A Multifaceted Intervention to Reduce Ventilator-Associated Pneumonia in the ICU

描述（由申请人提供）：本申请题为“减少ICU呼吸机相关肺炎的多方面干预是对PAR-10-038_健康传播和实施研究（R 01）计划公告的回应”。预防医疗相关感染（HAI）已成为国家公共卫生优先事项。呼吸机相关性肺炎（VAP）是第二常见的，也是最致命的HAI。拟议的研究旨在减少VAP的公共卫生负担。 许多指南提供了预防VAP的建议。尽管有这些指南，许多患者没有接受这些建议的干预措施。我们的研究团队此前已经开发并应用了一种多方面的干预措施，其中包括将研究证据转化为实践的新型综合模型和全面的基于单元的安全计划（CUSP），以改善当地安全和团队合作文化。这种多方面的干预包括几个关键属性;将证据转化为行为特定的捆绑包，专注于护理系统，当地跨学科团队的参与，对技术工作的集中支持，干预的本地适应，以及创造安全文化。在密歇根州100多个ICU中，使用这种干预措施与VAP和第三常见HAI（中心线相关血流感染（CLABSI））的大幅和持续减少有关。我们的跨学科团队目前正在努力在美国所有50个州传播CUSP：CLABSI干预措施。 拟议研究的方法将是更新我们以前成功的多方面模型，以反映当前预防VAP的建议，修改该模型，使其具有可扩展性，评估实施对全州ICU队列临床结局的影响，并评估与成功实施和可持续性相关的背景因素。成功完成拟议的研究将减少VAP在一个大型ICU队列中的发病率，并产生一个可扩展的模型和新知识，可用于在全国范围内传播干预措施。 公共卫生相关性：预防医疗获得性感染，包括呼吸机相关性肺炎，已成为国家公共卫生的优先事项。成功完成拟议的研究将减少呼吸机相关性肺炎的发病率在一个大的和多样化的ICU队列。拟议的研究将产生一个可扩展的模型和新的知识，可用于在全国范围内传播干预措施。

DESCRIPTION (provided by applicant): This application, titled "A Multifaceted Intervention to Reduce Ventilator-Associated Pneumonia in the ICU is in response to PAR-10-038_ Dissemination and Implementation Research in Health (R01) program announcement". Prevention of healthcare-associated infections (HAIs) has become a national public health priority. Ventilator-associated pneumonia (VAP) is the second most common, and the most lethal HAI. The proposed research seeks to reduce the public health burden of VAP. Numerous guidelines provide recommendations for the prevention of VAP. Despite these guidelines, many patients do not receive these recommended interventions. Our research team has previously developed and applied a multifaceted intervention that includes a novel integrated model for translating research evidence into practice and a comprehensive unit-based safety program (CUSP) to improve local safety and teamwork culture. This multifaceted intervention includes several key attributes; converting evidence into behavior specific bundles, focusing on systems of care, engagement of local interdisciplinary teams, centralized support for technical work, local adaptation of the intervention, and creating a culture of safety. The use of this intervention has been associated with substantial and sustained reductions in VAP and the third most common HAI, central line associated blood stream infections (CLABSI) in a over 100 Michigan ICUs. Our interdisciplinary team is currently leading efforts to disseminate the CUSP:CLABSI intervention in all 50 U.S. states. The approach of the proposed research will be to update our previously successful multifaceted model to reflect current recommendations for the prevention of VAP, modify this model so that it is scalable, evaluate the impact of implementation on clinical outcomes in a statewide cohort of ICUs, and evaluate contextual factors associated with successful implementation and sustainability. Successful completion of the proposed research will reduce the incidence of VAP in a large cohort of ICUs and generate a scalable model and new knowledge about can be used to disseminate the intervention nationally. PUBLIC HEALTH RELEVANCE: Prevention of healthcare acquired infections, including ventilator-associated pneumonia has become a national public health priority. Successful completion of the proposed research will reduce the incidence of ventilator-associated pneumonia in a large and diverse cohort of ICUs. The proposed research will generate a scalable model and new knowledge that can be used to disseminate the intervention nationally.