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CRITICAL CARE

Impact of a Protocol for Prevention of Ventilator-Associated Pneumonia

Pharmacist, McGill University Health Center, Montreal, Québec, Canada

Jihane Eid, BPharm MSc

Pharmacist, McGill University Health Center

Marc M Perreault, PharmD BCPS

Critical Care Specialist and Clinical Associate Professor, Faculty of Pharmacy, Université de Montréal and McGill University Health Center

Hala Yazbeck, BPharm MSc

Critical Care Pharmacist, McGill University Health Center

Djamal Berbiche, PhD

Faculty of Pharmacy, Université de Montréal

Ashvini Gursahaney, MD FRCP(C)

ICU Director, Montreal General Site, McGill University Health Center

Yola Moride, PhD FISPE

Faculty of Pharmacy, Université de Montréal

Reprints: Mrs. Omrane, 3921 Joachim du Bellay, Laval, Québec, H7P 0A2, Canada, rajae.omrane{at}umontreal.ca

BACKGROUND: Several interventions have been shown to be effective in reducing the incidence of ventilator-associated pneumonia (VAP), but their implementation in clinical practice has not gained widespread acceptance.

OBJECTIVE: To determine the impact of a protocol that incorporates evidence-based interventions shown to reduce the frequency of VAP on the overall rate of VAP, early-onset VAP, and late-onset VAP in the intensive care unit (ICU) of a tertiary care adult teaching hospital.

METHODS: This pre- and postintervention observational study included mechanically ventilated patients admitted to the Montreal General Hospital ICU between November 2003 and May 2004 (preintervention) and between November 2004 and May 2005 (postintervention). A multidisciplinary prevention protocol was developed, implemented, and reinforced. Rates of VAP per 1000 ventilator-days were calculated pre- and postprotocol implementation for all patients, for patients with early-onset VAP, and for those with late-onset VAP.

RESULTS: In the pre- and postintervention groups, 349 and 360 patients, respectively, were mechanically ventilated. Twenty-three VAP episodes occurred in 925 ventilator-days (crude incidence rate 25 per 1000) in the preintervention period. Following implementation, the VAP rate decreased to 22 episodes in 988 ventilator-days (crude incidence rate 22.3 per 1000), corresponding to a relative reduction in rate of 10.8% (p < 0.001). The incidence of early-onset VAP decreased from 31.0 to 18.5 VAP per 1000 ventilator-days (p < 0.001), while the incidence of late-onset VAP increased from 21.9 to 24.1 VAP per 1000 ventilator-days (p < 0.001). However, when all covariates were adjusted, the impact of the prevention protocol was not statistically significant.

CONCLUSIONS: Implementation of a VAP prevention protocol incorporating evidence-based interventions reduced the crude incidence of VAP, early-onset VAP, and late-onset VAP. However, when covariates were adjusted, the beneficial effect was no longer observed. Further research is needed to assess the impact of such measures on VAP, early-onset VAP, and late-onset VAP.

Key Words: prevention, protocol, ventilator-associated pneumonia

Published Online, August 14, 2007. www.theannals.com, DOI 10.1345/aph.1H678

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