Prevention of Ventilator-Associated Pneumonia: The Multimodal Approach of the Spanish ICU “Pneumonia Zero” Program

Álvarez-Lerma F, Palomar-Martínez M, Sánchez-García M, et al. Crit Care Med 2018;46:181-8. [CrossRef] [PubMed]

The Spanish “Pneumonia Zero” project is a prospective, interventional, multimodal intervention to prevent ventilator-associated pneumonia (VAP). Ten VAP prevention measures were implemented in 181 ICUs throughout Spain. In a total of 171,237 ICU admissions a total of 3,474 VAP episodes were diagnosed in 3,186 patients. The adjusted VAP incidence density rate decreased from 9.83 (95% CI, 8.42–11.48) per 1,000 ventilator days in the baseline period to 4.34 (95% CI, 3.22–5.84) after 19–21 months of participation. Outcomes data (contained in the on-line supplement http://links.lww.com/CCM/C886ICU) reported that mortality did not change (38.5% baseline vs. 40.9% intervention, p=0.0320). The ICU length of stay increased after the intervention (27.9 + 20.7 vs. 32.5 + 24.5 days, p<0.001). The reduction in VAP was sustained 21 months after implementation.