Prevention of ventilator-Associated pneumonia: The multimodal approach of the Spanish ICU "pneumonia zero" program

Francisco Álvarez-Lerma, Mercedes Palomar-Martínez, Miguel Sánchez-García, Montserrat Martínez-Alonso, Joaquín Álvarez-Rodríguez, Leonardo Lorente, Susana Arias-Rivera, Rosa García, Federico Gordo, José M. Añón, Rosa Jam-Gatell, Mónica Vázquez-Calatayud, Yolanda Agra

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Copyright © 2017 The Author(s). Objectives: The "Pneumonia Zero" project is a nationwide multimodal intervention based on the simultaneous implementation of a comprehensive evidence-based bundle measures to prevent ventilator-Associated pneumonia in critically ill patients admitted to the ICU. Design: Prospective, interventional, and multicenter study. Setting: A total of 181 ICUs throughout Spain. Patients: All patients admitted for more than 24 hours to the participating ICUs between April 1, 2011, and December 31, 2012. Intervention: Ten ventilator-Associated pneumonia prevention measures were implemented (seven were mandatory and three highly recommended). The database of the National ICU-Acquired Infections Surveillance Study (Estudio Nacional de Vigilancia de Infecciones Nosocomiales [ENVIN]) was used for data collection. Ventilator-Associated pneumonia rate was expressed as incidence density per 1,000 ventilator days. Ventilator-Associated pneumonia rates from the incorporation of the ICUs to the project, every 3 months, were compared with data of the ENVIN registry (April-June 2010) as the baseline period. Ventilator-Associated pneumonia rates were adjusted by characteristics of the hospital, including size, type (public or private), and teaching (postgraduate) or university-Affiliated (undergraduate) status. Measurements and Main Results: The 181 participating ICUs accounted for 75% of all ICUs in Spain. In a total of 171,237 ICU admissions, an artificial airway was present on 505,802 days (50.0% of days of stay in the ICU). A total of 3,474 ventilator-Associated pneumonia episodes were diagnosed in 3,186 patients. The adjusted ventilator-Associated pneumonia 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. Conclusions: Implementation of the bundle measures included in the "Pneumonia Zero" project resulted in a significant reduction of more than 50% of the incidence of ventilator-Associated pneumonia in Spanish ICUs. This reduction was sustained 21 months after implementation.
Original languageEnglish
Pages (from-to)181-188
JournalCritical Care Medicine
Issue number2
Publication statusPublished - 1 Feb 2018


  • Guideline Adherence
  • Intensive Care Units
  • Prevention & Control
  • Ventilator-Associated Pneumonia


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