Prevention of Ventilator–Associated Pneumonia in a Middle Eastern University Hospital: the Effect of care bundle Implementation

RadwaHamdi Bakr; Hesham Mohamed MamdouhAbdelaziz

Volume : III, Issue : X, October - 2014

Prevention of Ventilator–Associated Pneumonia in a Middle Eastern University Hospital: the Effect of care bundle Implementation

Radwahamdi Bakr, Hesham Mohamed Mamdouhabdelaziz

Abstract :

Background: Ventilator–associated pneumonia (VAP) is a serious health care–acquired infection that occurs in up to 30% of mechanically ventilated patients and leads to prolonged mechanical ventilation, increased hospital stay, and mortality. The aim of this study was to establish the effects of implementing a VAP prevention bundle on VAP rates, antibiotic use, duration of mechanical ventilation, and intensive care unit (ICU) length of stay. Design & Setting: This study used a before–and–after structure to analyze the effects of implementing a VAP prevention bundle in the surgical ICU of a Middle–Eastern university hospital Interventions: A ventilator–associated pneumonia care bundle, consisting of 30o head–of–bed elevation, oral chlorhexidine, continuous aspiration of subglottic secretions (CASS), daily sedation hold, and daily assessment for weaning. Results: During the pre–implementation phase, 323 patients were included in the study and 306 were included in the post–implementation phase. Compliance was 95% for the 30o head–up tilt and the oral chlorhexidine, 85% for the CASS, 75% for the daily sedation hold and assessment for weaning, and 70% for all five elements of the bundle. Rates of microbiologically confirmed VAP were 14 per thousand ventilator days in the pre– implementation period and 5 per thousand ventilator days in the post–implementation period (p=0.047). The mean length of time of antibiotic therapy was lower in the post–implementation phase but not reaching statistical significance. There was a significantly shorter duration of mechanical ventilation in the post–implementation phase (p=0.01). Conclusion: VAP care bundle is an effective measure for lowering VAP rates in the ICU.