Reduction of ventilator-associated pneumonia: active versus passive guideline implementation.

Abstract

Ventilator-associated pneumonia (VAP) is associated with increased morbidity, mortality and costs. We describe an active, multifaceted implementation of a VAP prevention bundle designed to improve staff compliance with evidence-based actions and reduce the incidence of VAP. A 'VAP prevention bundle' was designed then implemented, first passively, then actively, as defined by a multimodal programme incorporating staff education, process measurement and outcome measurement and feedback to staff and organisational change. Compliance with the VAP prevention bundle increased after active implementation. VAP incidence fell significantly from 19.2 to 7.5 per 1,000 ventilator days. Rate difference (99% CI) = 11.6 (2.3-21.0) per 1,000 ventilator days; rate ratio (99% CI) = 0.39 (0.16, 0.96). An active implementation programme increased staff compliance with evidence-based interventions and was associated with a significant reduction in VAP acquisition.