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

BACKGROUND: 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. MATERIALS AND METHODS: 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. RESULTS: 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). CONCLUSION: 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.

[1]  R. Porcher,et al.  Long-term impact of a multifaceted prevention program on ventilator-associated pneumonia in a medical intensive care unit. , 2010, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[2]  P. Fulbrook,et al.  The ventilator care bundle and its impact on ventilator-associated pneumonia: a review of the evidence. , 2011, Nursing in critical care.

[3]  J. Carlet,et al.  Ventilator-associated pneumonia. European Task Force on ventilator-associated pneumonia. , 2001, The European respiratory journal.

[4]  A. Marra,et al.  A program for sustained improvement in preventing ventilator associated pneumonia in an intensive care setting , 2012, BMC Infectious Diseases.

[5]  Carolyn L Cason,et al.  Nurses' implementation of guidelines for ventilator-associated pneumonia from the Centers for Disease Control and Prevention. , 2007, American journal of critical care : an official publication, American Association of Critical-Care Nurses.

[6]  P. Davey,et al.  Care bundles: the holy grail of infectious risk management in hospital? , 2009, Current opinion in infectious diseases.

[7]  古谷 良輔,et al.  Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. , 2008, American journal of respiratory and critical care medicine.

[8]  D. Warren,et al.  The long-term outcome of a multifaceted intervention to reduce ventilator-associated pneumonia: can zero really be achieved? , 2011, American journal of infection control.

[9]  L. Bouadma,et al.  Ventilator-associated pneumonia and its prevention , 2012, Current opinion in infectious diseases.

[10]  Jordi Rello,et al.  Epidemiology and outcomes of ventilator-associated pneumonia in a large US database. , 2002, Chest.

[11]  Peter J. Pronovost,et al.  Barriers to translating evidence into practice , 2003, Current opinion in critical care.

[12]  S. O'Keefe-McCarthy,et al.  Ventilator-associated pneumonia bundled strategies: an evidence-based practice. , 2008, Worldviews on evidence-based nursing.

[13]  T. Walsh,et al.  Reducing ventilator-associated pneumonia in intensive care: Impact of implementing a care bundle* , 2011, Critical care medicine.

[14]  Larry J. Anderson,et al.  Guidelines for preventing health-care-associated pneumonia, 2003 recommendations of the CDC and the Healthcare Infection Control Practices Advisory Committee. , 2004, Respiratory care.

[15]  C. Bridges,et al.  Guidelines for preventing health-care--associated pneumonia, 2003: recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee. , 2004, MMWR. Recommendations and reports : Morbidity and mortality weekly report. Recommendations and reports.

[16]  Polly Jones,et al.  Eliminating nosocomial infections at Ascension Health. , 2006, Joint Commission journal on quality and patient safety.

[17]  R. Gaynes,et al.  Nosocomial Infections in Combined Medical-Surgical Intensive Care Units in the United States , 2000, Infection Control &#x0026; Hospital Epidemiology.

[18]  M. Klompas.  Is a ventilator-associated pneumonia rate of zero really possible? , 2012, Current opinion in infectious diseases.

[19]  R. Salomão,et al.  Effectiveness of a multidimensional approach for prevention of ventilator-associated pneumonia in adult intensive care units from 14 developing countries of four continents: Findings of the International Nosocomial Infection Control Consortium* , 2012, Critical care medicine.

[20]  B. Kanna,et al.  Study of device use adjusted rates in health care-associated infections after implementation of "bundles" in a closed-model medical intensive care unit. , 2010, Journal of critical care.

[21]  S. Reeder,et al.  Using evidence-based practice to prevent ventilator-associated pneumonia. , 2012, Critical care nurse.

[22]  Z. Memish,et al.  The results of a 6-year epidemiologic surveillance for ventilator-associated pneumonia at a tertiary care intensive care unit in Saudi Arabia. , 2012, American journal of infection control.

[23]  Shuenn-Wen Kuo,et al.  Efficacy of ventilator-associated pneumonia care bundle for prevention of ventilator-associated pneumonia in the surgical intensive care units of a medical center. , 2015, Journal of microbiology, immunology, and infection = Wei mian yu gan ran za zhi.

[24]  H. Sax,et al.  Ventilator-associated pneumonia as a quality indicator for patient safety? , 2008, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[25]  D. Cook,et al.  Ventilator-associated pneumonia: Improving outcomes through guideline implementation. , 2008, Journal of critical care.

[26]  D. Dawson,et al.  Implementing quality initiatives using a bundled approach. , 2011, Intensive & critical care nursing.

[27]  Barry Evans.  Best-practice protocols: VAP prevention. , 2005, Nursing management.

[28]  A. Marra,et al.  Successful prevention of ventilator-associated pneumonia in an intensive care setting. , 2009, American journal of infection control.

[29]  Joseph H Abramson,et al.  WINPEPI (PEPI-for-Windows): computer programs for epidemiologists , 2004, Epidemiologic perspectives & innovations : EP+I.

[30]  K. Reinhart,et al.  Effects of staff training on the care of mechanically ventilated patients: a prospective cohort study. , 2009, British journal of anaesthesia.