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* From the Division of Infectious Diseases (Drs. Babcock and Fraser) and Pulmonary and Critical Care Division (Dr. Kollef), Washington University School of Medicine; and Departments of Hospital Epidemiology and Infection Control (Ms. Trovillion, Ms. Jones, Ms. Zack, and Ms. Garrison), BJC HealthCare, St. Louis, MO.
Correspondence to: Hilary M. Babcock, MD, Washington University School of Medicine, 660 South Euclid Ave, Campus Box 8051, St. Louis, MO 63110; e-mail: hbabcock{at}im.wustl.edu
Study objectives: To determine whether an educational initiative could decrease rates of ventilator-associated pneumonia in a regional health-care system.
Setting: Two teaching hospitals (one adult, one pediatric) and two community hospitals in an integrated health system.
Design: Preintervention and postintervention observational study.
Patients: Patients admitted to the four participating hospitals between January 1, 1999, and June 30, 2002, who acquired ventilator-associated pneumonia.
Intervention: An educational program for respiratory care practitioners and ICU nurses emphasizing correct practices for the prevention of ventilator-associated pneumonia. The program included a self-study module on risk factors for, and strategies to prevent, ventilator-associated pneumonia and education-based in-services. Fact sheets and posters reinforcing the information were posted throughout the ICU and respiratory care departments.
Measurements and results: Completion rates for the module were calculated by job title at each hospital. Rates of ventilator-associated pneumonia per 1,000 ventilator days were calculated for all hospitals combined and for each hospital separately. Overall 635 of 792 ICU nurses (80.1%) and 215 of 239 respiratory therapists (89.9%) completed the study module. There were 874 episodes of ventilator-associated pneumonia at the four hospitals during the 3.5-year study period out of 129,527 ventilator days. Ventilator-associated pneumonia rates for all four hospitals combined dropped by 46%, from 8.75/1,000 ventilator days in the year prior to the intervention to 4.74/1,000 ventilator days in the 18 months following the intervention (p < 0.001). Statistically significant decreased rates were observed at the pediatric hospital and at two of the three adult hospitals. No change in rates was seen at the community hospital with the lowest rate of study module completion among respiratory therapists (56%).
Conclusions: Educational interventions can be associated with decreased rates of ventilator-associated pneumonia in the ICU setting. The involvement of respiratory therapy staff in addition to ICU nurses is important for the success of educational programs aimed at the prevention of ventilator-associated pneumonia.
Key Words: education • infection • mechanical ventilation • pneumonia • prevention respiratory therapy
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