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
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.
Available from: John Muscedere
- "For example, VAP is associated with an increased duration of mechanical ventilation, crude death rates of 5% to 65%    , and increased healthcare costs   . However, VAP is preventable and many practices have been demonstrated to reduce the incidence of VAP and its associated burden of illness  . 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 . "
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ABSTRACT: Ventilator-associated pneumonia (VAP) is an important cause of morbidity and mortality in ventilated critically ill patients.
To develop evidence-based guidelines for the prevention of VAP.
MEDLINE, EMBASE, CINAHL, and the Cochrane Database of Systematic Reviews and Register of Controlled Trials.
The authors systematically searched for all relevant randomized, controlled trials and systematic reviews on the topic of prevention of VAP in adults that were published from 1980 to October 1, 2006.
Independently and in duplicate, the panel scored the internal validity of each trial. Effect size, confidence intervals, and homogeneity of the results were scored using predefined definitions. Scores for the safety, feasibility, and economic issues were assigned based on consensus of the guideline panel.
The following statements were used: recommend, consider, do not recommend, and no recommendation due to insufficient or conflicting evidence.
To prevent VAP: We recommend: that the orotracheal route of intubation should be used for intubation; a new ventilator circuit for each patient; circuit changes if the circuit becomes soiled or damaged, but no scheduled changes; change of heat and moisture exchangers every 5 to 7 days or as clinically indicated; the use of a closed endotracheal suctioning system changed for each patient and as clinically indicated; subglottic secretion drainage in patients expected to be mechanically ventilated for more than 72 hours; head of bed elevation to 45 degrees (when impossible, as near to 45 degrees as possible should be considered). Consider: the use of rotating beds; oral antiseptic rinses. We do not recommend: use of bacterial filters; the use of iseganan We make no recommendations regarding: the use of a systematic search for sinusitis; type of airway humidification; timing of tracheostomy; prone positioning; aerosolized antibiotics; intranasal mupirocin; topical and/or intravenous antibiotics.
There are a growing number of evidence-based strategies for VAP prevention, which, if applied in practice, may reduce the incidence of this serious nosocomial infection.
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ABSTRACT: In the majority of countries costs for health care are increasing and strategies to reduce adverse events in medical treatment have an increasing importance. Nosocomial infection remains the most common type of complication affecting hospitalized patients. As preventive strategies have indeed become more important they now have to show not only that they are effective in reducing nosocomial infections but also that they are cost effective. This paper investigates the contribution made by articles published in the last year to the development of nosocomial-infection surveillance and control policies.
At least 15 randomized controlled studies and six meta-analyses investigating various infection-control policies were published last year. They did not lead to any changes in present guidelines, but rather endorsed existing recommendations. At least nine studies were found reporting a substantial reduction in nosocomial infections by the introduction of quality management principles under routine working conditions. Furthermore there were a lot of studies published which focused on optimizing surveillance measures and investigating the use of reference data for reducing infection rates. Only seven studies estimating the burden of disease were found in the literature of the past year.
The predominant opinion voiced in the studies was that in many medical institutions some 30% or more of nosocomial infections could be prevented.
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ABSTRACT: Economic evidence is needed to assess the burden of health care-associated infections (HAIs) and cost-effectiveness of interventions aimed at reducing related morbidity and mortality. The objective of this study was conducted to assess the quality of economic evaluations related to HAI and synthesize the evidence.
A systematic review of research published between January 2001 and June 2004 was conducted. Quality of the publication was estimated using a Likert-type scale. All cost estimates were standardized into a common currency. Descriptive statistics and a logistic regression were conducted to identify predictors of high quality.
70 studies were audited. There was wide variation in these cost estimates. Publications estimating the cost attributable to an infection were almost 7 times more likely judged to be of higher quality than studies of the cost of interventions (P < .05). Papers in which the authors stated the perspective (hospital or societal) were twice as likely to be judged as being of high quality (P < .05).
There are more publications and growing interest in estimating the costs of HAI. However, the methods employed vary. We recommend (1) the use of guidelines for authors and editors on conducting an economic analysis, (2) development of more sophisticated mathematical models, and (3) training of infection control professionals in economic methods.
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