Rates of Pneumonia Dramatically Reduced in Patients on Ventilators in Michigan Intensive Care Units
Hospital staff in Michigan intensive care units (ICUs) cut by more than 70 percent the rate of pneumonia in patients who are on ventilators by using a targeted quality improvement initiative funded by the Agency for Healthcare Research and Quality (AHRQ). This reduction in the rate of ventilator-associated pneumonia was sustained for the duration of the study's follow-up, a period of up to two and a half years.
Ventilator-associated pneumonia is a lung infection that occurs in patients who are on ventilators to help them breathe and is a common cause of increased rates of patient illness and death, as well as increased health care costs. The study, published today in the journal Infection Control and Hospital Epidemiology, includes data from 112 ICUs in Michigan.
The quality improvement initiative, known as the Comprehensive Unit-based Safety Program (CUSP), includes tools to improve communication and teamwork among ICU staff teams and implement practices based on guidelines by the Centers for Disease Control and Prevention, such as checklists and hand washing, to reduce rates of catheter-related bloodstream infections and ventilator-associated pneumonia. The program also measures if ICUs reduce healthcare-associated infections (HAIs) and reports these results so they can improve care.
"We need to do more to ensure that when patients go to hospitals they get better, not sicker," said AHRQ Director Carolyn M. Clancy, M.D. "This research gives us a roadmap for targeting the problem and working systematically to prevent patients from developing infections in the health care system-and saving lives."
The researchers also noted a marked increase-from 32 percent to 84 percent-in the routine use of five evidence-based therapies to prevent the complications, including pneumonia, associated with ventilator use.
The CUSP approach was used and studied in the Keystone Intensive Care Unit Project, an AHRQ-funded initiative to reduce HAIs in Michigan ICUs. Previous research from the Keystone Project has shown that Michigan hospitals using CUSP-the targeted quality improvement program evaluated in this study-sharply reduced the number of blood stream infections from central lines and reduced the risk that patients will die in the ICU.
"These results are exciting and help to advance the field of quality improvement. We knew the CUSP approach reduced blood stream infections; however, we did not know if it could be applied to other types of preventable harm," said Peter J. Pronovost, M.D., Ph.D., a professor of anesthesiology and critical care medicine at The Johns Hopkins University School of Medicine. "This 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."
Dr. Pronovost led development of the AHRQ-sponsored Keystone Project and implemented it in Michigan hospitals in conjunction with the Michigan Health and Hospital Association.
"Far too many patients continue to suffer preventable harm from these respirator-linked pneumonias. This study documents one of the largest, most robust and longest sustained reductions in these infections," added lead author Sean M. Berenholtz, M.D., M.H.S., an associate professor of anesthesiology and critical care medicine at The Johns Hopkins University School of Medicine and Bloomberg School of Public Health.
AHRQ is supporting the nationwide implementation of the CUSP model for reducing HAIs through a contract to the Health Research & Educational Trust, an affiliate of the American Hospital Association, by reaching more hospitals and other settings in addition to ICUs and applying the approach to various HAIs. For more information on AHRQ's recently funded HAI projects, go to http://www.ahrq.gov/qual/haify10.htm. For more information on CUSP, go to http://www.ahrq.gov/qual/haicusp.htm.
The CUSP implementation initiative is part of a Department-wide effort to address HAIs, as outlined in the U.S. Department of Health and Human Services (HHS) Action Plan to Prevent Healthcare-Associated Infections (available at http://www.hhs.gov/ash/initiatives/hai/index.html). Partners across HHS, including AHRQ, CDC, the Centers for Medicare & Medicaid Services, Food and Drug Administration, Health Resources and Services Administration, Indian Health Service, and the National Institutes of Health, are working together to achieve the goals of the Action Plan.
Editor's Note: A study titled "Impact of a Statewide Intensive Care Unit Quality Improvement Initiative on Hospital Mortality and Length of Stay: Retrospective Comparative Analysis," published in the Feb. 1, 2011, issue of the British Medical Journal, details reductions in deaths in Michigan ICUs associated with the application of CUSP in the Keystone Project. Reductions in the rate of catheter-related bloodstream infections in Keystone were detailed in a Dec. 28, 2006, New England Journal of Medicine study by Pronovost and colleagues, titled "An Intervention to Decrease Catheter-Related Bloodstream Infections in the ICU."
For more information, please contact AHRQ Public Affairs: (301) 427-1864 or (301) 427-1855.