An Evaluation of the Ventilator Bundle for the Prevention of Ventilator-Associated Pneumonia in Patients Under Mechanical Ventilation at Selected Hospitals

Abstract

Background

Ventilator-associated pneumonia (VAP) is a leading cause of death and a major financial burden for healthcare systems worldwide. In order to reduce the occurrence of ventilator-associated pneumonia (VAP), our institution has instituted bundle care in the ICUs. The effectiveness of it is being assessed in this retrospective study.

Methods

We updated the VAP care bundle from the Institute for Healthcare Improvement and deployed it at five surgical intensive care units (SICUs) at National Taiwan University Hospital. This bundle of care required a diverse team. To determine the effect of the VAP bundle in a clinical context, this study examines the use of the intensive care unit (ICU), the number of patients ventilated, and the incidence of ventilator-associated pneumonia (VAP) from 2006 to 2013.

Result

Enrolment was limited to 27,125 patients; 12,913 patients were from the pre-VAP bundle phase and 14,212 from the post-VAP bundle phase. The study initially analysed 28,454 SICU patients; children younger than 18 were eliminated (n = 1329). There was a trend towards older patients and shorter stays in the SICU among patients in the post-VAP phase (p = 0.024 and p = 0.006, respectively). In the post-VAP bundle phase, patients had lower disease severity scores on the Therapeutic Intervention Scoring System, Glasgow Coma Scale, and Acute Physiology and Chronic Health Evaluation II score (p < 0.001), with the exception of the Injury Severity Score (p = 0.729). No change in SICU utilisation was observed between the pre- and post-VAP bundle phases in response to VAP interventions (p = 0.982), but there was a significant decrease in ventilator utilisation (p < 0.001), from 1148.5 to 956.1 ventilator days per month, and a remarkable decrease in VAP density (p < 0.001), from 3.3 to 1.4 cases per 1000 ventilator days.

Summary

When VAP bundle care is put into place, the occurrence of VAP in the SICU diminishes. The keys to success include interdisciplinary teamwork, education, and a thorough checklist to improve compliance among health-care personnel.