Journal of Critical Care
Volume 23, Issue 1 , Pages 118-125 , March 2008

Ventilator-associated pneumonia: Improving outcomes through guideline implementation

  • Tasnim Sinuff, MD, PhD

      Affiliations

    • Department of Critical Care, Sunnybrook Health Sciences Center and Interdepartmental Division of Critical Care, University of Toronto, Toronto, Ontario, Canada M4N 3M5
    • Corresponding Author InformationCorresponding author. Tel.: +1 416 480 6100x7694; fax: +1 416 480 4999.
  • ,
  • John Muscedere, MD

      Affiliations

    • Department of Medicine, Queen's University, Kingston, Ontario K7J 2V7
  • ,
  • Deborah Cook, MD, MSc

      Affiliations

    • Department of Medicine, McMaster University, Hamilton, Ontario L8N 3Z5
    • Department Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario L8N 3Z5
  • ,
  • Peter Dodek, MD, MHSc

      Affiliations

    • Department of Medicine and Center for Health Evaluation and Outcome Sciences, University of British Columbia, Vancouver, British Columbia, Canada V6Z 1Y6
  • ,
  • Daren Heyland, MD, MSc

      Affiliations

    • Department of Medicine, Queen's University, Kingston, Ontario K7J 2V7
  • ,
  • for the Canadian Critical Care Trials Group

References 

  1. Van Saene H, Peric M, De La Cal M, et al. Pneumonia during mechanical ventilation. Anest Intenziv Med. 2004;15:89–100
  2. Chastre J, Fagon J. Ventilator-associated pneumonia. Am J Resp Crit Care Med. 2002;65:867–903
  3. Muscedere J, Heyland D. The burden of illness from ventilator associated pneumonia in Canada. Proc Am Thorac Soc. 2006;A526
  4. Muscedere J, Heyland DK, Dodek P, et al. The prevention of ventilator associated pneumonia in Canadian critical care units. In: Presented at Toronto Critical Care Medicine Symposium, October. 2005;
  5. Davis D, Evans M, Jadad A, et al. The case for knowledge translation: shortening the journey from evidence to effect. BMJ. 2003;32(7405):33–35
  6. Schuster M, McGlynn E, Brook RH. How good is the quality of care in the United States?. Milbank Q. 1998;76:563
  7. Chassin MR, Galvin RW. The urgent need to improve health care quality. Institute of Medicine Round Table on Health Care Quality. JAMA. 1998;280:1000–1005
  8. Bero L, Grilli R, Grimshaw JM, et al. Closing the gap between research and practice: an overview of systematic reviews of interventions to promote the implementation of research findings. BMJ. 1998;317:464–468
  9. Grimshaw JM, Thomas RE, MacLennan G, et al. Effectiveness and efficiency of guideline dissemination and implementation strategies. Health Technol Assess 2004;8(6):iii-iv, 1-72.
  10. Grimshaw JM, Shirran L, Thomas R, et al. Changing provider behaviour: an overview of systematic reviews of interventions. Med Care. 2001;39(suppl 2):2–45
  11. Grimshaw J, Eccles M, Tetroe J. Implementing guidelines: current evidence and future implications. J Contin Educ Health Prof. 2004;24(Suppl1):S31–S37
  12. Davis D, Thomson O'Brien MA, Freemantle N, et al. Impact of formal continuing education: do conferences, workshops, rounds, and other traditional continuing education activities change physician behaviour or health care outcomes?. J Am Med Assoc. 1999;282:867–874
  13. Rogers EM. Lessons for guidelines from the diffusion of innovations Joint Commission. J Qual Improv. 1995;21:324–328
  14. Greer AG. The shape of resistance … the shapers of change. J Qual Improv. 1995;21:328–332
  15. Thomson O'Brien MA, Oxman AD, Davis DA, et al. Local opinion leaders: effects on professional practice and health care outcomes. Cochrane Library. 2002;(4):[Update software]
  16. Garg AX, Adhikari NK, McDonald H, et al. Effects of computerized clinical decision support systems on practitioner performance and patient outcomes: a systematic review. JAMA. 2005;293:1223–1238
  17. Hunt DL, Haynes RB, Hayward RSA, et al. Patient-specific evidence-based recommendations for diabetes mellitus: development and initial clinical experience with a computerized decision support system. Int J Med Inform. 1998;51:127–135
  18. Pilon CS, Leathley M, London R, et al. Practice guideline for arterial blood gas measurement in the intensive care unit decreases numbers and increases appropriateness of tests. Crit Care Med. 1997;25:1308–1313
  19. Pitimana-aree S, Forrest D, Brown G, et al. Implementation of a clinical practice guideline for stress ulcer prophylaxis increases appropriateness and decreases cost of care. Intensive Care Med. 1998;24:217–223
  20. Sinuff T, Cook DJ, Randall J, et al. Evaluation of a practice guideline for noninvasive positive pressure ventilation for acute respiratory failure. Chest. 2003;123:2062–2073
  21. McMullin JP, Cook DJ, Griffith LE, et al. Minimizing errors of omission: Behavioural rEinforcement of Heparin to Avert Venous Emboli (BEHAVE). Crit Care Med. 2006;34:694–699
  22. Wothius EK, Korevaar JC, Spronk P, et al. Feedback and education improve physician compliance in use of lung-protective mechanical ventilation. Intensive Care Med. 2005;31:540–546
  23. Martin CM, Doig GS, Heyland DK, et al. Multicenter, cluster-randomized clinical trial of algorithms for critical-care enteral and parenteral therapy (ACCEPT). CMAJ. 2004;170:197–204
  24. Burns SM, Earven S, Fisher C, et al. for the University of Virginia Long Term Mechanical Ventilation Team Implementation of an institutional program to improve clinical and financial outcomes of mechanically ventilation patients: one-year outcomes and lessons learned. Crit Care Med. 2003;31:2752–2763
  25. Cabana MD, Rand CS, Powe NR, et al. Why don't physicians follow clinical practice guidelines? A framework for improvement. JAMA. 1999;282:1458–1460
  26. Scott T, Mannion R, Marshall M, et al. Does organizational culture influence health care performance? A review of the evidence. J Health Serv Res Policy. 2003;8:105–117
  27. Hoff T, Jameson L, Hannan E, et al. A review of the literature examining linkages between organizational factors, medical errors, and patient safety. Med Care Res Rev. 2004;61:3–37
  28. Musson D, Helmreich R. Team training and resource management in health care: current issues and future directions. Harv Health Policy Rev. 2004;5:25–35
  29. Kutsogiannis DJ, Hague C, Triska OH, et al. The organizational structure of intensive care units and its influence on patient outcomes. Health Manage Forum. 2001;14:28–34
  30. Clemmer TP, Spuhler VJ, Oniki TA, et al. Results of a collaborative quality improvement program on outcomes and costs in a tertiary critical care unit. Crit Care Med. 1999;27:1768–1774
  31. Zimmerman J, Shortell S, Knaus W, et al. Value and cost of teaching hospitals: a prospective, multicenter, inception, cohort study. Crit Care Med. 1993;21:1432–1442
  32. Knaus WA, Draper EA, Wagner DP, et al. An evaluation of outcome from intensive care in major medical centers. Ann Intern Med. 1986;104:410–418
  33. Baggs JG, Schmitt MH, Mushlin AI, et al. Association between nurse-physician collaboration and patient outcomes in three intensive care units. Crit Care Med. 1999;27:1991–1998
  34. Wheelan S, Burchill C, Tilin F. The link between teamwork and patient outcomes in intensive care units. Am J Crit Care. 2003;12:527–534
  35. Shortell SM, Zimmerman JE, Rousseau DM, et al. The performance of intensive care units: does good management make a difference?. Med Care. 1994;32:508–525
  36. Sinuff T, Cook D. Guidelines in the intensive care unit. Clin Chest Med. 2003;24:739–749
  37. Cook DJ, Meade M, Hand L, et al. Toward understanding evidence uptake: semirecumbency for pneumonia prevention. Crit Care Med. 2002;30:1472–1477
  38. Sinuff T, Kahnamoui K, Cook DJ, et al. Practice guidelines as multipurpose tools: a qualitative study of non-invasive ventilation. Crit Care Med. 2007;35:776–782
  39. Sinuff T, Cook DJ, Giacomini M, et al. Facilitating guideline adherence in the intensive care unit: a multicentre study. Crit Care Med. 2007;34(Suppl):A142
  40. Heyland DK, Dhaliwal R, Drover JW, et al. and the Canadian Critical Care Clinical Practice Guidelines Committee Canadian clinical practice guidelines for nutrition support in mechanically ventilated, critically ill adult patients. J Parenter Enteral Nutr. 2003;27:355–373
  41. Heyland DK, Dhaliwal R, Day A, et al. Validation of the Canadian Practice Guidelines for nutrition support in mechanically ventilated, critically ill adult patients. Results of a prospective observational study. Crit Care Med. 2004;32:2260
  42. Jain MK, Heyland D, Dhaliwal R, et al. Dissemination of the Canadian Clinical Practice Guidelines for Nutrition Support: results of a cluster randomized controlled trial. Crit Care Med. 2006;34:2362–2369
  43. Baxter A, Allan J, Bedard J, et al. Adherence to simple and effective measure reduces the incidence of ventilator associated pneumonia. Can J Anaesthesia. 2005;52:535
  44. Bratebo G, Hofoss D, Flaatten H, et al. Education and debate. Quality improvement report: effect of a scoring system and protocol for sedation on duration of patients' need for ventilator support in a surgical intensive care unit. BMJ. 2002;324:1386–1389
  45. Merlani P, Garnerin P, Diby M, et al. Quality improvement report: linking guideline to regular feedback to increase appropriate requests for clinical tests: blood gas analysis in intensive care. BMJ. 2001;323:620–624
  46. Mascia MF, Koch M, Medicis JJ. Pharmacoeconomic impact of rational use guidelines on the provision of analgesia, sedation, and neuromuscular blockade in critical care. Crit Care Med. 2000;28:2300–2306
  47. Rello J, Lorente C, Bodi M, et al. Why do physicians not follow evidence based guidelines for preventing evidence based pneumonia. Chest. 2002;122:656
  48. Zack J, Garrison T, Trovillon E, et al. Effect of an education program aimed at reducing the occurrence of ventilator-associated pneumonia. Crit Care Med. 2002;30:2407–2412
  49. Kelleghan SI, Salemi C, Padilla S, et al. An effective continuous quality improvement approach to the prevention of ventilator-associated pneumonia. Am J Infect Control. 1993;21:322–330
  50. Salahuddin N, Zafarb A, Sukhyanic L, et al. Reducing ventilator-associated pneumonia rates through a staff education programme. J Hosp Infect. 2004;57:223–227
  51. Babcock H, Zack J, Garison T, et al. An educational intervention to reduce ventilator associated pneumonia in an integrated health system: a comparison of effects. Chest. 2004;125:2224–2231
  52. Abraham C, Sheeran P, Johnston M. From health beliefs to self-regulation: the theoretical advances in the psychology of action control. Psychol Health. 1999;13:569–593
  53. Parker K, Parikh S. Application of Prochaska's transtheoretical model to continuing medical education: from needs assessment to evaluation. Ann R Coll Phys Surg Can. 1999;32:97–99
  54. Kreuter M, Holt C. How do people process health information? Applications in an age of individualized communication. Curr Dir Psychol Sci. 2001;10(6):206–209
  55. Marriott S, Palmer C, Lelliott P. Disseminating healthcare information: getting the message across. Qual Health Care. 2000;9:58–62
  56. Weinstein ND, Rothman A, Sutton SR. Stage theories of health behaviour: conceptual and methodological issues. Health Psychol. 1998;17:290–299
  57. Pathman DE, Konrad TR, Freed GI, et al. The awareness-to-adherence model of the steps to clinical guideline compliance: the case of pediatric vaccine recommendations. Med Care. 1996;34:873–889
  58. http://www.ihi.org/IHI/Programs/Campaign/.
  59. http://www.saferhealthcarenow.ca/.

 Dr Sinuff is supported by a Canadian Institutes for Health Research Clinician Scientist Award. Dr Cook holds a Research Chair of the Canadian Institutes for Health Research.

PII: S0883-9441(08)00007-5

doi: 10.1016/j.jcrc.2007.11.013

Journal of Critical Care
Volume 23, Issue 1 , Pages 118-125 , March 2008