Reduction of ventilator-associated pneumonia: active versus passive guideline implementation

Intensive Care Med. 2009 Jul;35(7):1180-6. doi: 10.1007/s00134-009-1461-0. Epub 2009 Mar 24.


Purpose: Ventilator-associated pneumonia (VAP) is associated with increased morbidity, mortality and costs. We describe an active, multifaceted implementation of a VAP prevention bundle designed to improve staff compliance with evidence-based actions and reduce the incidence of VAP.

Method: A 'VAP prevention bundle' was designed then implemented, first passively, then actively, as defined by a multimodal programme incorporating staff education, process measurement and outcome measurement and feedback to staff and organisational change.

Results: Compliance with the VAP prevention bundle increased after active implementation. VAP incidence fell significantly from 19.2 to 7.5 per 1,000 ventilator days. Rate difference (99% CI) = 11.6 (2.3-21.0) per 1,000 ventilator days; rate ratio (99% CI) = 0.39 (0.16, 0.96).

Conclusions: An active implementation programme increased staff compliance with evidence-based interventions and was associated with a significant reduction in VAP acquisition.

MeSH terms

  • Clinical Protocols
  • Evidence-Based Medicine
  • Female
  • Guideline Adherence*
  • Humans
  • Intensive Care Units
  • Length of Stay
  • Male
  • Pneumonia, Ventilator-Associated / epidemiology
  • Pneumonia, Ventilator-Associated / prevention & control*
  • Severity of Illness Index
  • United Kingdom / epidemiology