Effectiveness of an Educational Program to Reduce Ventilator-Associated Pneumonia in a Tertiary Care Center in Thailand: A 4-Year Study

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). 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. 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. 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. (authors)