AN EFFECTIVE CONTINUOUS QUALITY IMPROVEMENT APPROACH TO THE PREVENTION OF VENTILATOR-ASSOCIATED PNEUMONIA

In 1989, our medical center used continuous quality improvement concep ts in the creation of a Nosocomial Pneumonia Prevention Team whose aim was to significantly reduce nosocomial ventilator-associated pneumoni a. The team included representatives from nursing, respiratory therapy , pulmonary medicine, internal medicine, anesthesiology, education and training, and infection control. Because the majority of mechanically ventilated patients were located in the intensive care unit, this uni t became the focus of the prevention efforts. Team meetings were held regularly, with all representatives brainstorming barriers, possible i nterventions, methods of outcome measurement, and frequency of evaluat ion. Policies and procedures were reviewed, surveillance was increased , handwashing practices were surveyed, periodic feedback to staff was begun, and an educational program was developed and presented. During 1990, we observed a 57% reduction in ventilator-associated pneumonia f rom the baseline years, 1987 and 1988. Statistical comparison of propo rtions by z test indicated a p value less than 0.05. Fifteen cases of nosocomial ventilator-associated pneumonia were prevented and a cost s aving of $105,000 was realized. Performance of traditional surveillanc e for outliers, coupled with literature-based thresholds, can lead to tolerance of inordinately high endemic rates. Infection control progra ms can significantly reduce endemic rates of nosocomial ventilator-ass ociated pneumonia through continuous quality improvement methods and m ultidisciplinary interventions, with standard infection control proced ures used for improvement.