Education Reduces Ventilator-Associated Pneumonia Rates

To the Editor—Given our particular involvement in infection prevention in the intensive care unit, we read with great interest the article by Apisarnthanarak et al. [1] that reported a significant reduction in ventilator-associated pneumonia (VAP) rates after implementation of a focused education intervention. The data provided by Apisarnthanarak et al. [1] are important, because they may convince others to set up an educational program to prevent VAP. With this letter, we want to encourage clinicians to dare to question the level of knowledge about evidence-based recommendations in their units and to take into account potential barriers to changing habits. Getting your team to be informed and educated about recommended prevention strategies appears to be a cornerstone when it comes to fighting VAP. Recently, the level of knowledge about evidence-based guidelines for the prevention of VAP was assessed in a sample of 638 intensive care unit nurses by means of a reliable and validated multiple-choice questionnaire [2, 3]. Preventive strategies covered by the questionnaire included oral endotracheal intubation, frequency of ventilator circuit changes, heat and moisture exchanger, frequency of humidifier changes, closed suction system, frequency of change in suction system, drainage of subglottic secretions, kinetic beds, and semirecumbent positioning [3]. The respondents' mean score on the questionnaire was 41.2% correct [2], demonstrating a poor knowledge of evidence-based guidelines for VAP prevention. These disappointing results add a new perspective to understanding low rates of adherence to VAP guidelines, as reported elsewhere [4–6]. Obviously, knowledge of what is recommended is a primary condition for adherence. As a consequence, educational programs may play a pivotal role in improving guideline adherence and, subsequently, in reducing rates of VAP. A recent study by Sinuff et al. [7] has identified education tailored to the learning preferences of the target group as a strategy to overcome potential barriers to adherence. This finding stresses the importance of involving all members of the interprofessional team in the development and implementation of educational programs. Moreover, participants in the same study [7] suggested that their adherence to guidelines might be improved by a system of reminders and audit feedback. Indeed, reminders and regular feedback may help to ensure long-term beneficial effects. In addition, appreciation, acknowledgement, and—why not?—celebration of positive team results may be supportive for sustaining joint efforts to reduce infection rates and for creating a constructive team culture. Finally, educational programs were shown to be successful when integrated into quality programs that take a multifaceted and multiple-step approach [8]. Such programs may help to empower caregivers, heighten their awareness of individual responsibilities within the multidisciplinary team, and facilitate a reduction of complexity in implementation processes. Potential conflicts of interest.All authors: no conflicts.