Impact of four sequential measures on the prevention of ventilator-associated pneumonia in cardiac surgery patients

INTRODUCTION Ventilator-associated pneumonia (VAP) is the most frequent infection in patients admitted to intensive care units. METHODS We compared rates of VAP, days on mechanical ventilation (MV), and cost of antimicrobial agents before and during implementation. RESULTS We collected data from 401 patients before the intervention and from 1,534 patients during the intervention. Both groups were comparable. No significant differences in EuroSCORE were observed between the patients of both periods (6.4 versus 6.3; P = 0.7). The rates of VAP (episodes/1,000 days of ventilation) were, respectively, 23.9 versus 13.5 (P = 0.005). Mean number of days of MV/1,000 days of stay was 507 versus 375 (P = 0.001), and the cost of antimicrobial therapy (Euros/1,000 days of stay) was €70,612 versus €52,775 (P = 0.10). The main effect of sequential application of preventive measures in time achieved a relative-rate reduction of VAP of 41% (IRR, 0.41; 95% CI, 0.28 to 0.62). The mortality rate before and during the intervention was 13.0% and 10.2%, respectively. CONCLUSIONS A sequentially applied bundle of four preventive measures reduces VAP rates, days of MV, and the cost of antimicrobial therapy in patients admitted to the major heart surgery ICU. TRIAL REGISTRATION Clinical Trials.gov: NCT02060045. Registered 4 February 2014.