Prevention of Ventilator-Associated Pneumonia : The Multimodal Approach of the Spanish ICU "Pneumonia Zero" Program*
Álvarez Lerma, Francisco (Institut Hospital del Mar d'Investigacions Mèdiques)
Palomar Martínez, Mercedes (Institut Hospital del Mar d'Investigacions Mèdiques)
Sánchez-García, Miguel (Hospital Clínico San Carlos (Madrid))
Martínez-Alonso, Montserrat
Álvarez-Rodríguez, Joaquín (Service of Intensive Care Medicine, SEMICYUC Working Group on Safety, Quality and Management, Hospital de Fuenlabrada, Fuenlabrada, Madrid, Spain)
Lorente, Leonardo (Hospital Universitario de Canarias (La Laguna))
Arias-Rivera, Susana (Hospital Universitario de Getafe (Madrid))
Garcia, Rosa (Hospital de Basurto (Bilbao, Biscaia))
Gordo, Federico (Hospital Universitario del Henares ( Madrid))
Añón, José Manuel (Instituto de Investigación Sanitaria del Hospital Universitario La Paz)
Jam-Gatell, Rosa (Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí (I3PT))
Vázquez-Calatayud, Mónica (Clínica Universidad de Navarra)
Agra Varela, Yolanda (Patient Safety Unit, Spanish Ministry of Health, Social Policy and Equality, Madrid, Spain)
Universitat Autònoma de Barcelona

Data:	2018
Resum:	Supplemental Digital Content is available in the text. The "Pneumonia Zero" project is a nationwide multimodal intervention based on the simultaneous implementation of a comprehensive evidence-based bundle measures to prevent ventilator-associated pneumonia in critically ill patients admitted to the ICU. Prospective, interventional, and multicenter study. A total of 181 ICUs throughout Spain. All patients admitted for more than 24 hours to the participating ICUs between April 1, 2011, and December 31, 2012. Ten ventilator-associated pneumonia prevention measures were implemented (seven were mandatory and three highly recommended). The database of the National ICU-Acquired Infections Surveillance Study (Estudio Nacional de Vigilancia de Infecciones Nosocomiales [ENVIN]) was used for data collection. Ventilator-associated pneumonia rate was expressed as incidence density per 1,000 ventilator days. Ventilator-associated pneumonia rates from the incorporation of the ICUs to the project, every 3 months, were compared with data of the ENVIN registry (April-June 2010) as the baseline period. Ventilator-associated pneumonia rates were adjusted by characteristics of the hospital, including size, type (public or private), and teaching (postgraduate) or university-affiliated (undergraduate) status. The 181 participating ICUs accounted for 75% of all ICUs in Spain. In a total of 171,237 ICU admissions, an artificial airway was present on 505,802 days (50. 0% of days of stay in the ICU). A total of 3,474 ventilator-associated pneumonia episodes were diagnosed in 3,186 patients. The adjusted ventilator-associated pneumonia incidence density rate decreased from 9. 83 (95% CI, 8. 42-11. 48) per 1,000 ventilator days in the baseline period to 4. 34 (95% CI, 3. 22-5. 84) after 19-21 months of participation. Implementation of the bundle measures included in the "Pneumonia Zero" project resulted in a significant reduction of more than 50% of the incidence of ventilator-associated pneumonia in Spanish ICUs. This reduction was sustained 21 months after implementation.
Nota:	Altres ajuts: MSCBS/2012/07/CM016
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, i la comunicació pública de l'obra, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original. No es permet la creació d'obres derivades.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Guideline adherence ; Intensive care units ; Prevention & control ; Ventilator-associated pneumonia
Publicat a:	Critical Care Medicine, Vol. 46 (january 2018) , p. 181-188, ISSN 1530-0293

DOI: 10.1097/CCM.0000000000002736
PMID: 29023261

8 p, 202.9 KB

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