Application of ventilator care bundle and its impact on ventilator associated pneumonia incidence rate in the adult intensive care unit

ABSTRACT

To reduce ventilator associated pneumonia [VAP] incidence rate, lessen the cost of care, and correlate VAP bundles compliance with VAP incidence rate. This study was a prospective longitudinal study conducted on adult intensive care unit [ICU] patients at Hera General Hospital, Makkah, Kingdom of Saudi Arabia from January to December 2010. The following Institute for Healthcare Improvement VAP prevention bundle was applied head-of-bed elevation; daily "sedation-vacation" along with a readiness-to-wean assessment; peptic ulcer disease [PUD] prophylaxis; and deep venous thrombosis [DVT] prophylaxis. Among a total of 2747 patients, the bundle compliance rate in January 2010 was 30%, and reached to 100% in December 2010, while the overall rate was 78.9%. The individual bundle compliance rates were as follows head-of-bed elevation - 99.9%; daily sedation vacation - 88.9%; PUD prophylaxis - 94.9%; and DVT prophylaxis - 85.7%. At the beginning, VAP rate was 2.5/1000 ventilator days, and reduced to 0.54 in the next month. The overall VAP incidence rate in 2010 was found to be 1.98 with a reduction of 1.41 by comparing with the same data of year 2009 collected retrospectively. The total reduction cost in one year was $154,930. A significant correlation was found between the VAP rate and its bundle compliance [p=0.001]. Most frequent pathogens found were Pseudomonas aeruginosa [30.8% of all isolates] followed by Acinetobacter baumannii [27.7%], and methicillin-resistant Staphylococcus aureus [15.4%]. Application of VAP prevention bundle reduced the VAP incidence rate and lowered the cost of care