Hospital-acquired Pneumonia in Intensive Care Unit

Study Overview
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Brief Summary
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hospital-acquired pneumonia are a common disease in intensive care unit. The prevention, the diagnosis and the treatment of hospital acquired pneumonia are a frequent challenge. Nevertheless it seems that there are great differences in standard of care between hospitals. The investigators hypothesized that medical education and implementation of evidence-base guidelines can reduce the duration of mechanical ventilation in patients presenting of hospital acquired pneumonia

Detailed Description
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The before period (phase 1) will consist of all consecutive patients admitted to the participating ICUs before the national guidelines publication concerning healthcare associated pneumonia. The second period (phase 2) will consist of all consecutive patients admitted to the participating ICUs after the publication of the national guidelines publication concerning healthcare associated pneumonia. Afterward, an interphase will occur during which all physicians, residents, physiotherapists and nurses will receive a formal training for the processes and procedures related to the new guidelines published in september 2017. In the intervention group, on top of the standard training, the centers receive an analysis of the evolution of the practices of their center and the future of their patients between phases 1 and 2, as well as these same values for the data set. The centers are then called to conduct a meeting to determine their priority improvement points based on this audit. The third and final period (phase 3) will consist of all consecutive patients admitted to the participating ICUs after the formal training.

Official Title
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Hospital Acquired and Ventilator Associated Pneumonia : Impact of the New French Guidelines on Patients Care and Outcomes.

Conditions
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Hospital Acquired Pneumonia, Ventilator-Associated Pneumonia, Sepsis, Pneumonia

Intervention / Treatment
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* Other: Guidelines publication and application
* Other: Targeted experience feedback


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age > 18 years ; IGS-II score > 15 ; Hospital stay >= 3 days Exclusion Criteria: Community-acquired pneumonia, pregnant women, refusal to participate

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| The before period<br>The before period (control phase) will consist of all consecutive patients admitted to the participating ICUs before the national guidelines publication concerning hospital-acquired pneumonia. | Other: Guidelines publication and application<br>* Passing recommendations on using the guidelines in the intensive care units<br>|
| The second period<br>Intensive care units are randomized in two groups: Standard training: The centers will receive the text of the recommendation electronically. The principal investigator of each center will then train doctors, interns, nurses and physiotherapists to the use of these recommendations (team leader). A computer presentation common to all the centers will be used and a communication strategy vis-à-vis the other caregivers of the investigative services will be put in place. All doctors, interns and nurses must have attended this theoretical training during the awareness phase. | Other: Guidelines publication and application<br>* Passing recommendations on using the guidelines in the intensive care units<br>Other: Targeted experience feedback<br>* Targeted experience feedback: On top of the standard training, the centers receive an analysis of the evolution of the practices of their center and the future of their patients between phases 1 and 2, as well as these same values for the data set. The centers are then called to conduct a meeting to determine their priority improvement points based on this audi<br>|
| The third and final period<br>The third and final period will consist of all consecutive patients admitted to the participating ICUs after the formal training. | Other: Guidelines publication and application<br>* Passing recommendations on using the guidelines in the intensive care units<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Unit length of stay | Duration of ICU hospitalization Safety Issue: NA | 28 days | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Intensive Care Unit free-days at day 28 | The number of days from day 1 to day 28 on which a patient is alive outside of intensive care unit Safety Issue | 28 days | 
| Hospital-acquired pneumonia | definition based on the appearance of a new infiltrate or changes in an existing infiltrate on chest X-ray associated with any two of the following clinical signs: body temperature >38°C, leucocytosis >12,000/ml or leukopenia <4000/ml, and purulent pulmonary secretions that were associated with a positive quantitative or semi-quantitative bacteriological culture of a respiratory tract sample. | 28 days | 
| Composite measure of compliance to guidelines | defined as the total number of performed eligible measures divided by the total number of measures for which each patient was eligible | 28 days | 
| Empirical treatment failure | Defined as one or more pathogen involved in the pneumonia is not susceptible to the antibiotics used empirically | 28 days | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Intensive care unit, Pneumonia, Ventilator associated, Hospital acquired pneumonia, Guidelines