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Preventing Ventilator-Associated Pneumonia in the United States: A Multicenter Mixed-Methods Study

Published online by Cambridge University Press:  02 January 2015

Sarah L. Krein ,
Christine P. Kowalski ,
Laura Damschroder ,
Jane Forman ,
Samuel R. Kaufman  and
Sanjay Saint
Sarah L. Krein*
Affiliation:
Department of Veterans Affairs Ann Arbor Health Services Research and Development Center of Excellence, Department of Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
Christine P. Kowalski
Affiliation:
Department of Veterans Affairs Ann Arbor Health Services Research and Development Center of Excellence, Department of Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
Laura Damschroder
Affiliation:
Department of Veterans Affairs Ann Arbor Health Services Research and Development Center of Excellence, Department of Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
Jane Forman
Affiliation:
Department of Veterans Affairs Ann Arbor Health Services Research and Development Center of Excellence, Department of Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
Samuel R. Kaufman
Affiliation:
Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan Ann Arbor Department of Veterans Affairs–University of Michigan Patient Safety Enhancement Program, Ann Arbor, Michigan
Sanjay Saint
Affiliation:
Department of Veterans Affairs Ann Arbor Health Services Research and Development Center of Excellence, Department of Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan Ann Arbor Department of Veterans Affairs–University of Michigan Patient Safety Enhancement Program, Ann Arbor, Michigan
*
Veterans Affairs Ann Arbor Health Services Research and Development Center of Excellence, Veterans Affairs Ann Arbor Healthcare System, PO Box 130170, Ann Arbor, MI 48113 (skrein@umich.edu)
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Abstract

Objective.

To determine what practices are used by hospitals to prevent ventilator-associated pneumonia (VAP) and, through qualitative methods, to understand more fully why hospitals use certain practices and not others.

Design.

Mixed-methods, sequential explanatory study.

Methods.

We mailed a survey to the lead infection control professionals at 719 US hospitals (119 Department of Veterans Affairs [VA] hospitals and 600 non-VA hospitals), to determine what practices are used to prevent VAP. We then selected 14 hospitals for an in-depth qualitative investigation, to ascertain why certain infection control practices are used and others not, interviewing 86 staff members and visiting 6 hospitals.

Results.

The survey response rate was 72%; 83% of hospitals reported using semirecumbent positioning, and only 21% reported using subglottic secretion drainage. Multivariable analyses indicated collaborative initiatives were associated with the use of semirecumbent positioning but provided little guidance regarding the use of subglottic secretion drainage. Qualitative analysis, however, revealed 3 themes: (1) collaboratives strongly influence the use of semirecumbent positioning but have little effect on the use of subglottic secretion drainage; (2) nurses play a major role in the use of semirecumbent positioning, but they are only minimally involved with the use of subglottic secretion drainage; and (3) there is considerable debate about the evidence supporting subglottic secretion drainage, despite a meta-analysis of 5 randomized trials of subglottic secretion drainage that generally supported this preventive practice, compared with only 2 published randomized trials of semirecumbent positioning, one of which concluded that it was ineffective at preventing the development of VAP.

Conclusion.

Semirecumbent positioning is commonly used to prevent VAP, whereas subglottic secretion drainage is used far less often. We need to understand better how evidence related to prevention practices is identified, interpreted, and used to ensure that research findings are reliably translated into clinical practice.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 29 , Issue 10 , October 2008 , pp. 933 - 940
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2008

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