Impact of a Program of Intensive Surveillance and Interventions Targeting Ventilated Patients in the Reduction of Ventilator‐Associated Pneumonia and Its Cost‐Effectiveness •

Department of Medicine, Division of Infectious Diseases, University of Massachusetts Medical School, University of Massachusetts Medical Center, Worcester, MA 01655, USA.
Infection Control and Hospital Epidemiology (Impact Factor: 4.18). 12/2003; 24(11):859-63. DOI: 10.1086/502150
Source: PubMed


We hypothesized that a program of prospective intensive surveillance for ventilator-associated pneumonia (VAP) and concomitant implementations of multimodal, multidisciplinary preventive and intervention strategies would result in a reduction in the incidence of VAP and would be cost-effective.
Medical and surgical intensive care units (ICUs) in a university teaching hospital.
All ventilated patients in the medical and surgical ICUs were monitored for VAP from January 1997 through December 1998. Interventions including elevation of the head of the bed, use of sterile water and replacement of stopcocks with enteral valves for nasogastric feeding tubes, and prolongation of changing of in-line suction catheters from 24 hours to as needed were implemented.
The rates of VAP decreased by 10.8/1,000 ventilator-days in the medical ICU (CI95, 4.65-16.91) and by 17.2/1,000 ventilator-days in the surgical ICU (CI95, 2.85-31.56) when they were compared for 1997 and 1998. With the use of the estimated cost of a VAP of dollars 4,947 from the literature, the reduction resulted in cost savings of dollars 178,092 and dollars 148,410 in the medical and surgical ICUs, respectively, for a total of dollars 326,482. In addition, dollars 25,497 was saved due to the lengthening of the time for the change of in-line suction catheters, resulting in a cost savings of dollars 351,979. This total cost savings of dollars 351,979 minus the cost of enteral valves of dollars 2,100 resulted in total net savings of dollars 349,899.
Intensive surveillance and interventions targeted at ventilated patients resulted in reduction of VAP and appeared to be cost-effective.

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    • "For example, VAP is associated with an increased duration of mechanical ventilation, crude death rates of 5% to 65% [2] [3] [4] [5], and increased healthcare costs [6] [7] [8]. However, VAP is preventable and many practices have been demonstrated to reduce the incidence of VAP and its associated burden of illness [9] [10]. Because the body of literature on VAP is extensive and in some cases, conflicting, it has become increasingly difficult for critical care practitioners to assimilate and apply best evidence into clinical practice [11]. "
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