Background and importance Ventilator-associated pneumonia is related to hospital complications and economic costs.
Aim and objectives To describe the implementation in the intensive care unit (ICU) of a tertiary level hospital of a ‘Selective Decontamination of the Digestive Tract (SDD)’ protocol for preventing ventilator-associated pneumonia (VAP); to study the evolution of VAP incidence over two consecutive years, and to evaluate the economic cost of the protocol.
Material and methods The SDD protocol is a strategy included among the specific optional measures in the Pneumonia Zero Project (PZ) whose aim is to contribute to reducing the incidence of VAP in those critical care units where rates are above the recommended levels. Its application is intended to prevent and/or eradicate the oropharyngeal and gastrointestinal carrier state of potentially pathogenic microorganisms. It consists of applying an oropharyngeal paste in the oral cavity and a solution introduced through a nasogastric tube four times a day in patients on mechanical ventilation.
We prepared the paste and solution in the Pharmacy Service and incorporated their criteria for use as an ICU pharmacotherapeutic protocol for both intravenous antibiotic prophylaxis and SDD formulations in the electronic prescription programme. We applied the protocol to all the mechanically ventilated patients who met the selection criteria.
We compared VAP data between February and December 2019 with the same period in 2018.
Results In 2018, the VAP rate per 1000 days of mechanical ventilation was 12.34. After performing the SDD protocol in 2019, the rate of VAP per 1000 mechanical ventilation days decreased to 5.75. Between the two periods the overall incidence of pneumonia decreased from 5.8% to 2.7%.
We estimated a production cost in 2019 of €5.37 per SDD paste and €2.20 per SDD solution. We produced 610 units of SDD paste and 850 units of SDD solution in 2019 with a total estimated production cost of €5145.70.
Conclusion and relevance SDD applied with other recommended VAP control measures gave preliminary positive results in reducing the rate of VAP infections. We need to extend the study period to confirm these findings.
Conflict of interest No conflict of interest