Stepwise implementation of prevention strategies and their impact on ventilator-associated pneumonia incidence: A 13-Year observational surveillance study

Objective: To describe the practice of ventilator-associated pneumonia (VAP) prevention and control through the incremental introduction of prevention strategies and assess the effect on VAP incidence. Design: Historical observational surveillance study conducted over 13 years. Setting: A 12-bed adult intensive care unit (ICU) in a general hospital in Belgium. Participants: Patients admitted between 2007 and 2019, with ICU stays of >= 48 h. Interventions: Incremental introduction of VAP preventive measures from 2008, including head-of-bed elevation, cuff pressure control, endotracheal tubes with tapered cuffs, subglottic secretion drainage, chlorhexidine oral care, and daily sedation assessment. Measurements and main results: A significant decline in VAP incidence density rates was observed, from 18.3 to 2.6 cases per 1000 ventilator days from the baseline to the final period. Conclusions: Systematic implementation of VAP preventive measures significantly reduced VAP incidence. However, this reduction did not translate into decreased overall ICU mortality. Implications for Practice: The study underscores the importance of continuous VAP surveillance and preventive measures in reducing VAP incidence.