A team of researchers at Johns Hopkins and collaborators conducted research to determine if deadly hospital-acquired infections could be prevented. For some patients, mechanical ventilation is the only difference in life and death. In the United States there are nearly 800,000 hospital patients that undergo mechanical ventilation annually, related to a vast array of conditions and illnesses, such as stroke, pneumonia and brain injury.
While a ventilator is capable of providing the much-needed breathing assistance to patients, it can be risky and lead to serious complications called ventilator-associated events, such as lung damage, ventilator-associated pneumonia and blood clots. Ventilator-associated pneumonia is classified as one of the most deadly and common hospital-acquired infections in the intensive care unit.
The findings demonstrate that there are steps health care providers can take to reduce ventilator-associated events.
“When patients are sick, complications can happen and in some cases, health care-associated infections are thought to be inevitable,” says Sean Berenholtz, M.D., professor of anesthesiology. “This is the largest study to date to show that these conditions of mechanical ventilation or ventilator associated events are also preventable.”
A total of 56 intensive care units at 38 hospitals in Pennsylvania and Maryland agreed to take part in the study, which was conducted over a nearly three-year-period from October 2012 to March 2015. The research team set goals that would allow health care providers improve adherence with evidence-based practices, safety culture and unit teamwork. In many cases, patients do not receive the evidence-based therapies that they should.
The research team coached and trained quality improvement teams that included staff and providers at the designated sites, while focusing on the Society of Critical Care Medicine and Society for Healthcare Epidemiology of America intervention recommendations for patients on ventilators, including suctioning a patient’s mouth tube; elevating the head of the patient’s bed; performing spontaneous awakening and breathing trials by decreasing sedatives and narcotics; performing oral care with chlorehexidine mouthwash and tooth brushing; and screening the patient for improvement.
The researchers also trained the quality improvement teams to implement the Agency for Healthcare Research and Quality’s, or AHRQ, Comprehensive Unit-based Safety Program (CUSP) on their units. CUSP is a five-step intervention that gets the frontline healthcare staff involved in curbing harm.
Throughout the study period, the number of ventilator-associated events in participating intensive care units reduced from “7.34 cases per 1,000 patient ventilator days to 4.58 cases after 24 months” – a reduction of about 38 percent. The infection-related ventilator-associated complications also decreased more than 50 percent from 3.15 to 1.56 cases, while probable and possible ventilator-associated pneumonia cases decreased 78 percent from 1.41 to .31 cases per 1,000 patient ventilator days.
The study was published in the journal Critical Care Medicine on April 26, 2017.