targeting hand hygiene. A hand hygiene protocol was implemented as part of the orientation for new staff. Face-to-face educational seminars were conducted for nurses and physicians where solutions to overcome obstacles to hand washing were provided; 2 sessions were provided for physicians and 10 for nurses. A task-oriented analysis was performed to identify strategies for hand washing during complex procedures. Demonstrations were conducted at regular intervals, and reminder pictures were posted at each hand washing basin. | Infection rate after intervention: 6.4 VAP per 1,000 ventilator days | ||||
| p=NS | ||||||
| Adherence to protocols for hand hygiene: | ||||||
| before intervention: 40% | ||||||
| after intervention: 53% | ||||||
| p<0.01 | ||||||
- *
This study addresses prevention of surgical site infections, central line-associated bloodstream infections, ventilator-associated pneumonia and catheter-associated urinary tract infections.
- **
This study addresses prevention of central line-associated bloodstream infections and ventilator-associated pneumonia.
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