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

描述(由申请人提供)：这份名为“减少重症监护室呼吸机相关肺炎的多方面干预措施是对PAR-10-038_传播和实施健康研究(R01)计划公告的响应”的申请。预防医疗保健相关感染(HAIs)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。这项拟议的研究旨在减轻VAP的公共卫生负担。许多指南为预防VAP提供了建议。尽管有这些指南，许多患者并没有接受这些推荐的干预措施。我们的研究团队此前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集成模型，以及旨在改善当地安全和团队文化的全面单位安全计划(CUSP)。这种多方面的干预措施包括几个关键属性：将证据转化为针对行为的捆绑，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，干预措施的当地适应，以及创造安全文化。在100多个密歇根州的ICU中，这种干预措施的使用与VAP和第三种最常见的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领导在美国所有50个州传播CUSP：CLABSI干预措施的努力。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队列的临床结果的影响，并评估与成功实施和可持续性相关的背景因素。拟议研究的成功完成将减少大量ICU中VAP的发生率，并产生一个可扩展的模型和关于VAP的新知识，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.