Checklists and hand washing are again documented as strategies that have reduced ventilator-associated pneumonia, this time by 70% in a cohort of patients in 112 Michigan hospital intensive care units, according to a study sponsored by the federal Agency for Healthcare Research and Quality.
The study is published in the journal Infection Control and Hospital Epidemiology.
"These results are exciting and help to advance the field of quality improvement," said Peter Pronovost, MD, professor of anesthesiology and critical care medicine at Johns Hopkins University School of Medicine. "The study demonstrates that it is equally effective at reducing pneumonia. Broad implementation of this program may largely prevent the thousands of deaths from pneumonia each year."
The results are from a quality improvement initiative known as CUSP, or Comprehensive Unit-based Safety Program. It includes ways that help intensive care unit staff teams improve communication and teamwork. The program also helps these teams measure healthcare-associated infections and report these results.
The researchers also found an increase from 32% to 84% in the routine use of five evidence-based therapies to prevent complications such as ventilator-associated pneumonia.
The CUSP process involves these five steps:
1. Staff are educated on the science of safety training.
2. Staff use a written survey to help identify defects based on unit reports, liability claims, and sentinel events.
3. A senior hospital executive partners with the unit to improve communications and educate leadership.
4. Staff learn from unit defects.
5. Staff use tools to improve teamwork, communication, and other systems of work.
The report is another finding from the Michigan Keystone Project, which has previously revealed reductions in catheter-associated bloodstream infections from the use of checklists and hand washing.
Variations in CUSP projects funded by AHRQ are now implemented in 10 states and more than 100 hospitals nationally.
Interventions included semi-recumbent positioning, daily interruption of sedation infusions and prophylaxis for peptic ulcer disease and deep venous thrombosis.