Association of compliance of ventilator bundle with incidence of ventilator-associated pneumonia and ventilator utilization among critical patients over 4 years

ABSTRACT

Several studies showed that the implementation of the Institute for Healthcare Improvement [IHI] ventilator bundle alone or with other preventive measures are associated with reducing Ventilator-Associated Pneumonia [VAP] rates. However, the association with ventilator utilization was rarely examined and the findings were conflicting. The objectives were to validate the bundle association with VAP rate in a traditionally high VAP environment and to examine its association with ventilator utilization. The study was conducted at the adult medical-surgical intensive care unit [ICU] at King Abdulaziz Medical City, Saudi Arabia, between 2010 and 2013. VAP data were collected by a prospective targeted surveillance as per Centers for Disease Control and Prevention [CDC]/National Healthcare Safety Network [NHSN] methodology while bundle data were collected by a cross-sectional design as per IHI methodology. Ventilator bundle compliance significantly increased from 90% in 2010 to 97% in 2013 [P for trend < 0.001]. On the other hand, VAP rate decreased from 3.6 [per 1000 ventilator days] in 2010 to 1.0 in 2013 [P for trend = 0.054] and ventilator utilization ratio decreased from 0.73 in 2010 to 0.59 in 2013 [P for trend < 0.001]. There were negative significant correlations between the trends of ventilator bundle compliance and VAP rate [cross-correlation coefficients -0.63 to 0.07] and ventilator utilization [cross-correlation coefficients -0.18 to -0.63]. More than 70% improvement of VAP rates and approximately 20% improvement of ventilator utilization were observed during IHI ventilator bundle implementation among adult critical patients in a tertiary care center in Saudi Arabia. Replicating the current finding in multicenter randomized trials is required before establishing any causal link