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Victor Zaydfudim, MD, MPH; Lesly A. Dossett, MD, MPH; John M. Starmer, MD; Patrick G. Arbogast, PhD; Irene D. Feurer, PhD; Wayne A. Ray, PhD; Addison K. May, MD; C. Wright Pinson, MBA, MD

Arch Surg. 2009;144(7):656-662.

Background  Ventilator-associated pneumonia (VAP) causes significant morbidity and mortality in critically ill surgical patients. Recent studies suggest that the success of preventive measures is dependent on compliance with ventilator bundle parameters.

Hypothesis  Implementation of an electronic dashboard will improve compliance with the bundle parameters and reduce rates of VAP in our surgical intensive care unit (SICU).

Design  Time series analysis of VAP rates between January 2005 and July 2008, with dashboard implementation in July 2007.

Setting  Multidisciplinary SICU at a tertiary-care referral center with a stable case mix during the study period.

Patients  Patients admitted to the SICU between January 2005 and July 2008.

Main Outcome Measures  Infection control data were used to establish rates of VAP and total ventilator days. For the time series analysis, VAP rates were calculated as quarterly VAP events per 1000 ventilator days. Ventilator bundle compliance was analyzed after dashboard implementation. Differences between expected and observed VAP rates based on time series analysis were used to estimate the effect of intervention.

Results  Average compliance with the ventilator bundle improved from 39% in August 2007 to 89% in July 2008 (P < .001). Rates of VAP decreased from a mean (SD) of 15.2 (7.0) to 9.3 (4.9) events per 1000 ventilator days after introduction of the dashboard (P = .01). Quarterly VAP rates were significantly reduced in the November 2007 through January 2008 and February through April 2008 periods (P < .05). For the August through October 2007 and May through July 2008 quarters, the observed rate reduction was not statistically significant.

Conclusions  Implementation of an electronic dashboard improved compliance with ventilator bundle measures and is associated with reduced rates of VAP in our SICU.

Author Affiliations: Departments of Surgery (Drs Zaydfudim, Dossett, Feurer, May, and Pinson), Biomedical Informatics (Dr Starmer), Biostatistics (Drs Arbogast and Feurer), and Preventive Medicine (Drs Arbogast and Ray), Vanderbilt University Medical Center, Nashville, Tennessee.

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