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A program for sustained improvement in preventing ventilator associated pneumonia in an intensive care setting

Raquel A Caserta1*, Alexandre R Marra1, Marcelino S Durão1, Cláudia Vallone Silva2, Oscar Fernando Pavao dos Santos3, Henrique Sutton de Sousa Neves4, Michael B Edmond5 and Karina Tavares Timenetsky1

Author affiliations

1 Intensive Care Unit, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627/701 - 5º Andar – Bloco B, São Paulo, CEP 05651-901, Brazil

2 Infection Control Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil

3 Medical Practice Department, Hospital Israelita Albert Einstein, São Paulo, Brazil

4 Hospital Israelita Albert Einstein, São Paulo, Brazil

5 Department of Internal Medicine, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA

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Citation and License

BMC Infectious Diseases 2012, 12:234  doi:10.1186/1471-2334-12-234

Published: 29 September 2012



Ventilator-associated pneumonia (VAP) is a common infection in the intensive care unit (ICU) and associated with a high mortality.


A quasi-experimental study was conducted in a medical-surgical ICU. Multiple interventions to optimize VAP prevention were performed from October 2008 to December 2010. All of these processes, including the Institute for Healthcare Improvement’s (IHI) ventilator bundle plus oral decontamination with chlorhexidine and continuous aspiration of subglottic secretions (CASS), were adopted for patients undergoing mechanical ventilation.


We evaluated a total of 21,984 patient-days, and a total of 6,052 ventilator-days (ventilator utilization rate of 0.27). We found VAP rates of 1.3 and 2.0 per 1,000 ventilator days respectively in 2009 and 2010, achieving zero incidence of VAP several times during 12 months, whenever VAP bundle compliance was over 90%.


These results suggest that it is possible to reduce VAP rates to near zero and sustain these rates, but it requires a complex process involving multiple performance measures and interventions that must be permanently monitored.

Ventilator associated pneumonia; Prevention; Intensive care; VAP bundle