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Collaborative Cohort Study of an Intervention to Reduce Ventilator-Associated Pneumonia in the Intensive Care Unit

Published online by Cambridge University Press:  02 January 2015

Sean M. Berenholtz*
Johns Hopkins University School of Medicine, Baltimore, Maryland Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
Julius C. Pham
Johns Hopkins University School of Medicine, Baltimore, Maryland
David A. Thompson
Johns Hopkins University School of Medicine, Baltimore, Maryland
Dale M. Needham
Johns Hopkins University School of Medicine, Baltimore, Maryland
Lisa H. Lubomski
Johns Hopkins University School of Medicine, Baltimore, Maryland
Robert C. Hyzy
University of Michigan, Ann Arbor, Michigan
Robert Welsh
William Beaumont Hospital, Royal Oak, Michigan
Sara E. Cosgrove
Johns Hopkins University School of Medicine, Baltimore, Maryland
J. Bryan Sexton
Johns Hopkins University School of Medicine, Baltimore, Maryland
Elizabeth Colantuoni
Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
Sam R. Watson
Michigan Health and Hospital Association Keystone Center, Lansing, Michigan
Christine A. Goeschel
Johns Hopkins University School of Medicine, Baltimore, Maryland Johns Hopkins University School of Nursing, Baltimore, Maryland Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
Peter J. Pronovost
Johns Hopkins University School of Medicine, Baltimore, Maryland Johns Hopkins University School of Nursing, Baltimore, Maryland Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
Johns Hopkins University, Quality and Safety Research Group, 1909 Thames Street, Second floor, Baltimore, MD 21231 (



To evaluate the impact of a multifaceted intervention on compliance with evidence-based therapies and ventilator-associated pneumonia (VAP) rates.


Collaborative cohort before-after study.


Intensive care units (ICUs) predominantly in Michigan.


We implemented a multifaceted intervention to improve compliance with 5 evidence-based recommendations for mechanically ventilated patients and to prevent VAP. A standardized CDC definition of VAP was used and maintained at each site, and data on the number of VAPs and ventilator-days were obtained from the hospital's infection preventionists. Baseline data were reported and postimplementation data were reported for 30 months. VAP rates (in cases per 1,000 ventilator-days) were calculated as the proportion of ventilator-days per quarter in which patients received all 5 therapies in the ventilator care bundle. Two interventions to improve safety culture and communication were implemented first.


One hundred twelve ICUs reporting 3,228 ICU-months and 550,800 ventilator-days were included. The overall median VAP rate decreased from 5.5 cases (mean, 6.9 cases) per 1,000 ventilator-days at baseline to 0 cases (mean, 3.4 cases) at 16–18 months after implementation (P < .001) and 0 cases (mean, 2.4 cases) at 28-30 months after implementation (P < .001). Compared to baseline, VAP rates decreased during all observation periods, with incidence rate ratios of 0.51 (95% confidence interval, 0.41–0.64) at 16–18 months after implementation and 0.29 (95% confidence interval, 0.24–0.34) at 28–30 months after implementation. Compliance with evidence-based therapies increased from 32% at baseline to 75% at 16–18 months after implementation (P < .001) and 84% at 28–30 months after implementation (P < .001).


A multifaceted intervention was associated with an increased use of evidence-based therapies and a substantial (up to 71%) and sustained (up to 2.5 years) decrease in VAP rates.

Original Article
Copyright © The Society for Healthcare Epidemiology of America 2011

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Duke University School of Medicine, Department of Psychiatry, Raleigh, North Carolina


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