Effectiveness of an educational program to reduce ventilator-associated pneumonia in a tertiary care center in Thailand: A 4-year study

Apisarnthanarak, Anucha; Pinitchai, Uayporn; Thongphubeth, Kanokporn; Yuekyen, Chanart; Warren, David K.; Zack, Jeanne E.; Warachan, Boonyasit; Fraser, Victoria J.

doi:10.1086/520987

Effectiveness of an educational program to reduce ventilator-associated pneumonia in a tertiary care center in Thailand: A 4-year study

Author(s)

Apisarnthanarak, Anucha

Pinitchai, Uayporn

Thongphubeth, Kanokporn

Yuekyen, Chanart

Warren, David K.

Zack, Jeanne E.

Warachan, Boonyasit

Fraser, Victoria J.

Date Issued

September 15, 2007

Type

Article

DOI

10.1086/520987

Abstract

Background. Ventilator-associated pneumonia (VAP) is considered to be an important cause of infection-related death and morbidity in intensive care units (ICUs). We sought to determine the long-term effect of an educational program to prevent VAP in a medical ICU (MICU). Methods. A 4-year controlled, prospective, quasi-experimental study was conducted in an MICU, surgical ICU (SICU), and coronary care unit (CCU) for 1 year before the intervention (period 1), 1 year after the intervention (period 2), and 2 follow-up years (period 3). The SICU and CCU served as control ICUs. The educational program involved respiratory therapists and nurses and included a self-study module with preintervention and postintervention assessments, lectures, fact sheets, and posters. Results. Before the intervention, there were 45 episodes of VAP (20.6 cases per 1000 ventilator-days) in the MICU, 11 (5.4 cases per 1000 ventilator-days) in the SICU, and 9 (4.4 cases per 1000 ventilator-days) in the CCU. After the intervention, the rate of VAP in the MICU decreased by 59% (to 8.5 cases per 1000 ventilator-days; P = .001) and remained stable in the SICU (5.6 cases per 1000 ventilator-days; P = .22) and CCU (4.8 cases per 1000 ventilator-days; P = .48). The rate of VAP in the MICU continued to decrease in period 3 (to 4.2 cases per 1000 ventilator-days; P = .07), and rates in the SICU and CCU remained unchanged. Compared with period 1, the mean duration of hospital stay in the MICU was reduced by 8.5 days in period 2 (P < .001) and by 8.9 days in period 3 (P < .001). The monthly hospital antibiotic costs of VAP treatment and the hospitalization cost for each patient in the MICU in periods 2 and 3 were also reduced by 45%-50% (P < .001) and 37%-45% (P < .001), respectively. Conclusions. A focused education intervention resulted in sustained reductions in the incidence of VAP, duration of hospital stay, cost of antibiotic therapy, and cost of hospitalization. © 2007 by the Infectious Diseases Society of America. All rights reserved.

Citation

Clinical Infectious Diseases, 45(6), 704-711, 2007