Ventilator-associated Pneumonia Bundle Research Articles

Development of ventilator-associated pneumonia (VAP) prevention model in the hospital based on Six Sigma and VAP Bundle

Background & Objective: Ventilator-Associated Pneumonia (VAP) is the leading cause of death in Healthcare-Associated Infections (HCAI), with 30-day mortality of 59% of patients with ventilator devices. The aim of this research was to develop a VAP prevention model in the intensive care unit (ICU) based on Six Sigma and VAP Bundle, involving individual, organizational and work characteristics factors. Methodology: This research was carried out in the ICU, Poltekkes Kemenkes Malang, Malang, Indonesia, using a cross-sectional design. The research subjects were nurses, selected using a simple random sampling technique. All variables were measured through filling out questionnaires. Next, the measurement data was analyzed using Partial Least Square (PLS), based on Six Sigma and VAP Bundle. Results: Based on Six Sigma and VAP Bundle, the results of the analysis of the effects of the three factors on the implementation of VAP prevention were: 1) for individual factors, path coefficient = 0.189 and P = 0.000, so it was interpreted that this factor had a significant effect on the implementation of VAP prevention; 2) for organizational factors, path coefficient = 0.496 and P = 0.003, so it was interpreted that this factor also had a significant effect; 3) for the work characteristics factors, path coefficient = 0.289 and P = 0.000, so this factor also had a significant effect on the implementation of VAP prevention. Conclusion: Based on the research results, a VAP prevention model based on Six Sigma and VAP bundle was successfully built in the ICU, which involved organizational factors, work characteristics and individual factors. Abbreviations: HCAI - Healthcare-Associated Infections; HAP - Hospital-acquired pneumonia; PLS - Partial Least Square; SOP - standard operating procedure; VAP - ventilator-associated pneumonia; Keywords: Ventilator-Associated Pneumonia, VAP, Prevention; Six Sigma, VAP Bundle; Intensive Care Unit; organizational factors; work characteristics; individual factors Citation: Yuswanto TJA, Ernawati N, SolikhahFK, Nugroho HSW. Development of a prevention model for ventilator-associated pneumonia based on Six Sigma and VAP bundle. Anaesth. pain intensive care 2024;28(5):876−882; DOI: 10.35975/apic.v28i5.2574 Received: July 14, 2024; Reviewed: July 28, 2024; Accepted: July 28, 2024

Effect of Compliance to Ventilator Bundle Care in Decreasing Ventilator-associated Pneumonia Rates in a Neonatal Intensive Care Unit: A Quality Improvement Initiative

Purpose Prevention of ventilator-associated pneumonia (VAP) can be achieved by a group of evidence-based interventions known as the “VAP bundle.” In this study, we observed the effect of increasing compliance to bundle care in reducing VAP rates. Methods We did a quality improvement (QI) study in an outborn level 3 neonatal intensive care unit (NICU) enrolling 95 neonates less than 28 days of life; and receiving ventilator care for more than 2 days of hospitalization in NICU. A standardized VAP bundle was implemented with the goal of decreasing VAP rates in NICU. A total of 45 neonates were enrolled in the pre-bundle study group (Group I) and 50 in post-bundle study group (Group II). Results Average bundle compliance increased to 62.26 ± 8.31% in Group II from a baseline compliance value of 52.6 ± 6.87% in Group I ( P < .05). VAP rate was reduced from 37.6 per 1000 MV days (Mechanical Ventilation days) to 25.5 per 1000 MV days ( P < .05). Conclusion Increased compliance to ventilator bundle care leads to a decreased VAP rate resulting in shortening of the MV days per case, decreasing duration of hospital stay, and reducing antibiotic course duration, thereby better employing the health care resources in neonatal care.

Effectiveness of Staff Compliance to VAP Bundle in Aswan Heart Center

Effectiveness of Staff Compliance to VAP Bundle in Aswan Heart Center

Nurses’ Knowledge on the Prevention of Ventilator-Associated Pneumonia (VAP) among Critically Ill Patients

Background: Ventilator-associated pneumonia (VAP) is a significant concern in healthcare settings, particularly among critically ill patients who require mechanical ventilation. Nurses play a vital role in preventing VAP through their knowledge and implementation of evidence-based practices. However, there exists a notable gap in the research regarding nurses’ knowledge of preventing VAP to improve patient outcomes and reduce healthcare costs.Purpose: This study aimed to assess nurses’ knowledge of preventing VAP among critically ill patients using the ventilator bundle checklist.Methods: This study used a one-group pretest-posttest design to test the change in the nurses’ knowledge scores on VAP working in two government hospitals in Buraidah, Al Qassim Region, Saudi Arabia. The study covered 250 purposively and conveniently sampled nurses from intensive care units. Data collection was performed in three phases: pre-test, VAP educational program, and post-test. Data were collected using self-administered questionnaires on nurses’ socio-demographics, a 20-item self-made survey about the knowledge of VAP and its prevention and the adapted ventilator bundle checklist. The collected data were entered, prepared, and analyzed using SPSS version 25.0. Relevant ethical issues were strictly considered.Results: The results showed that during the pre-test, correct responses were accounted for but showed low scores in the following areas: general knowledge of VAP (27.6%), factors associated with VAP (36%), international guidelines for prevention (20.8%), and nurses’ roles in prevention (16.4%). However, in the post-test, there was a remarkable increase in the knowledge scores in the same categories (95.2%) on general knowledge, on factors associated with VAP (74.8%), on international guidelines (73.6%) and on nurses’ roles in prevention (61.6%). The program significantly improved overall VAP knowledge and knowledge in specific areas like general VAP, associated factors, international guidelines, and nurses’ roles in prevention (p<0.000).Conclusion: A pre-test revealed low baseline knowledge across all four areas assessed: general VAP knowledge, factors associated with VAP, international VAP prevention guidelines, and nurses’ roles in VAP prevention. However, post-test scores markedly increased in all areas, indicating the educational program’s effectiveness. Hence, the findings suggest that educational intervention focused on VAP screening and bundle protocols could be beneficial to address the gap in knowledge on VAP.

BACTERIOLOGICAL STUDY OF VENTILATOR-ASSOCIATED PNEUMONIA AND ANTIBIOTIC SUSCEPTIBILITY OF ISOLATES

Objective: The present study determined the prevalence of various aerobic bacteria causing ventilator-associated pneumonia in adult patients. Initially the bacteria causing ventilator-associated pneumonia was isolated from ET samples and studied the antimicrobial susceptibility pattern of bacterial isolates.
 Methods: Total 250 endotracheal aspiration (ET) samples were collected from patients admitted in Medical, Respiratory and Surgical ICUs for 1 y period. ET aspirates were collected under aseptic precautions and processed as per standard operating procedure for the identification of microorganisms. The antibiotic susceptibility test was performed by using Kirby-Bauer disk diffusion method as per CLSI guidelines.
 Results: Out of the 250 samples processed, culture-positive were 34.8% (n=87) and culture-negative were 65.2% (n=163). Out of 87 culture-positive samples, polymicrobial growth was observed in 9.19% (n=8) and monomicrobial growth was observed in 90.8% (n=79). Gram negative bacilli 95.7% (n=91), and gram-positive cocci isolates are 4.2% (n=4). Among Gram-negative organisms isolated, A. baumannii is the most common isolate 33 (34.7%), followed by P. aeruginosa 28 (29.5%) and K. pneumoniae 20 (21.0%) E. coli 8 (8.4%) and E. cloacae 2 (2.1%). Out of 4 Gram-positive organisms isolated, 3 (3.1%) were MSSA, and 1(1.1%) was MRSA.
 Conclusion: VAP is increasingly associated with multidrug-resistant (MDR) pathogens due to the production of ESBL, Amp C b-lactamase, Metallo-b-lactamase. It is important to carry out aggressive surveillance to determine the prevalence of MDR organisms and to generate a local antibiogram periodically. Early and appropriate antibiotics in right doses followed by de-escalation based on microbiological culture results are essential to curtail the VAP rate. VAP bundle care shall be implemented correctly.

Teaching Bundle Care Approach to Intensive Care Nurses to Prevent Ventilator Associated Pneumonia with a Stratified Validated Module.

Module-based teaching of ventilator-associated pneumonia (VAP) with a systematic, stratified approach is expected to have a promising role in teaching. We hypothesized it to improve the skill and knowledge of intensive care unit nurses. The aim of this study was to determine the efficacy of the teaching module with debriefing sessions on the VAP bundle care approach, and the secondary objective was to estimate the improvement in individual components of the VAP bundle. A total of 200 paramedical staff were exposed to a teaching module consisting of pretest didactic lectures, debriefing sessions, reflection by participants, and feedback. Posttest analysis was done to assess knowledge. Skill assessment was done with directly observed procedural skills (DOPS) assessment, and feedback was taken from participants. Follow-up was done at 6 months to assess decay in knowledge and skills. Preworkshop and postworkshop DOPS scores were analyzed using the Mann-Whitney U test. Subgroup analysis was performed using the paired t test. Median pretest and posttest scores were 6 (interquartile range, 4-8) and 13 (interquartile range, 11-15), respectively (P < .001). Comparing DOPS scores before and after exposure to the teaching module, the number of subjects with scores that were below expectations was 24 and 4; meeting expectations was 94 and 24; borderline expectations were 36 and 104; and above expectations was 46 and 58, respectively, between the groups (P < .001). A decay in knowledge and skills was noted in the follow-up. A validated teaching module with debriefing sessions is useful in training bundle care approaches to intensive care unit nurses.

Impact of introduction of a rounding checklist in a pediatric intensive care unit of a developing country: A quality improvement project

Abstract Background: Patients admitted to critical care need timely interventions after evaluating all clinical parameters. This study aims to assess the impact of the comprehensive rounding checklist on physician compliance and patient-related outcomes in a multidisciplinary pediatric intensive care unit (PICU). Subjects and Methods: This prospective observational study was conducted in two phases over period of 2 months at multidisciplinary PICU from Pakistan. A structured rounding checklist of 35 components encompassing patient care was introduced and implemented in the PICU. During the preimplementation phase, a nurse took notes of relevant patient clinical details missed by the physician during the round, included them in the rounding checklist. And during the implementation phase, the nurse actively intervened when a physician did not discuss a particular component during the round. All components discussed were check marked. Results: The checklist was completed for 812 rounds (162 patients) in preimplementation and 2348 rounds (590 patients) in the postimplementation phase. Most frequently missed components in the preimplementation phase were checking for surgical site infection (8.9%), discharge plan (7.5%), deep vein thrombosis (DVT) prophylaxis (7.3%), and ventilator-associated pneumonia bundles (7.0%). Whereas, during the postimplementation phase, resident teaching (8.0%), discharge plan (7.2%), and DVT prophylaxis (6.5%) were most frequently missed. Hospital length of stay decreased from 4.5 ± 3.7 to 4.1 ± 2.9 days (P = 0.05), and overall mortality decreased from 19% to 11.4% (P &lt; 0.05). Conclusions: Introducing the checklist with a prompter, improved physician compliance and patient-related outcomes in our PICU.

Description Of Implementation Of Ventilator Bundle (VB) at ICU Of Mangusada District Hospital

The ventilator is a breathing apparatus that maintains oxygen delivery for a long time. One of the impacts caused by using a ventilator for a long time is a nosocomial infection called Ventilator Associated Pneumonia (VAP). &#x0D; Research is a quantitative descriptive study using a cross-sectional research design. The population in this study amounted to 30 with a non-probability type sample, and researchers will use a total sampling technique. &#x0D; There were 17 women (56.7%) who had washed their hands, in the ICU training characteristics, there were 14 people (46.7%) who did not have ICU training who had done hand washing, and there were 15 people (50%) nurses with D3 nursing education who had done washing hands. There were 18 people (60%) of the female sex had taken oral hygiene measures. In the ICU training characteristics, there were 15 people (50%) who did not have ICU training who had carried out oral hygiene. In the characteristics of the education level, 17 people (56.7%) with an education level of D3 nursing have already performed oral hygiene. VAP Bundles are a set of evidence-based practices (EBP) that result in VAP improvements when carried out collectively and consistently by health workers, namely nurses and doctors responsible for patients on mechanical ventilators.

VAP Bundle Components and Their Compliance in a Tertiary Intensive Care Unit

VAP Bundle Components and Their Compliance in a Tertiary Intensive Care Unit

Evaluation of a bundle approach for the prophylaxis of ventilator-associated pneumonia: A retrospective single-center Study.

Ventilator-associated pneumonia (VAP) is defined as pneumonia occurring after the first 48 hours of intubation and mechanical ventilation and is the most frequent hospital-acquired infection associated with intensive care unit (ICU) admissions. Herein, we defined a novel VAP bundle including 10 preventive items. We analyzed compliance rates and clinical effectiveness associated with this bundle in patients undergoing intubation at our medical center. A total of 684 consecutive patients who underwent mechanical ventilation were admitted to the ICU between June 2018 and December 2020. VAP was diagnosed by at least two physicians based on the relevant United States Centers for Disease Control and Prevention criteria. We retrospectively evaluated associations between compliance and VAP incidence. The overall compliance rate was 77%, and compliance generally remained steady during the observation period. Moreover, although the number of ventilatory days remained unchanged, the incidence of VAP improved statistically significantly over time. Low compliance was identified in four categories: head-of-bed elevation of 30- 45º, avoidance of oversedation, daily assessment for extubation, and early ambulation and rehabilitation. The incidence of VAP was lower in those with an overall compliance rate of ≥ 75% than its incidence in the lower compliance group (15.8 vs. 24.1%, p = 0.018). When comparing low-compliance items between these groups, we found a statistically significant difference only for daily assessment for extubation (8.3 vs. 25.9%, p = 0.011). In conclusion, the evaluated bundle approach is effective for the prophylaxis of VAP and is thus eligible for inclusion in the Sustainable Development Goals.

The Effect of VAP BUNDLE Use on the Prevention of VAP Incidents in Hospitalized Patients - Human Rights Hospital ICU

The Effect of VAP BUNDLE Use on the Prevention of VAP Incidents in Hospitalized Patients - Human Rights Hospital ICU

Assessment of nurses’ knowledge and compliance to evidence based guidelines regarding bundle of ventilator associated pneumonia in a military hospital

Ventilator-associated pneumonia is the most common hospital-acquired infection among patients receiving mechanical ventilation in an intensive care unit. Different evidence based guidelines for the prevention of ventilator-associated pneumonia have been developed and recommended. Intensive Care Units’ nurses have been found to be in the best position to put knowledge into practice as they are at the patient’s bedside 24 hours daily providing nursing care and therefore play an important role in the prevention of VAP. This study focuses on enhancing nurses’ knowledge and compliance regarding ventilator-associated pneumonia (VAP) bundle for prevention of ventilator-associated pneumonia (VAP) in intensive care units in a Military Hospital. Objectives: To assess the critical care nurses' knowledge of and compliance with the preventive care bundle of ventilator associated pneumonia. All head and staff nurses (N=80) working in different intensive care units (N=9) in a Military Hospital were included. The study tools included a self-administered questionnaire designed to test nurse's knowledge and an observational checklist to test nurses’ compliance with ventilator associated pneumonia bundle. Results: The total mean score of nurses’ compliance (70.6%) was more than the total mean score of nurses’ knowledge (52.4 %) of evidence based guidelines regarding ventilator associated pneumonia bundle. Nurses’ knowledge levels were excellent in 16% of the studied nurses, very good in 7.2%, good in 17.6%, fair in 14.9% &amp; poor in 44.3% of the studied nurses. Nurses’ compliance levels were excellent in 56.4%, very good in 3.5%, good in 2%, fair in 24.5% &amp; Poor in 13.43% of the studied nurses. In conclusion: The knowledge of VAP bundle components in the study group was considerably lower than the compliance levels, which indicates that training educational programs directed towards infection prevention and control of device-associated infections should stress on explaining the principle behind the procedure, and manuals, information booklets and self-instruction modules should be implemented to guide healthcare personnel in areas of prevention of VAP.

The impact of teaching on nurses’ knowledge to VAP prevention bundle

Introduction: There are limited Indian studies that evaluate the nurses’ knowledge of VAP prevention bundle. Aim: Our study aimed to assess the effectiveness of a structured teaching programme on VAP bundle among staff nurses in critical care unit. Methodology: The prospective, quasi-experimental study was conducted among critical care nurses. The final sample (n=57) nurses was selected by purposive sampling technique on the basis of set inclusion criteria. The nurses were first assessed for their knowledge of guidelines to prevent VAP. They were then educated using a standard teaching module and the assessment performed again. Results: There was a statistically significant increase in the knowledge level of participants by a mean (±S.D) 5.68 (±2.8) score with 95% C.I (4.94 – 6.43) and p &lt;0.001. Conclusion: The 2-hour teaching module significantly enhanced nurses’ knowledge towards evidence based guidelines for the prevention of VAP.

Effect of Designed Bundle Protocol about Ventilator Associated Pneumonia on Nurses' Performance, Compliance, and Patient Outcomes

Context: Ventilator-associated pneumonia (VAP) is considered one of the leading causes of morbidity and mortality due to nosocomial infections among ventilated patients.&#x0D; Aim: To evaluate the effect of a designed bundle protocol about ventilator-associated pneumonia on nurses' performance, compliance, and patient outcomes.&#x0D; Methods: The study employed the quasi-experimental research (pre/post-test) (study/control) design. This study was conducted at the intensive care unit of Benha University Hospital. A convenience sample of 50 critical care nurses and a purposive sample of 66 patients were enrolled in the current study. Three tools were used to collect data. Nurses' knowledge assessment questionnaire; nurses' practice assessment checklist; The VAP bundle compliance checklist; and patient outcomes assessment record.&#x0D; Results: Statistically significant improvement in total knowledge and practice mean scores post implementing a designed bundle protocol compared to pre-implementing a designed bundle protocol at p &lt;0.001. Also, there was a statistically significant improvement in nurses’ compliance with a highly statistically significant difference between nurses’ compliance with practices of VAP bundle pre-and post designed bundle protocol implementation. Immediately after a designed bundle protocol implementation, the study group patients exhibited a statistically significant difference between all clinical pulmonary infection score items except for oxygenation status and radiographic findings.&#x0D; Conclusion: The study group nurses who received designed bundle protocol training would get improved knowledge, practices, and compliance scores than pre-designed bundle protocol training. Also, the study group of patients who were cared for by trained nurses on the designed bundle protocol would get better outcomes such as a better score of CPIS, shorter length of stay in the intensive care unit, less duration on mechanical ventilation compared to the control group who received routine hospital nursing care. The study recommended replication of the study using a large probability sample from a different geographical area to allow for greater generalization of the results.

Ventilator-associated pneumonia in PICU - how are we doing?

Background Ventilator-associated pneumonia (VAP) is a common hospital-acquired infection in children, leading to an increase in morbidity and mortality. A previous study in 2013 showed that VAP rates decreased dramatically after implementation of a VAP bundle and appointing a VAP coordinator. As part of a ‘Plan, Do, Study, Act’ cycle, it was necessary to evaluate the efficacy of these interventions. Objectives To evaluate the VAP rate in the paediatric intensive care unit (PICU) over 2 years (2017 - 2018), and to describe the causative organisms and antibiotic sensitivity/resistance patterns during this period. Methods This was a retrospective, descriptive study using the existing PICU VAP database as well as clinical folders. Results Over the 2 years, 31 VAP cases were identified. The VAP rate for 2017 was 4.0/1 000 ventilator days and 5.4/1 000 ventilator days for 2018. Compliance with the VAP bundle was 68% in 2017 and 70% in 2018. The median (interquartile range (IQR)) duration of ventilation in 2017 was 9 (6 -12) days and 15 (11 - 28) days in 2018. The median (IQR) length of PICU stay in 2017 was 11 (8 - 22) days and 25 (17 - 37) days in 2018. The most common cultured organism was an extended-spectrum beta-lactamase (ESBL) Klebsiella pneumoniae sensitive to amikacin and carbapenems. Conclusion Our VAP rate has not decreased since 2013. It is imperative that we improve compliance with the VAP bundle, in order to reduce VAP rates. K. pneumoniae and Pseudomonas aeruginosa were the most common organisms causing VAPs and empiric use of piptazobactam and amikacin is still appropriate. Contributions of the study This study highlights the need for ongoing evaluation of quality improvement initiatives in PICU, considering that VAP rates remained largely unchanged from 2013 to 2018.

Early Tracheostomy in Prolonged Mechanical Ventilation Due to Severe Head Injury to Prevent Ventilator-Associated Pneumonia (VAP)

Introduction: Early tracheostomy needs to be considered if the use of a ventilator is expected to be used for a long time. Early Tracheostomy is recommended because it can improve respiratory function, reduce the risk of Ventilator-Associated Pneumonia, improve patient comfort, cleanse secretions in the throat, reduce laryngeal ulceration, improve mobilization, and speech efforts, and allow treatment outside the Intensive Care Unit (ICU). Case Report: We report four cases of severe head injury with early tracheostomy which illustrates prevent of VAP. In these four cases, early tracheostomy was performed (£ 4 days) with consideration of the initial critical GCS, the location of the lesion, and mechanical ventilation is expected to be used for a long period time. During treatment, there is no VAP which is evidenced by a sputum culture examination. Based on a meta-analysis study early tracheostomy can reduce mortality due to VAP by up to 50% and reduce the length of stay in ICU compared to delayed/late tracheostomy (&gt; 10 days) or prolonged intubation (&gt; 14 days). Conclusion: VAP prevention efforts are carried out by applying VAP Bundle. An early tracheostomy provides more benefits than prolonged intubation or delayed/late tracheostomy. VAP Bundle is performed on every patient who uses a ventilator, and it can be proven scientifically that the application of VAP Bundle can reduce the incidence of VAP by up to 25%.

An in-depth look at ventilator-associated pneumonia in trauma patients and efforts to increase bundle compliance, education and documentation in a surgical trauma critical care unit

BackgroundVentilator-associated pneumonia (VAP) is considered the most common hospital acquired infection seen in critical care settings and leading cause of death in Intensive Care Units (ICU). The objective of this study was to assess whether specimen collection impacted diagnosis and if implementation of a VAP bundle would decrease rates at our center. MethodsThis single center study design is a retrospective chart review from 2017 to 2020 utilizing the electronic medical record. A pre-/postintervention comparison was performed following implementation of a unit wide VAP bundle and nursing education. Descriptive statistics and continuous variables were analyzed with independent group t -tests, and categorical variables were analyzed with chi-squared tests. ResultsVentilator-associated pneumonia rates decreased in the postimplementation time (20.8%, n = 74 vs 12.2%, n = 15; P = .03). There were no significant differences in the patient profile of those who acquired VAP (ie, males 79.7% vs 86.7%, blunt injuries 63.5% vs 86.7% and severity scores 24.8 vs 25.1, pre vs postimplementation, respectively, all P-values greater than .05). Discussion/ConclusionsReduction in VAP rates were achieved by implementing a standardized, evidence based, prevention protocol. Further research is warranted as studies have noted that patients requiring mechanical ventilation are at greater risk for VAP than other ICU patients due to the nature of their injuries and increased risk of prolonged mechanical ventilation ≥ 21 days.

Ventilator-Associated Pneumonia Bundle of Care Training of Nursing Officers Using Simulation and Its Impact on Their Knowledge and Incidence of Ventilator-Associated Pneumonia: A Quasi-Experimental Study.

The objective of this study was to assess the effectiveness of simulation-based training (SBT) of a ventilator-associated pneumonia (VAP) bundle of care on the knowledge and practice of nursing officers working in the pediatric intensive care unit (PICU) and its impact on the incidence of VAP. This study was a single-center, pre- and postsimulation-based educational interventional tool conducted in a six-bed PICU located in Western Rajasthan, India. Thirty nursing officers working in the PICU participated in the study. Baseline knowledge and practice regarding VAP bundle of care were assessed using a questionnaire and practice checklist. It was followed by 1:1 SBT of the VAP bundle of care following which all participants were immediately reassessed and then again at 3 months postintervention. The incidence of VAP (events/1,000 ventilation days) was subsequently compared both at 6 months pre- and postintervention. Thirty nursing officers participated in the study of which 63% were male. Baseline knowledge and practice increased significantly immediately after the VAP bundle of care training and then again at 3 months in comparison to preintervention testing (baseline 20.27 ± 4.51, immediate postintervention 26.0 ± 3.67, 3 months postintervention 23.97 ± 4.69). The incidence of VAP showed a declining trend from 46.1 to 36.5/1,000 ventilation days; however, this finding was not statistically significant ( p = 0.22). The simulation-based teaching program significantly enhanced nursing officers' knowledge and practice toward utilization of a preventive VAP bundle of care. There was decay in knowledge with time indicating that repetitive sessions are required at regular intervals to sustain this effect.

VENTILATOR ASSOCIATED PNEUMONIA-REVIEW ARTICLE

Ventilator-associated pneumonia (VAP) is one of the most frequent ICU-acquired infections and a leading cause of death among patients in Intensive Care Unit (ICU). VAP is associated with prolonged duration of mechanical ventilation and ICU stay. The estimated mortality of VAP is around 10%. There are many risk factors including host related, device related and personnel related. For prevention of VAP it is recommended to minimize the exposure to mechanical ventilation and encouraging early liberation. VAP bundle as a group of evidence-based practices that, results in decrease in the incidence of VAP should be used. Patients should be reassessed daily to conrm ongoing suspicion of disease, antibiotics should be guided by cultures reports, and clinicians should consider stopping antibiotics if cultures are 1 negative.

Effect of modified care bundle for prevention of ventilator-associated pneumonia in critically-ill neurosurgical patients.

Background:Care bundles for ventilator-associated pneumonia (VAP) have been shown to minimize the rate of VAP in critically ill patients. Standard care bundles may need to be modified in resource-constrained situations. The goal of this study was to see if our modified VAP-care bundles lowered the risk of VAP in neurosurgical patients.Methods:A prospective cohort study was conducted in mechanically ventilated neurosurgical patients. The VAP bundle was adjusted in the cohort group by increasing the frequency of intermittent endotracheal tube cuff pressure monitoring to six times a day while reducing oral care with 0.12% chlorhexidine to three times a day. The rate of VAP was compared to the historical control group.Results:A total of 146 and 145 patients were enrolled in control and cohort groups, respectively. The mean age of patients was 52±16 years in both groups (P=0.803). The admission Glasgow coma scores were 7.79±2.67 and 7.80±2.77 in control and cohort group, respectively (P=0.969). VAP was found in nine patients in control group but only one patient in cohort group. The occurrence rate of VAP was significantly reduced in cohort group compared to control group (0.88/1,000 vs. 6.84/1,000 ventilator days, P=0.036).Conclusions:The modified VAP bundle is effective in lowering the VAP rate in critically ill neurosurgical patients. It requires low budget and manpower and can be employed in resource-constrained settings.