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

  • Sean M. Berenholtz (a1) (a2), Julius C. Pham (a1), David A. Thompson (a1), Dale M. Needham (a1), Lisa H. Lubomski (a1), Robert C. Hyzy (a3), Robert Welsh (a4), Sara E. Cosgrove (a1), J. Bryan Sexton (a1), Elizabeth Colantuoni (a2), Sam R. Watson (a5), Christine A. Goeschel (a1) (a6) (a2) and Peter J. Pronovost (a1) (a6) (a2)...

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.

Corresponding author
Johns Hopkins University, Quality and Safety Research Group, 1909 Thames Street, Second floor, Baltimore, MD 21231 (
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Duke University School of Medicine, Department of Psychiatry, Raleigh, North Carolina

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Infection Control & Hospital Epidemiology
  • ISSN: 0899-823X
  • EISSN: 1559-6834
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