Study of Knowledge Translation of Clinical Practice Guidelines for Ventilator Associated Pneumonia (ABATEVAP)

Active Observational Study of the Adoption and Transfer of Clinical Practice Guidelines Through Education, for Ventilator Associated Pneumonia (ABATE VAP Study)

The purpose of this prospective, multicentre, time-series study is to develop, implement, refine, and evaluate a sustainable behaviour change strategy in the intensive care unit (ICU).

Study Overview

• Status: Completed
• Conditions: Ventilator Associated Pneumonia
• Intervention / Treatment: Behavioral: Education

Detailed Description

Background:

In order to improve the care of our patients, it is necessary for research evidence to be translated into clinical practice. There are gaps in our understanding of knowledge translation (KT) and this is evident in the Intensive Care Unit (ICU), specifically as it applies to the prevention, diagnosis and treatment of ventilator-associated pneumonia (VAP). VAP is associated with a high burden of illness in the critically ill and there is an extensive amount of research evidence on this disease. It has been demonstrated that best practice as defined by research evidence is not uniformly applied to VAP. In addition, recent advances in VAP knowledge need be disseminated and implemented in order to improve patient safety and outcomes from VAP. A systematic process of knowledge transfer is crucial to translate this research into evidence-based bedside practice and the development and implementation of evidence based Clinical Practice Guidelines (CPGs) may facilitate VAP knowledge uptake. In addition, there is a need to study knowledge translation (KT) in the ICU since there is little information about optimal KT and CPG implementation strategies in this environment and efforts that are effective in other clinical areas may not result in meaningful change in the ICU.

Research Question:

What is the effect of VAP CPGs implemented by a multidisciplinary behaviour change strategy (consisting of multifaceted educational strategies led by local opinion leaders and augmented with reminders) on VAP guideline concordance and on clinical VAP outcomes in the ICU?

Research Plan:

Data will only be collected on consecutive patients mechanically ventilated for at least 48 hours. The following health care professionals will be studied to assess the behaviour change strategy for the VAP CPGs: physicians (intensivists, ICU fellows, ICU rotating residents), nurses, respiratory therapists, dieticians, physiotherapists and ICU administrators.

The study will be conducted in 3 phases:

1. Development of a behaviour change strategy consisting of three components:

   • Local opinion leader team
   • Educational strategy
   • Reminder system
2. Prospective implementation of the behaviour change strategy over a 24 month period

3. Prospective evaluation of the behaviour change strategy over a 24 month period

   • Concordance with VAP guidelines over time
   • Factors associated with VAP guideline concordance
   • Clinical VAP outcomes pre- and post-guideline implementation

• Study Type: Observational
• Enrollment (Actual): 1320

Contacts and Locations

Study Locations

• Canada
  • British Columbia
    • New Westminister, British Columbia, Canada, V3L 3W4
      • Royal Columbian Hospital, University of British Columbia
    • Vancouver, British Columbia, Canada, V6Z 1Y6
      • St. Paul Hospital, University of British Columbia
    • Victoria, British Columbia, Canada, V8R 1J8
      • Vancouver Island Health Research Centre
  • Ontario
    • Hamilton, Ontario, Canada, L8N 4A6
      • St. Joseph's Healthcare, McMaster University
    • Kingston, Ontario, Canada, K7L 2V7
      • Kingston General Hospital, Queen's University
    • Ottawa, Ontario, Canada, K1H 8L7
      • The Ottawa Hospital, University of Ottawa
    • Thunder Bay, Ontario, Canada, P7B 6V4
      • Thunder Bay Regional Health Sciences Centre
    • Toronto, Ontario, Canada, M4N 3M5
      • Sunnybrook Health Sciences Centre, University of Toronto
    • Toronto, Ontario, Canada
      • William Osler Health Centre
    • Windsor, Ontario, Canada, N4A 1E1
      • Hotel Dieu Grace Hospital
• United States
  • Pennsylvania
    • Danville, Pennsylvania, United States, 17821-4400
      • Geisinger Health Centre, Temple University

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 17 years and older (Child, Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

• Sampling Method: Probability Sample

Study Population

Patients invasively mechanically ventilated > 48 hours in the critical care setting.

Description

Inclusion Criteria:

• Age >= 17 years old
• Mechanically ventilated > 48 hours < 96 hours

Exclusion Criteria:

• Previous enrollment in the study

Study Plan

How is the study designed?

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
1; Patients receiving invasive mechanical ventilation > 48 hours.	Behavioral: Education; Implementation of clinical practice guideline for ventilator associated pneumonia through education.

Collaborators and Investigators

• Sponsor: Canadian Critical Care Trials Group
• Collaborators: Bayer; Canadian Institutes of Health Research (CIHR); AstraZeneca; Queen's University
• Investigators: Study Chair: John Muscedere, MD, Kingston General Hospital, Queen's University; Study Chair: Tasmin Sinuff, MD, PhD, Sunnybrook Health Sciences Centre, University of Toronto; Principal Investigator: Daren Heyland, MD, Kingston General Hospital, Queen's University; Principal Investigator: Deborah Cook, MD, St. Joseph's Healthcare, McMaster University; Principal Investigator: Peter Dodek, MD, St. Paul's University, University of British Columbia; Principal Investigator: Redouane Bouali, MD, The Ottawa Hospital, University of Ottawa; Principal Investigator: Sean Keenan, MD, Royal Columbian Hospital, University of British Columbia; Principal Investigator: Kevin Eva, PhD, McMaster University; Principal Investigator: Brenda Morgan, RN, London Health Sciences Centre, University of Western Ontario; Principal Investigator: Lori Hand, RRT, Hamilton Health Sciences Centre, McMaster University

Publications and helpful links

General Publications

• Sinuff T, Muscedere J, Cook DJ, Dodek PM, Anderson W, Keenan SP, Wood G, Tan R, Haupt MT, Miletin M, Bouali R, Jiang X, Day AG, Overvelde J, Heyland DK; Canadian Critical Care Trials Group. Implementation of clinical practice guidelines for ventilator-associated pneumonia: a multicenter prospective study. Crit Care Med. 2013 Jan;41(1):15-23. doi: 10.1097/CCM.0b013e318265e874.

Study record dates

Study Major Dates

• Study Start: April 1, 2007
• Study Completion (Actual): July 1, 2010

Study Registration Dates

• First Submitted: February 12, 2007
• First Submitted That Met QC Criteria: February 12, 2007
• First Posted (Estimate): February 13, 2007

Study Record Updates

• Last Update Posted (Estimate): September 1, 2010
• Last Update Submitted That Met QC Criteria: August 31, 2010
• Last Verified: August 1, 2010

More Information

Terms related to this study

• Keywords: Ventilator Associated Pneumonia; Education; Knowledge Translation; Clinical Practice Guidelines; Behaviour Change
• Additional Relevant MeSH Terms: Pathologic Processes; Infections; Respiratory Tract Infections; Respiratory Tract Diseases; Lung Diseases; Disease Attributes; Cross Infection; Iatrogenic Disease; Healthcare-Associated Pneumonia; Pneumonia; Pneumonia, Ventilator-Associated
• Other Study ID Numbers: ABATE VAP