Preventable proportion of intubation- associated pneumonia: Role of adherence to a care bundle

Objective The aim of the present study was to estimate the preventable proportion of Intubation-Asso- ciated Pneumonia (IAP) in the Intensive Care Units (ICUs) participating in the Italian Noso- comial Infections Surveillance in ICUs (SPIN-UTI) network, taking into account differences in intrinsic patients’ risk factors, and additionally considering the compliance with the Euro- pean bundle for IAP prevention. Methods A prospective patient-based survey was conducted and all patients staying in ICU for more than 2 days were enrolled in the surveillance. Compliance with the bundle was assessed using a questionnaire for each intubated patient. A twofold analysis by the parametric g-for- mula was used to compute the number of infections to be expected if the infection incidence in all ICUs could be reduced to that one of the top-tenth-percentile-ranked ICUs and to that one of the ICU with the highest compliance to all five bundle components. Results A total of 1,840 patients and of 17 ICUs were included in the first analysis showing a prevent- able proportion of 44% of IAP. In a second analysis on a subset of data, considering compli- ance with the European bundle, a preventable proportion of 40% of IAP was shown. A significant negative trend of IAP incidences was observed with increasing number of bundle components performed (p