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Multifaceted intervention prevents ventilator-associated pneumonia

A multifaceted intervention which included training and coaching on evidence-based mediations and safety practices resulted in reductions in ventilator-associated events, infection-related ventilator-associated complications and probable ventilator-associated pneumonia and improvements in compliance, according to research published in Critical Care Medicine.

“Approximately 800,000 hospitalized patients undergo mechanical ventilation each year in the United States, representing 2.7 episodes per 1,000 hospitalizations,” Nishi Rawat, MD, from Johns Hopkins School of Medicine and Armstrong Institute, and colleagues wrote.

These episodes or complications, known as ventilator-associated events (VAEs), include blood clots, lung damage and ventilator-associated pneumonia, which is considered one of the most common and deadly hospital-acquired infections, according to the researchers.

“VAEs are associated with prolonged mechanical ventilation, increased mortality, antimicrobial use, and ICU and hospital lengths of stay,” they wrote.

Rawat and colleagues performed a two-state collaborative study of a multifaceted intervention aimed to improve adherence and decrease VAEs with evidence-based practices, unit teamwork and safety culture.

“Unfortunately, patients don’t always receive the evidence-based therapies they should,” Sean Berenholtz, MD, co-author of the study and professor of anesthesiology and critical care medicine at the Johns Hopkins University School of Medicine, said in a related press release.

The longitudinal quasi-experimental study was conducted between October 2012 and March 2015 in 56 ICUs at 38 hospitals in Maryland and Pennsylvania. Via monthly teleconferences, the researchers trained quality improvement teams on implementing evidence-based interventions, including head-of-bed elevation, use of subglottic secretion drainage endotracheal tubes, oral care, chlorhexidine mouth care and daily spontaneous awakening and breathing trials, as well as screening for improvement. In addition, teams were trained to employ the Agency for Healthcare Research and Quality’s (AHRQ) Comprehensive Unit-based Safety Program to prevent patient harm.

Data indicated that over time, compliance with all evidence-based interventions improved. After 24 months, the total number of VAEs in the ICUs significantly declined by almost 38%, decreasing from 7.34 to 4.58 cases per 1,000 patient ventilator days. In addition, there was a more than 50% reduction in the number of infection-related ventilator-associated complications (from 3.15 to 1.56 cases per 1,000 ventilator days) and a 78% reduction in the number of possible and probable ventilator-associated pneumonia (from 1.41 to 0.31 cases per 1,000 ventilator days).

“When patients are sick, complications can happen, and, in some cases, health care-associated infections are thought to be inevitable,” Berenholtz said. “This is the largest study to date to show that [VAEs] are also preventable.”

“These complications prolong the duration of mechanical ventilation, and they keep patients in the hospital longer,” he added. “This, in turn, leads to higher complications, higher mortality, higher lengths of stay and higher costs. So decreasing these complications is a national priority and helps our patients recover sooner.” – by Alaina Tedesco

Disclosure: The researchers report funding from AHRQ, NIH/National Heart, Lung and Blood Institute, the Moore Foundation, AMA and the Armstrong Institute.