Sustained effect of a multifaceted VAP prevention program over more than seven years including the COVID-19 pandemic

We report the long-term impact of a multifaceted intervention bundle containing nine measures to reduce the incidence of ventilator-associated pneumonia (VAP) in mechanically ventilated patients admitted to the intensive care division at Geneva University Hospitals over a prolonged follow-up period of more than seven years, including the COVID-19 pandemic. The original study included a follow-up of 11 months and showed a marked decrease in VAP incidence. We compared the five pre-defined time periods (pre-intervention, intervention, post-intervention, prolonged follow-up, and COVID-19 pandemic period) using a Poisson model. The incidence of VAP per 1000 ventilator days reduced from 24.3 (95% confidence interval [CI] 18.8-30.9) in the pre-intervention period to 3.9 (95%CI 2.0-6.8) in the post-intervention period. During the prolonged follow-up and the COVID-19 pandemic periods, VAP incidence per 1000 ventilator-days remained similar as in the initial post-intervention period with 4.0 (95%CI 2.9-5.4) and 3.7 (95%CI 2.8-4.7), respectively. Adherence to the bundle measures was assessed using the monthly percentage of correct observations and shown overall for each of the five time periods. Adherence to all but two bundle measures (oral care and hand hygiene) remained high or even improved during the prolonged follow-up period. In conclusion, after implementing a VAP prevention bundle in 2014, there was a sustained effect on VAP incidence during a 7-year follow-up, including the COVID-19 pandemic period.