PURPOSE: Ventilator associated pneumonia (VAP) is associated with increased mortality, length of stay and cost in critically ill patients. A number of interventions are shown to decrease the rate of VAP individually. The objective was to evaluate the effect of these preventive interventions as a “bundle” on the rate of VAP in our intensive care unit (ICU).
METHODS: Targetted surveillance for VAP was done from 2003 onwards using National Nosocomial Infection Surveillance criteria.The VAP prevention bundle was instituted in August 2005, which included 7 components: head of bed elevation, daily sedation vacation and assessment for continuation, daily spontaneous breathing trials, blood glucose control, mouth care, prophylaxis for deep vein thrombosis and stress ulcers. The incidence of VAP was calculated before and after the intervention. In addition, the compliance with each component of the bundle was also assessed from medical record review starting August 2005.
RESULTS: We surveyed patient records for 26.6 % of the 5103 ventilator days logged in the ICU to audit compliance with VAP prevention bundle components. Our pre-bundle VAP rates were 11.73 in 2003 and 9.35 in 2004. Post-bundle, the VAP rate was 0.98 (August 2005 to December 2006). Poisson regression analysis of incidence-rate-ratios (IRR) showed highly significant reductions in the post-bundle time blocks. The IRR was 0.197 (95% Confidence Interval 0.06-0.64, p=0.007) in August to December 2005, compared with an IRR of 1.0 in the pre-bundle one-year period, and fell further to 0.073 (95% CI 0.01-0.53, p=0.01) in the first half of 2006 and 0.069 (95% CI 0.01-0.50, p=0.008) in the second half of 2006.
CONCLUSION: The implementation of the 7 component VAP prevention bundle, including education of caregivers in the critical care units and audits of their performance, appears to be a very effective working model to significantly reduce the incidence of VAP in the ICU.
CLINICAL IMPLICATIONS: The incidence of VAP can be significantly reduced by grouping evidence-based practices into care bundles, educating caregivers regarding their importance, and ensuring compliance with constant auditing and feedback.
DISCLOSURE: Arun Devakonda, No Financial Disclosure Information; No Product/Research Disclosure Information