Improving the quality of the intensive care follow-up of ventilated patients during a national registration program

Care bundle; Educational intervention; Hospital-acquired infections; Procedural intervention; Ventilator-associated pneumonia (VAP); Article; Belgium; Pneumonia, Ventilator-Associated; Checklist; Critical Care; Cross Infection; Evidence-Based Practice; Feasibility Studies; Guideline Adherence; Humans; Intensive Care Units; Medical Staff, Hospital; Practice Guidelines as Topic; Program Evaluation; Quality Improvement; Registries; Respiration, Artificial; Retrospective Studies

Abstract :

[en] Objectives The Belgian Public Health Organization is concerned with rates of hospital-acquired infections like ventilator-associated pneumonia (VAP). Implementing best practice guidelines for these nosocomial infections has variable success in the literature. This retrospective study was undertaken to see whether implementation of the evidence-based practices as a bundle was feasible, would influence compliance, and could reduce the rates of VAP. Study design We utilized easily collectable data about regular care to rapidly assess whether interventions already in place were effectively successfully applied. This avoided cumbersome data collection and review. Methods Retrospective compliance rates and VAP ratios were compared using z tests with P-values < 0.05 considered statistically significant. This data review attempted to examine the impact of education campaigns, staff meetings, in-services, physician checklist, nurse checklist, charge nurse checklist implementation, systematic VAP bundle application, and systematic protocols for oral care and sedation protocols. Additionally, VAP ratio could be registered by the participating centers. Results A total of 10,211 intensive care unit (ICU) patients were included in the study which represents 66,817 ICU days under artificial ventilation with an endotracheal tube. The general compliance for VAP bundle raised from VAP was 61% in February 2012 and 74.16% in December 2012 (P < 0.001). The incidence rate of VAP went from 8.34 occurrences/1000 vent days in 2009 to 4.78 occurrences/1000 vent days in 2012 (P < 0.001—Pearson test). Conclusions Efforts to improve physician and staff education, and checklist implementation resulted in an increase in compliance for VAP bundle and a decrease in VAP ratio. This study confirms the applicability of best practice guidelines about regular care but results on VAP incidence have to be confirmed. © 2017 The Royal Society for Public Health

Disciplines :

Anesthesia & intensive care

Author, co-author :

Reper, P.; Ministry of Public Health, Belgium, Brugmann University Hospital, Université Libre de Bruxelles, Brussels, Belgium, Ministry of Public Health, College of Physicians for Intensive Care Medicine, Belgium

Dicker, D.; Ministry of Public Health, Belgium

Damas, Pierre ; Université de Liège - ULiège > Département des sciences cliniques > Anesthésie et réanimation

Huyghens, L.; Ministry of Public Health, College of Physicians for Intensive Care Medicine, Belgium, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium

Haelterman, M.; Ministry of Public Health, Belgium

Language :

English

Title :

Improving the quality of the intensive care follow-up of ventilated patients during a national registration program

Publication date :

2017

Journal title :

Public Health

ISSN :

0033-3506

eISSN :

1476-5616

Publisher :

Elsevier B.V.

Volume :

148

Pages :

159-166

Peer reviewed :

Peer Reviewed verified by ORBi

Available on ORBi :

since 16 January 2018

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