Cumplimiento del bundle de neumonía asociada a ventilación mecánica en el Hospital Universitario La Paz / Compliance with the pneumonia bundle associated with mechanical ventilation in La Paz University Hospital, Madrid

Introducción: Los bundles son grupos de medidas que buscan reducir la incidencia de la infección nosocomial. Decidimos evaluar el cumplimiento del bundle de neumonía asociada a ventilación mecánica y, en función de los resultados, promover un plan de mejora. Pacientes y método: El bundle incluye: elevar el cabecero 30° o más, valorar diariamente la necesidad de sedación, aplicar profilaxis antitrombótica y de úlcera de estrés. Se evaluó en la unidad de cuidados intensivos (UCI), en la reanimación de la primera planta (REA1) y en la de la tercera (REA3) diariamente desde el 25 de junio hasta el 20 de julio de 2007. Resultados: En la UCI se realizaron 222 observaciones (189 completas); en la REA1, 34 observaciones (26 completas), y en la REA3, 35 observaciones (27 completas). El cumplimiento del bundle fue del 77,2% en UCI, el 50% en REA1 y el 70,2% en REA3. El menor cumplimiento correspondió a la elevación del cabecero (UCI, el 85,8%; REA1, el 57,6% y REA3, el 69%). Las medidas propuestas fueron: incluir orden estandarizada de elevación de la cabeza a 45°, realización de ventanas de sedación por enfermería y reflejar en la historia cuando no se pueda realizar alguna medida. Conclusiones: Las estrategias de mejora mediante bundles son una forma fácil y rápida de obtener medidas de proceso que nos ayudan a mejorar la prevención de la infección nosocomial

Introduction: Bundles are groups of interventions to reduce nosocomial infection rates. We evaluated the current status of ventilator-associated pneumonia bundle compliance in our hospital to propose an improvement plan on the basis of the results. Patients and method: Bundle includes: raising the head of the bed $ 30°, daily assessment of sedation requirements, peptic ulcer disease and deep venous thrombosis prophylaxis. It was evaluated in the intensive care unit (ICU) and two postoperative recovery units (called REA1 and REA3) from June 25 until July 20, 2007. Results: In ICU, 222 observations were made (189 complete), in REA1 34 observations (26 complete) and in REA3, 35 observations (27 complete). Bundle compliance was 77.2% in ICU, 50% in REA1 and 70.2% in REA3. Lowest compliance component was raising the head of the bed (UCI, 85.8%; REA1, 57.6%, and REA3, 69%). Improved interventions proposed were to include standardised requirements for raising the head of the bed to 45°, to empower nurses to make daily "sedation vacations" (interruption of sedation to point of alertness) and mention in medical history when an item cannot be carried out. Conclusions: Improvement strategies through bundles are a quick and easy way to obtain process indicators that help us improve the prevention of nosocomial infections (AU)

[Not Available]. / Cumplimiento del bundle de neumonía asociada a ventilación mecánica en el Hospital Universitario La Paz.

INTRODUCTION: Bundles are groups of interventions to reduce nosocomial infection rates. We evaluated the current status of ventilatorassociated pneumonia bundle compliance in our hospital to propose an improvement plan on the basis of the results. PATIENTS AND METHOD: Bundle includes: raising the head of the bed (30°, daily assessment of sedation requirements, peptic ulcer disease and deep venous thrombosis prophylaxis. It was evaluated in the intensive care unit (ICU) and two postoperative recovery units (called REA1 and REA3) from June 25 until July 20, 2007. RESULTS: In ICU, 222 observations were made (189 complete), in REA1 34 observations (26 complete) and in REA3, 35 observations (27 complete). Bundle compliance was 77.2% in ICU, 50% in REA1 and 70.2% in REA3. Lowest compliance component was raising the head of the bed (UCI, 85.8%; REA1, 57.6%, and REA3, 69%). Improved interventions proposed were to include standardized requirements for raising the head of the bed to 45°, to empower nurses to make daily "sedation vacations" (interruption of sedation to point of alertness) and mention in medical history when an item cannot be carried out. CONCLUSIONS: Improvement strategies through bundles are a quick and easy way to obtain process indicators that help us improve the prevention of nosocomial infections.