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.
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.
Authors: Lila Bouadma; Bruno Mourvillier; Véronique Deiler; Nelly Derennes; Bertrand Le Corre; Isabelle Lolom; Bernard Régnier; Michel Wolff; Jean-Christophe Lucet Journal: Intensive Care Med Date: 2010-04-30 Impact factor: 17.440
Authors: J R Zahar; M Garrouste-Orgeas; A Vesin; C Schwebel; A Bonadona; F Philippart; C Ara-Somohano; B Misset; J F Timsit Journal: Intensive Care Med Date: 2013-08-31 Impact factor: 17.440
Authors: Nancy J Ames; Pawel Sulima; Jan M Yates; Linda McCullagh; Sherri L Gollins; Karen Soeken; Gwenyth R Wallen Journal: Am J Crit Care Date: 2011-09 Impact factor: 2.228
Authors: Karim Asehnoune; Ségolène Mrozek; Pierre François Perrigault; Philippe Seguin; Claire Dahyot-Fizelier; Sigismond Lasocki; Anne Pujol; Mathieu Martin; Russel Chabanne; Laurent Muller; Jean Luc Hanouz; Emmanuelle Hammad; Bertrand Rozec; Thomas Kerforne; Carole Ichai; Raphael Cinotti; Thomas Geeraerts; Djillali Elaroussi; Paolo Pelosi; Samir Jaber; Marie Dalichampt; Fanny Feuillet; Véronique Sebille; Antoine Roquilly Journal: Intensive Care Med Date: 2017-03-18 Impact factor: 17.440
Authors: Tom Jefferson; Chris B Del Mar; Liz Dooley; Eliana Ferroni; Lubna A Al-Ansary; Ghada A Bawazeer; Mieke L van Driel; Sreekumaran Nair; Mark A Jones; Sarah Thorning; John M Conly Journal: Cochrane Database Syst Rev Date: 2011-07-06