A European survey of nosocomial infection control and hospital-acquired pneumonia prevention practices

Abstract

We aimed to examine organizational, structural and routine infection control measures provided by European ICUs and staff practices in ventilator-associated pneumonia prevention in relation with current recommendations. European ICU staffs were invited to complete a web-based 20 closed-item questionnaire. 675 nurses and 886 physicians from 13 countries answered the questionnaire. Median number of respondents per country was 118.0 (64.5-155.5). Availability and organizational aspects of infection control revealed wide variations between countries. Among them, single-patient rooms was the aspect with the lowest availability (median availability 38%), but the largest variation ranging from 15 to 84%. Self-reported median adherence rate to recommendations was 72% (34.5-83.0) with a strong correlation between nurses and physicians responses (r²=0.96; p<0.0001). Sub-glottic drainage (31%), and infrequent ventilatory-circuit change (24%) were the measures with the lowest adherence rate whereas preferential use of oral intubation (90%) and of NIV (84%) and use of HMEs (82%) were the three with the highest rate. Organization of infection control was consistently self-reported. Disparities among countries were more frequent for specific actions regarding airway management, and even moreso for controversial issues (subglottic drainage, closed-suction systems). This European survey shows a 72% overall adherence rate to VAP prevention measures; with strong agreements between physician and nurses but considerable differences among countries for availability and organization aspects of infection control, providing healthcare authorities with figures for future programs.