A multifaceted program to prevent ventilator-associated pneumonia: Impact on compliance with preventive measures
To determine the effect of a 2-yr multifaceted program aimed at preventing ventilator-acquired pneumonia on compliance with eight targeted preventive measures. Pre- and postintervention observational study. A 20-bed medical intensive care unit in a teaching hospital. A total of 1649 ventilator-days...
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| Veröffentlicht in: | Critical care medicine 2010-03, Vol.38 (3), p.789-796 |
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| creator | BOUADMA, Lila MOURVILLIER, Bruno DEILER, Véronique LE CORRE, Bertrand LOLOM, Isabelle REGNIER, Bernard WOLFIF, Michel LUCET, Jean-Christophe |
| description | To determine the effect of a 2-yr multifaceted program aimed at preventing ventilator-acquired pneumonia on compliance with eight targeted preventive measures.
Pre- and postintervention observational study.
A 20-bed medical intensive care unit in a teaching hospital.
A total of 1649 ventilator-days were observed.
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).
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).
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. |
| doi_str_mv | 10.1097/CCM.0b013e3181ce21af |
| format | Article |
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Pre- and postintervention observational study.
A 20-bed medical intensive care unit in a teaching hospital.
A total of 1649 ventilator-days were observed.
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).
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).
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Pre- and postintervention observational study.
A 20-bed medical intensive care unit in a teaching hospital.
A total of 1649 ventilator-days were observed.
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).
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).
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.</description><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</subject><subject>Biological and medical sciences</subject><subject>Critical Care - methods</subject><subject>Critical Care - standards</subject><subject>Cross-Sectional Studies</subject><subject>Emergency and intensive respiratory care</subject><subject>Employee Performance Appraisal</subject><subject>Guideline Adherence - utilization</subject><subject>Hand Disinfection - standards</subject><subject>Hospitals, University</subject><subject>Humans</subject><subject>Inservice Training</subject><subject>Intensive care medicine</subject><subject>Intensive Care Units</subject><subject>Leadership</subject><subject>Medical sciences</subject><subject>Paris</subject><subject>Patient Care Team - statistics & numerical data</subject><subject>Pneumonia, Ventilator-Associated - epidemiology</subject><subject>Pneumonia, Ventilator-Associated - prevention & control</subject><subject>Prospective Studies</subject><subject>Protective Clothing - utilization</subject><subject>Utilization Review</subject><issn>0090-3493</issn><issn>1530-0293</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2010</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdkM1u1TAQRi0EopfCGyDkDWKVMs7Ejs2uuuKnUis2sI4mvhMwSuJgO0V9-6b0FqRuZmZxvhnNEeK1gjMFrn2_31-dQQ8KGZVVnmtFwxOxUxqhgtrhU7EDcFBh4_BEvMj5F4BqdIvPxUkNYGxj1E4s53JaxxIG8lz4IJcUfySaZInbyNc8F3lXwkglpopyjj7QX3DmdYpzoA_yYlrIFxln6eO0jIFmz_JPKD8fVoRrlhNTXhPnl-LZQGPmV8d-Kr5_-vht_6W6_Pr5Yn9-WXlEUyrU2iChP4CqSeu-bltn-8Ex2VaRVY1tfGvZNWSor73x1umDtmwaRAXo8VS8u9-7ffR75Vy6KWTP40gzxzV3LWILpnawkc096VPMOfHQLSlMlG46Bd2d6m5T3T1WvcXeHA-s_cSHf6EHtxvw9ghQ9jQOafMS8n-u1ko7Z_AWdEOKIQ</recordid><startdate>20100301</startdate><enddate>20100301</enddate><creator>BOUADMA, Lila</creator><creator>MOURVILLIER, Bruno</creator><creator>DEILER, Véronique</creator><creator>LE CORRE, Bertrand</creator><creator>LOLOM, Isabelle</creator><creator>REGNIER, Bernard</creator><creator>WOLFIF, Michel</creator><creator>LUCET, Jean-Christophe</creator><general>Lippincott Williams & Wilkins</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20100301</creationdate><title>A multifaceted program to prevent ventilator-associated pneumonia: Impact on compliance with preventive measures</title><author>BOUADMA, Lila ; MOURVILLIER, Bruno ; DEILER, Véronique ; LE CORRE, Bertrand ; LOLOM, Isabelle ; REGNIER, Bernard ; WOLFIF, Michel ; LUCET, Jean-Christophe</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c336t-35563a3cd012a55b27798bf9ea871a81484c78e94a6ab2c6c895d58e6433103c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2010</creationdate><topic>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</topic><topic>Biological and medical sciences</topic><topic>Critical Care - methods</topic><topic>Critical Care - standards</topic><topic>Cross-Sectional Studies</topic><topic>Emergency and intensive respiratory care</topic><topic>Employee Performance Appraisal</topic><topic>Guideline Adherence - utilization</topic><topic>Hand Disinfection - standards</topic><topic>Hospitals, University</topic><topic>Humans</topic><topic>Inservice Training</topic><topic>Intensive care medicine</topic><topic>Intensive Care Units</topic><topic>Leadership</topic><topic>Medical sciences</topic><topic>Paris</topic><topic>Patient Care Team - statistics & numerical data</topic><topic>Pneumonia, Ventilator-Associated - epidemiology</topic><topic>Pneumonia, Ventilator-Associated - prevention & control</topic><topic>Prospective Studies</topic><topic>Protective Clothing - utilization</topic><topic>Utilization Review</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>BOUADMA, Lila</creatorcontrib><creatorcontrib>MOURVILLIER, Bruno</creatorcontrib><creatorcontrib>DEILER, Véronique</creatorcontrib><creatorcontrib>LE CORRE, Bertrand</creatorcontrib><creatorcontrib>LOLOM, Isabelle</creatorcontrib><creatorcontrib>REGNIER, Bernard</creatorcontrib><creatorcontrib>WOLFIF, Michel</creatorcontrib><creatorcontrib>LUCET, Jean-Christophe</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Critical care medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>BOUADMA, Lila</au><au>MOURVILLIER, Bruno</au><au>DEILER, Véronique</au><au>LE CORRE, Bertrand</au><au>LOLOM, Isabelle</au><au>REGNIER, Bernard</au><au>WOLFIF, Michel</au><au>LUCET, Jean-Christophe</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>A multifaceted program to prevent ventilator-associated pneumonia: Impact on compliance with preventive measures</atitle><jtitle>Critical care medicine</jtitle><addtitle>Crit Care Med</addtitle><date>2010-03-01</date><risdate>2010</risdate><volume>38</volume><issue>3</issue><spage>789</spage><epage>796</epage><pages>789-796</pages><issn>0090-3493</issn><eissn>1530-0293</eissn><coden>CCMDC7</coden><abstract>To determine the effect of a 2-yr multifaceted program aimed at preventing ventilator-acquired pneumonia on compliance with eight targeted preventive measures.
Pre- and postintervention observational study.
A 20-bed medical intensive care unit in a teaching hospital.
A total of 1649 ventilator-days were observed.
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).
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).
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.</abstract><cop>Hagerstown, MD</cop><pub>Lippincott Williams & Wilkins</pub><pmid>20068461</pmid><doi>10.1097/CCM.0b013e3181ce21af</doi><tpages>8</tpages></addata></record> |
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| ispartof | Critical care medicine, 2010-03, Vol.38 (3), p.789-796 |
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| language | eng |
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| source | MEDLINE; Journals@Ovid Ovid Autoload |
| subjects | Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Biological and medical sciences Critical Care - methods Critical Care - standards Cross-Sectional Studies Emergency and intensive respiratory care Employee Performance Appraisal Guideline Adherence - utilization Hand Disinfection - standards Hospitals, University Humans Inservice Training Intensive care medicine Intensive Care Units Leadership Medical sciences Paris Patient Care Team - statistics & numerical data Pneumonia, Ventilator-Associated - epidemiology Pneumonia, Ventilator-Associated - prevention & control Prospective Studies Protective Clothing - utilization Utilization Review |
| title | A multifaceted program to prevent ventilator-associated pneumonia: Impact on compliance with preventive measures |
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