Abstract
BackgroundOn average 7% of patients admitted to intensive-care units (ICUs) suffer from a potentially preventable ventilator-associated pneumonia (VAP). Our objective was to survey attitudes and practices of ICUs doctors in the field of VAP prevention.MethodsA questionnaire was made available online in 6 languages from April, 1st to September 1st, 2012 and disseminated through international and national ICU societies. We investigated reported practices as regards (1) established clinical guidelines for VAP prevention, and (2) measurement of process and outcomes, under the assumption “if you cannot measure it, you cannot improve it”; as well as attitudes towards the implementation of a measurement system. Weighted estimations for Europe were computed based on countries for which at least 10 completed replies were available, using total country population as a weight. Data from other countries were pooled together. Detailed country-specific results are presented in an online additional file.ResultsA total of 1730 replies were received from 77 countries; 1281 from 16 countries were used to compute weighted European estimates, as follows: care for intubated patients, combined with a measure of compliance to this guideline at least once a year, was reported by 57% of the respondents (95% CI: 54–60) for hand hygiene, 28% (95% CI: 24–33) for systematic daily interruption of sedation and weaning protocol, and 27% (95%: 23–30) for oral care with chlorhexidine. Only 20% (95% CI: 17–22) were able to provide an estimation of outcome data (VAP rate) in their ICU, still 93% (95% CI: 91–94) agreed that “Monitoring of VAP-related measures stimulates quality improvement”. Results for 449 respondents from 61 countries not included in the European estimates are broadly comparable.ConclusionsThis study shows a low compliance with VAP prevention practices, as reported by ICU doctors in Europe and elsewhere, and identifies priorities for improvement.
Highlights
Ventilator-associated pneumonia (VAP) is a frequent and severe health-care associated infection
In Europe, pneumonia occur in 7.0% of patients staying at least 2 days in intensive care units (ICUs); 91% of these pneumonia are ventilator-associated pneumonia (VAP) [1]
Questionnaire We developed a questionnaire with 3 parts: 1) Characteristics of the respondent and her/his intensive-care units (ICUs), 2) VAP prevention practices
Summary
Ventilator-associated pneumonia (VAP) is a frequent and severe health-care associated infection. The top 5 clinical interventions (we did not consider “trained staff” as a clinical intervention) were: 1) no ventilatory circuit change unless indicated; 2) strict hand hygiene with alcohol especially before managing the airways; 3) daily sedation vacation and weaning protocol; 4) oral care with chlorhexidine; and 5) cuff pressure control at least every 24 hrs. It was beyond the scope of our study to assess the evidence behind each of these interventions, but none appears to be controversial. Detailed country-specific results are presented in an online additional file
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