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Sustained Reduction of Ventilator-Associated Pneumonia Rates Using Real-Time Course Correction With a Ventilator Bundle Compliance Dashboard

Published online by Cambridge University Press:  11 August 2015

Thomas R. Talbot ,
Devin Carr ,
C. Lee Parmley ,
Barbara J. Martin ,
Barbara Gray ,
Anna Ambrose  and
Jack Starmer
Thomas R. Talbot*
Affiliation:
Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee Department of Health Policy, Vanderbilt University School of Medicine, Nashville, Tennessee
Devin Carr
Affiliation:
Hospital Administration, Vanderbilt University Medical Center, Nashville, Tennessee
C. Lee Parmley
Affiliation:
Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, Tennessee
Barbara J. Martin
Affiliation:
Quality, Safety, and Risk Prevention, Vanderbilt University Medical Center, Nashville, Tennessee
Barbara Gray
Affiliation:
Department of Trauma, Vanderbilt University School of Medicine, Nashville, Tennessee
Anna Ambrose
Affiliation:
Department of Respiratory Care, Vanderbilt University Medical Center, Nashville, Tennessee
Jack Starmer
Affiliation:
Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, Tennessee
*
Address correspondence to Thomas R. Talbot, MD, MPH, A-2200 Medical Center North, 1161 21st Avenue South, Vanderbilt University Medical Center, Nashville, TN 37232 (tom.talbot@vanderbilt.edu).
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Abstract

BACKGROUND

The effectiveness of practice bundles on reducing ventilator-associated pneumonia (VAP) has been questioned.

OBJECTIVE

To implement a comprehensive program that included a real-time bundle compliance dashboard to improve compliance and reduce ventilator-associated complications.

DESIGN

Before-and-after quasi-experimental study with interrupted time-series analysis.

SETTING

Academic medical center.

METHODS

In 2007 a comprehensive institutional ventilator bundle program was developed. To assess bundle compliance and stimulate instant course correction of noncompliant parameters, a real-time computerized dashboard was developed. Program impact in 6 adult intensive care units (ICUs) was assessed. Bundle compliance was noted as an overall cumulative bundle adherence assessment, reflecting the percentage of time all elements were concurrently in compliance for all patients.

RESULTS

The VAP rate in all ICUs combined decreased from 19.5 to 9.2 VAPs per 1,000 ventilator-days following program implementation (P<.001). Bundle compliance significantly increased (Z100 score of 23% in August 2007 to 83% in June 2011 [P<.001]). The implementation resulted in a significant monthly decrease in the overall ICU VAP rate of 3.28/1,000 ventilator-days (95% CI, 2.64–3.92/1,000 ventilator-days). Following the intervention, the VAP rate decreased significantly at a rate of 0.20/1,000 ventilator-days per month (95% CI, 0.14–0.30/1,000 ventilator-days per month). Among all adult ICUs combined, improved bundle compliance was moderately correlated with monthly VAP rate reductions (Pearson correlation coefficient, −0.32).

CONCLUSION

A prevention program using a real-time bundle adherence dashboard was associated with significant sustained decreases in VAP rates and an increase in bundle compliance among adult ICU patients.

Infect. Control Hosp. Epidemiol. 2015;36(11):1261–1267

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 36 , Issue 11 , November 2015 , pp. 1261 - 1267
Copyright
© 2015 by The Society for Healthcare Epidemiology of America. All rights reserved 

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Footnotes

Presented in part: Fifth Decennial International Conference on Healthcare-Associated Infections; Atlanta, Georgia; March 21, 2010 (Abstract 744).

References

REFERENCES

1. Davis, KA. Ventilator-associated pneumonia: a review. J Intensive Care Med 2006;21:211–226.Google Scholar
2. Kollef, MH, Hamilton, CW, Ernst, FR. Economic impact of ventilator-associated pneumonia in a large matched cohort. Infect Control Hosp Epidemiol 2012;33:250–256.CrossRefGoogle Scholar
3. Institute for Healthcare Improvement. Implement the IHI ventilator bundle. http://www.ihi.org/knowledge/Pages/Changes/ImplementtheVentilatorBundle.aspx. Accessed August 31, 2011.Google Scholar
4. Zilberberg, MD, Shorr, AF, Kollef, MH. Implementing quality improvements in the intensive care unit: ventilator bundle as an example. Crit Care Med 2009;37:305–309.Google Scholar
5. Berenholtz, SM, Pham, JC, Thompson, DA, et al. Collaborative cohort study of an intervention to reduce ventilator-associated pneumonia in the intensive care unit. Infect Control Hosp Epidemiol 2011;32:305–314.CrossRefGoogle ScholarPubMed
6. Lawrence, P, Fulbrook, P. The ventilator care bundle and its impact on ventilator-associated pneumonia: a review of the evidence. Nurs Crit Care 2011;16:222–234.Google Scholar
7. O’Grady, NP, Murray, PR, Ames, N. Preventing ventilator-associated pneumonia: does the evidence support the practice? JAMA 2012;307:2534–2539.CrossRefGoogle ScholarPubMed
8. Wip, C, Napolitano, L. Bundles to prevent ventilator-associated pneumonia: how valuable are they? Curr Opin Infect Dis 2009;22:159–166.Google Scholar
9. Klompas, M. The paradox of ventilator-associated pneumonia prevention measures. Crit Care 2009;13:315.Google Scholar
10. Bird, D, Zambuto, A, O’Donnell, C, et al. Adherence to ventilator-associated pneumonia bundle and incidence of ventilator-associated pneumonia in the surgical intensive care unit. Arch Surg 2010;145:465–470.Google Scholar
11. Crunden, E, Boyce, C, Woodman, H, Bray, B. An evaluation of the impact of the ventilator care bundle. Nurs Crit Care 2005;10:242–246.CrossRefGoogle ScholarPubMed
12. Zaydfudim, V, Dossett, LA, Starmer, JM, et al. Implementation of a real-time compliance dashboard to help reduce SICU ventilator-associated pneumonia with the ventilator bundle. Arch Surg 2009;144:656–662.Google Scholar
13. Sessler, CN, Gosnell, MS, Grap, MJ, et al. The Richmond Agitation-Sedation Scale: validity and reliability in adult intensive care unit patients. Am J Respir Crit Care Med 2002;166:1338–1344.Google Scholar
14. Ely, EW, Truman, B, Shintani, A, et al. Monitoring sedation status over time in ICU patients: reliability and validity of the Richmond Agitation-Sedation Scale (RASS). JAMA 2003;289:2983–2991.CrossRefGoogle ScholarPubMed
15. Linden, A. Conducting interrupted time series analysis for single and multiple group comparisons. Stata Journal 2015;15:480–500.Google Scholar
16. Al-Tawfiq, JA, Abed, MS. Decreasing ventilator-associated pneumonia in adult intensive care units using the Institute for Healthcare Improvement bundle. Am J Infect Control 2010;38:552–556.CrossRefGoogle ScholarPubMed
17. Blamoun, J, Alfakir, M, Rella, ME, et al. Efficacy of an expanded ventilator bundle for the reduction of ventilator-associated pneumonia in the medical intensive care unit. Am J Infect Control 2009;37:172–175.CrossRefGoogle ScholarPubMed
18. Bouadma, L, Deslandes, E, Lolom, I, et al. Long-term impact of a multifaceted prevention program on ventilator-associated pneumonia in a medical intensive care unit. Clin Infect Dis 2010;51:1115–1122.CrossRefGoogle Scholar
19. Klompas, M. Interobserver variability in ventilator-associated pneumonia surveillance. Am J Infect Control 2010;38:237–239.Google Scholar
20. Klompas, M. Eight initiatives that misleadingly lower ventilator-associated pneumonia rates. Am J Infect Control 2012;40:408–410.Google Scholar
21. Magill, SS, Klompas, M, Balk, R, et al. Developing a new, national approach to surveillance for ventilator-associated events: executive summary. Infect Control Hosp Epidemiol 2013;34:1239–1243.Google Scholar