Prevention of Ventilator-Associated Pneumonia in the Calgary Health Region: A Canadian Success Story!

Esmail, Rosmin; Duchscherer, Greg; Giesbrecht, Jennifer; King, Joan E.; Ritchie, Pamela; Zuege, Dan

doi:10.12927/hcq.2008.19662

Cited by 7 publications

(10 citation statements)

References 14 publications

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“…Wall et al37 and Pronovost and colleagues19, 21, 22, 25 highlighted the strategic effectiveness of embedding a checklist as a behavioral and data collection tool into frontline care process, leading to a redefined role of nursing, as well as new data for further cycles of improvement that collectively reduced infection rates. In our study, the Virtual Collaborative group did not have greater use of CLABSI and VAP checklists until the QI teams had been formed months into the project, consistent with the hypothesis that beneficial translation of desired changes in process of care to observed improvements in patient outcomes may take longer than 18 months to achieve19, 25, 27, 38 as opposed to the remarkable 3 months reported in the Keystone ICU project 21…”

Section: Discussionsupporting

confidence: 80%

Quality improvement projects targeting health care–associated infections: Comparing virtual collaborative and toolkit approaches

Speroff

Ely

Greevy

et al. 2011

Journal of Hospital Medicine

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BACKGROUND: Collaborative and toolkit approaches have gained traction for improving quality in health care. OBJECTIVE: To determine if a quality improvement virtual collaborative intervention would perform better than a toolkit‐only approach at preventing central line–associated bloodstream infections (CLABSIs) and ventilator‐associated pneumonias (VAPs). DESIGN AND SETTING: Cluster randomized trial with the Intensive Care Units (ICUs) of 60 hospitals assigned to the Toolkit (n=29) or Virtual Collaborative (n=31) group from January 2006 through September 2007. MEASUREMENT: CLABSI and VAP rates. Follow‐up survey on improvement interventions, toolkit utilization, and strategies for implementing improvement. RESULTS: A total of 83% of the Collaborative ICUs implemented all CLABSI interventions compared to 64% of those in the Toolkit group (P = 0.13), implemented daily catheter reviews more often (P = 0.04), and began this intervention sooner (P < 0.01). Eighty‐six percent of the Collaborative group implemented the VAP bundle compared to 64% of the Toolkit group (P = 0.06). The CLABSI rate was 2.42 infections per 1000 catheter days at baseline and 2.73 at 18 months (P = 0.59). The VAP rate was 3.97 per 1000 ventilator days at baseline and 4.61 at 18 months (P = 0.50). Neither group improved outcomes over time; there was no differential performance between the 2 groups for either CLABSI rates (P = 0.71) or VAP rates (P = 0.80). CONCLUSION: The intensive collaborative approach outpaced the simpler toolkit approach in changing processes of care, but neither approach improved outcomes. Incorporating quality improvement methods, such as ICU checklists, into routine care processes is complex, highly context‐dependent, and may take longer than 18 months to achieve. © Society of Hospital Medicine Journal of Hospital Medicine 2011

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Section: Discussionsupporting

confidence: 80%

Quality improvement projects targeting health care–associated infections: Comparing virtual collaborative and toolkit approaches

Speroff

Ely

Greevy

et al. 2011

Journal of Hospital Medicine

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“…1 or 2 years. In three studies about ventilator bundle implementation [ 57 , 59 – 61 ], compliance rates of 100 % were reached. In these studies, the compliance was calculated monthly by using the AON approach.…”

Section: Resultsmentioning

confidence: 99%

What are effective strategies for the implementation of care bundles on ICUs: a systematic review

2015

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BackgroundCare bundles have proven to be effective in improving clinical outcomes. It is not known which strategies are the most effective to implement care bundles. A systematic review was conducted to determine the strategies used to implement care bundles in adult intensive care units and to assess the effects of these strategies when implementing bundles.MethodsThe databases MEDLINE/PubMed, Ovid/Embase, CINAHL and CENTRAL were searched for eligible studies until January 31, 2015. Studies with (non)randomised designs on central line, ventilator or sepsis bundles were included if implementation strategies and bundle compliance were reported. Methodological quality was assessed by using the Downs and Black checklist. Data extraction and quality assessments were independently performed by two reviewers.ResultsIn total, 1533 records were screened and 47 studies were finally included. In 49 %, pre/post designs were used, 38 % prospective cohorts, and the remaining studies used retrospective designs (6 %), interrupted time series (4 %) and longitudinal designs (2 %). The methodological quality was classified as ‘fair’ in 77 %, and the remaining as ‘good’ (13 %) and ‘poor’ (11 %). The most frequently used strategies were education (86 %), reminders (71 %) and audit and feedback (63 %). Our results show that compliance is influenced by multiple factors, i.e. types and numbers of elements varied and different compliance measurements were reported. Furthermore, compliance was calculated within different time frames. Also, detailed information about compliance, such as numerators and denominators, was not reported. Therefore, recalculation of consistent monthly compliance levels was not possible.ConclusionsThe three most frequently used strategies were education, reminders and audit and feedback. We conclude that the heterogeneity among the included studies was high due to the variety in study designs, number and types of elements and types of compliance measurements. Due to the heterogeneity of the data and the poor quality of the studies, conclusions about which strategy results in the highest levels of bundle compliance could not be determined. We strongly recommend that studies in quality improvement should be reported in a formalised way in order to be able to compare research findings. It is imperative that authors follow the standards for quality improvement reporting excellence (SQUIRE) guidelines whenever they report quality improvement studies.Electronic supplementary materialThe online version of this article (doi:10.1186/s13012-015-0306-1) contains supplementary material, which is available to authorized users.

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“…This large-scale project demonstrated significant reductions in VAP rates that were likely the result of translating evidence into practical behaviors and bundling them in a multifaceted quality improvement intervention that also included safety culture and communication improvements. 29,30 Studies of single hospitals 17,[31][32][33][34] and small multicenter studies 16,[35][36][37][38] have decreased VAP rates by increasing compliance with evidence-based recommendations. Our research builds on these studies by demonstrating that a larger cohort of ICUs can rapidly and significantly reduce VAP rates with a focused multifaceted intervention.…”

Section: Discussionmentioning

confidence: 99%

Collaborative Cohort Study of an Intervention to Reduce Ventilator-Associated Pneumonia in the Intensive Care Unit

Berenholtz

Pham

Thompson

et al. 2011

Infect. Control Hosp. Epidemiol.

191

154

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Prevention of Ventilator-Associated Pneumonia in the Calgary Health Region: A Canadian Success Story!

Cited by 7 publications

References 14 publications

Quality improvement projects targeting health care–associated infections: Comparing virtual collaborative and toolkit approaches

Quality improvement projects targeting health care–associated infections: Comparing virtual collaborative and toolkit approaches

What are effective strategies for the implementation of care bundles on ICUs: a systematic review

Collaborative Cohort Study of an Intervention to Reduce Ventilator-Associated Pneumonia in the Intensive Care Unit

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