Ventilator-associated Pneumonia Care Bundle Research Articles

Evaluation of ventilator-associated pneumonia care practice in the intensive care units of a comprehensive specialized hospital in Northwest Ethiopia: a 1.5-year prospective observational study.

Nosocomial infections pose a global health threat, with Ventilator-Associated Pneumonia (VAP) emerging as a prominent hospital-acquired infection, particularly in intensive care units (ICU).VAP is the commonest form of pneumonia in ICUs, contributing significantly to morbidity and mortality rates, which can reach around 30%. Despite the substantial impact of VAP on healthcare, there is a lack of data on adherence to VAP prevention protocols in our hospital. Consequently, this study aims to assess the adherence to ventilator-associated pneumonia care bundles in critical care units at a comprehensive specialized hospital in northwest Ethiopia. A hospital-based prospective observational study was conducted from July 3, 2022, to January 7, 2024. All adult patients who were on mechanical ventilators for more than 48h during the study period were included. Data were collected using the Institute of Healthcare Improvement VAP prevention standards as checklists via direct observation and chart review. The data were entered and analyzed using SPSS version 20. A total of 300 surgical and medical ICU patients were observed. Among the patients, 66.3% were from the medical ICU. In terms of admission reasons, 22.3%, 15.7% and, 12% were attributed to infections excluding respiratory origin, respiratory disorders, and other causes, respectively. The rate of compliance with all components of the bundle was 70%. A 100% adherence rate was observed for the prophylaxis for peptic ulcer and deep vein thrombosis (DVT). The lowest adherence rate was observed in the practice of oral hygiene with 0.5% chlorhexidine solution (0%) followed by humidification with heat and moisture exchangers (23.3%). Endotracheal tube cuff pressure measurement and use of endotracheal tubes with subglottic suction were not applicable. The study revealed suboptimal compliance with the VAP care bundle, indicating unsatisfactory overall practice. Specific attention is warranted for subglottic suction, cuff pressure measurement, humidification, oral care with chlorhexidine, and sedation vacation.

Efficacy of compliance with ventilator-associated pneumonia care bundle: A 24-month longitudinal study at Bach Mai Hospital, Vietnam.

To decrease the risk of complications from ventilator-associated pneumonia, it is essential to implement preventative measures in all ICU patients. Since 2018, with the help of Japanese experts, we have applied a ventilator-associated pneumonia care bundle with 10 basic standards in patient care and monitoring. Therefore, we conducted a study to evaluate the results of applying 10 solutions to prevent ventilator-associated pneumonia over 24 months. A cross-sectional descriptive study with longitudinal follow-up for 24 months on 170 mechanically ventilated patients at the Center for Critical Care Medicine, Bach Mai Hospital. According to the Centers for Disease Control (CDC, 2021), the diagnosis of ventilator-associated pneumonia is when pneumonia appears 48 h after intubation by confirmation by at least two doctors. Evaluate compliance with each solution in the care bundle through camera monitoring, medical records, and directly on patients daily. The rate of ventilator-associated pneumonia is 12.9%, the frequency of occurrence is 16.54 of 1000 days. The compliance rate for complete compliance with a 10-item ventilator-associated pneumonia was only 1.8%, while the average value was 84.1%. Average values of compliance with each solution for hand hygiene, head elevation 30-45 degrees, oral hygiene, stopping sedation, breathing circuit management, cuff pressure management, hypoplastic suction, Spontaneous breathing trial (SBT) daily and assessed extubation, mobilization and early leaving bed, ulcer and thrombosis prevention were 96.9%, 97.3%, 99.4%, 81.5%, 99.9%, 99.9%, 86.3%, 83.5%, 49.3%, and 46.4%, respectively. The time to appear ventilator-associated pneumonia in the high compliance group was 46.7 ± 5.0 days, higher than in the low compliance group, 10.3 ± 0.7 days, p < 0.001. A 10-item ventilator-associated pneumonia care bundle has helped reduce the incidence of ventilator-associated pneumonia. To reduce the risk of ventilator-associated pneumonia and shorten ICU and hospital stays, it is essential to fully adhere to subglottic secretion suction, daily SBT, and early mobilization and leaving the bed.

Application of an Automatic Medical Information System to Implement Bundle Care for the Prevention of Ventilator-Associated Pneumonia.

Ventilator-associated pneumonia is a common hospital-acquired infection. It causes patients to stay longer in the hospital and increases medical costs. This study explores the effect of applying an automatic medical information system to implement five-item prevention care bundles on the prevention of ventilator-related pneumonia. This study was a retrospective cohort study. This study was conducted from October 2017 to February 2018 and collected data from the intensive care unit of a medical center in southern Taiwan from January 2013 to May 2016. The control group (enrolled from January 2013 to June 2014) received oral hygiene. The experimental group (enrolled from July 2014 to December 2015) received five-item ventilator-associated pneumonia prevention care bundles, which consisted of (1) elevation of the head of the bed to 30–45°; (2) daily oral care with 0.12−0.2% chlorhexidine twice daily; (3) daily assessment of readiness to extubate; (4) daily sedative interruption; and (5) emptying water from the respirator tube. Results showed the incidence of ventilator-associated pneumonia in the bundle group was significantly less than the oral hygiene group (p = 0.029). The factors that significantly affected the incidence of ventilator-associated pneumonia were ventilator-associated pneumonia care bundle, ventilator-days, and intensive care unit length of stay. A significant reduction in ventilator-associated pneumonia rate in the bundle group compared to the oral hygiene group (OR = 0.366, 95% CI = 0.159–0.840) was observed, with 63.4% effectiveness. Application of an automatic medical information system to implement bundle care can significantly reduce the incidence of ventilator-associated pneumonia.

ASSESSMENT OF KNOWLEDGE AND COMPLIANCE OF CRITICAL CARE NURSES REGARDING VENTILATOR ASSOCIATED PNEUMONIA (VAP) CARE BUNDLE IN A TERTIARY CARE HOSPITAL, ASSAM, INDIA

Background: Ventilator-associated pneumonia (VAP) is reported to be the second most common nosocomial infection and the leading cause of death from nosocomial infections in critically ill patients. The purpose of the study was to assess the knowledge and compliance of critical care nurses regarding ventilator-associated pneumonia (VAP) care bundle. Research Methods: A descriptive study was conducted in December 2018in a tertiary care hospital, Assam. 60 Critical care nurses were selected as samples by convenient sampling technique. Structured knowledge questionnaire and compliance checklist was used for data collection. Results: The result revealed that the critical care nurses had mean knowledge score of 13.7±2.3 (68.5%) which indicated average knowledge score. Area wise mean knowledge score was highest in the area of Concept of VAP (85%) and was lowest in the area of the common causative organism of VAP (45%). Mean compliance score was 24.23 ±1.49 (93.2%) which indicated good compliance score. The maximum compliance was found in patient positioning (98%) and oral care (98%) and minimum compliance was found sedation vacation and weaning trials (90%). A weak positive relationship (0.39) was found between knowledge and compliance of the critical care nurses regarding VAP care bundle which was significant (p&lt;0.05). There was no significant association between the knowledge and the selected variables. Conclusions: The study showed various degree of deficiency among the critical care nurses in the knowledge and compliance area regarding VAP care bundle. The findings of the study have implications in the field of nursing. So, the researcher recommends that further research can be conducted to evaluate a structured teaching program on VAP care bundle, and an exploratory study can be done to identify the factors and its barriers responsible for noncompliance of VAP care bundle among the critical care nurses.

Compliance of ventilator associated pneumonia care bundle by staff nurses in critical care units

INTRODUCTION: Ventilator-associated pneumonia (VAP) is a type of hospital-acquired pneumonia that occurs in patients who are mechanically ventilated for more than 48 hours. VAP is the leading cause of nosocomial infections in patients in intensive care units (ICUs). The pathogenesis of VAP originates from microbial pathogens that are aspirated through the tracheal tube cuff and into the lower respiratory tract. Subsequent colonization and overwhelming of the host's mechanical, body fluids, and cellular defense mechanisms leads to the development of VAP. Objectives:1. To assess the compliance on VAP care Bundle by staff nurses in critical care units.2. To identify the reason for the non-compliance on VAP care bundle.3.To associate the level of compliance on VAP care bundle with demographic variables. Material and Methods: A Descriptive study conducted in critical care units at a tertiary teaching hospital at Puducherry. Institutional review board permission was obtained. The data collection period was one month in the year 2018. The population was nurses who are taking care of mechanical ventilator patients. Samples were selected by census method. The sample size was 50. After getting group consent (verbal consent) from each staff nurses, they were observed by using observational checklist to assess the compliance of VAP care bundle in critical care units. After continuous 3 observations, the participant information sheet was provided and written consent was obtained from each staff nurses. After that the data related to demographic variables and self administered questionnaires on compliance of VAP care bundle was administered over a period of 20 minutes for every participant. Results: In the present study majority 76% (38) staff nurses had average level of compliance to VAP care bundle, 72% (36) of the staff nurses belongs to the age group of 22-25 years,86% (43) of them were females ,96% (48) had completed BSc Nursing,46% (23) of them had 13-36 months of working experience and 58%(29) had not attended CNE regarding VAP care bundle. Conclusion: The present study assessed the level of compliance of VAP care bundle by staff nurses in critical care units. The practices were observed by using observational checklist and the reasons for non compliance to VAP care bundle given by staff nurses were expensive equipment, lack of awareness and dependence on doctor’s order. The study concludes that the level of compliance among majority of staff nurses were average, so there is need for improvement in nurses performance in implementing VAP care bundle protocol in critical care units.

Audit on compliance of ventilator associated pneumonia care bundle in Intensive Care units in National Hospital Sri Lanka

The Sri Lankan Journal of Anaesthesiology is the official journal of the College of Anaesthesiologists of Sri Lanka. It publishes clinical investigations, research articles, audits, case reports, review articles and CME articles relating to anaesthesiology, critical care and pain. It is published bi annually in January and June. Sri Lankan Journal of Anaesthesiology is included on DOAJ and Scopus.

Prevention of ventilator-associated pneumonia: Use of the care bundle approach.

The ventilator-associated pneumonia (VAP) care bundle consists of evidence-based practices to improve the outcomes of patients receiving mechanical ventilatory therapy. This study aimed to investigate the implementation of the care bundle on VAP rates in this quasiexperimental study. The protocol of this study consisted of 3 phases. In the initial phase, observations were made to determine the VAP care bundle adherence of intensive care unit (ICU) nurses. In the second phase, education was provided to ICU nurses on the subject of the VAP care bundle. For the third phase, the effect of VAP care bundle adherence on the VAP rates after education was investigated. The nurses' VAP care bundle adherence improved after education from 10.8% (n = 152) to 89.8% (n = 1,324) and showed statistically significant improvement (P = .0001 and P < .05). In this study, the VAP rates were determined as 15.91/103 ventilator-days before education and 8.50/103 ventilator days after education. It was found that the VAP rates after the education period were significantly lower than the VAP rates before education. VAP care bundle implementation with education prepared according to evidence-based guidelines decreased VAP rates. Thus, implementation of the VAP care bundle on mechanically ventilated patients care is recommended.

Nurse-led implementation of a ventilator-associated pneumonia care bundle in a children’s critical care unit

Ventilator-associated pneumonia (VAP) is the leading cause of death with hospital-acquired infections, and preventing it is one of the Saving Lives initiatives ( Department of Health 2007 ). This article discusses the implementation of a purpose-designed VAP care bundle in a children's intensive care unit and examines the unique role of nurses in the management of the change process. A nurse-led VAP education, implementation and surveillance programme was set up. Nurse education was paramount, as nursing staff acceptance and involvement was a key feature. A multi-method training strategy was implemented, providing staff with multiple training opportunities and introducing VAP project education as a routine part of staff induction. Bundle compliance was monitored regularly and graphs of the results produced quarterly; feedback proved to be useful in keeping staff informed and engaged in VAP reduction. Comparison of VAP incidence before and after introduction of the care bundle showed a reduction after its implementation. With a co-ordinated, multidisciplinary approach, VAP care bundles can result in significant and sustained reductions in VAP rates in the paediatric intensive care unit. Effective co-ordination and leadership is crucial to successful implementation of the VAP bundle, and nurses are well placed to undertake this role.

G222 Does the implementation of a ventilator associated pneumonia (vap) care bundle reduce incidence of vap in picu?

Ventilator associated pneumonia (VAP) is pneumonia that develops 48 h after intubation. VAP is the second most common nosocomial infection in PICU patients and is associated with increased duration of ventilation, ICU stay, hospital stay, and cost. VAP is a preventable healthcare acquired infection and a Department of Health (1999) Saving Lives initiative. This poster aims to discover whether the introduction of a VAP care bundle (VCB) is effective at reducing VAP rates in PICU. A search of various databases was undertaken, including MedLine, Pubmed, CINHAL, EBSCO, using relevant PICO key words. 3 paediatric research studies were found and 4 published presentations of data. Due to the limited amount of paediatric data the search was extended to include adult studies, producing 12 valid studies. Results conclusively showed a decrease in VAP following the introduction of a VAP care bundle. Paediatric studies showed a reduction ranged from 76%–100% (91% average), with 210 days – 3 years VAP free with associated decreases in length of stay and cost. Adult studies found a 62% average decrease in VAP, with higher reduction in VAP associated with increased compliance. Due to limitations of the observational designs used, various implementation strategies, and lack of consistency in VCB elements, it is difficult to determine what is responsible for the measured outcomes. However the weight of evidence showing VAP reduction with VCB use suggests a strong relationship. And although the evidence is not at the highest experimental level, it is at the highest ethically acceptable level. It should also be taking into consideration that each individual bundle component is supported by its own breadth of high level experimental evidence. Routine use of VCB is widespread in adult ICUs, and the adult and paediatric literature agree that care bundles are an effective method for reducing the incidence of ventilator associated pneumonia. Therefore in absence of any contradictory data, care bundles should be adopted in paediatric intensive care practice. Further research is required to examine individual elements of the paediatric VCB; but with a synchronised team approach, VCB can result in continued reductions in VAP, length of stay, and costs.

Care bundle for ventilator-associated pneumonia in a medical intensive care unit in Northern Taiwan

Background: Ventilator-associated pneumonia (VAP) occurs in patients requiring mechanical ventilators for more than 48 h. VAP is the most common nosocomial infection and the leading cause of complications and death in intensive care units (ICUs). Materials and Methods: Two historical comparison groups of 375 patients who used mechanical ventilators for more than 48 h in the medical ICU (MICU) from December 1, 2011 to May 31, 2012 and December 1, 2013 to May 31, 2014 were enrolled in this study. There were 194 adult patients in the control group that received traditional care, and there were 181 patients in the experimental VAP care bundle group. Our VAP care bundle entailed several preventive strategies including daily assessments of sedation, daily consideration of weaning and extubation by the doctors and respiratory therapists charged with the care of the patients, maintenance of the intra-cuff pressure values at approximately 20-30 cm H 2 O, hand hygiene, daily oral hygiene, personal protective equipment for suctioning, the placement of patients in semi-recumbent positions with the head of the bed elevated to at least 30°, aspiration of an endotracheal tube and oral cavity prior to position changes, daily cleaning of the ventilator and suction bottle with sterile distilled water, weekly replacement of the ventilator circuit and heater, sterilization of the circuit by pasteurization, and the use of an independent care room. The data were collected by reviewing the patients' medical records and by retrieving information from the Nosocomial Infection Control Unit of one medical center in Northern Taiwan. Results: The incidence of VAP in the VAP care bundle group (0.281 cases per 1000 ventilator days) was significantly lower than that in the control group (0.495 cases per 1000 ventilator days). We estimated that the occurrence of VAP in the MICU increased the medical costs by an average of NT $68317 per patient. Conclusions: VAP care bundle is an effective strategy to reduce the incidence of VAP in the MICU and to reduce healthcare costs.

Compliance of a ventilator-associated pneumonia care bundle in an adult intensive care setting

Ventilator-associated pneumonia (VAP) is the leading cause of death amongst hospital-acquired infections and is also linked to an increased length of stay and cost of care. The Institute for Healthcare Improvement ventilator bundle is comprised of a series of interventions, which, when implemented together, have been shown to decrease the incidence of VAP. The aim of this study was to determine the compliance of the bundle and if <95% [1] devise strategies to improve compliance.

Education alone is not enough in ventilator associated pneumonia care bundle compliance.

Objective:Ventilator-associated pneumonia (VAP) described as a secondary and preventable consequence in mechanically ventilated patients, emerges 48 h or more after patients intubation. Considering the high morbidity and mortality rate of VAP and the fact that VAP is preventable, it seemed necessary to evaluate care bundle compliance rate and effect of education on its improvement.Methods:This observational study was conducted on 10 Intensive Care Units (ICUs) of four university affiliated hospitals in three steps. In the first step, VAP care bundle compliance including head of bed (HOB) elevation, endotracheal cuff pressure (ETCP), mouthwash time, utilizing close suction systems, subglottic secretion drainage, type of suction package, and hand wash before suctioning was evaluated. In the second and third steps, ICU staffs were trained and its effect on VAP care bundle compliance was investigated. Finally, an inquiry from nurses was conducted to evaluate the obtained results.Findings:A total of 552 checklists consisting of 294 observations in the pre-education group and 258 observations in the posteducation group were filled. Mean VAP care bundle compliance in pre-education and posteducation stages was 36.5% and 41.2%, respectively (P > 0.05). Except for patients' mouth washing, there were no improvement in HOB elevation (>30°), hand washing and ETCP after education. Based on the results of questionnaire received from nurses at the end of study, more than 90% of nurses believed that lack of rigid monitoring of VAP care bundle is a main reason of low adherence for VAP care bundle compliance.Conclusion:The adherence to VAP care bundle was inappropriate. Education seems to be ineffective on improving VAP care bundle compliance. Frequent recall of the necessity of the VAP care bundle and the continuous supervision of ICU staffs is highly recommended.

Compliance of a ventilator-associated pneumonia care bundle in an adult intensive care setting

Ventilator-associated pneumonia (VAP) is the leading cause of death amongst hospital-acquired infections and is also linked to an increased length of stay and cost of care. The Institute for Healthcare Improvement ventilator bundle is comprised of a series of interventions, which, when implemented together, have been shown to decrease the incidence of VAP. The aim of this study was to determine the compliance of the bundle and if <95% [1] devise strategies to improve compliance.

Efficacy of ventilator-associated pneumonia care bundle for prevention of ventilator-associated pneumonia in the surgical intensive care units of a medical center

Ventilator-associated pneumonia (VAP) is one of the most serious treatment-related infections resulting in high mortalities and costs. Our hospital has implemented bundle care in the intensive care units (ICUs) with special focus on VAP prevention. This is a retrospective study to evaluate its efficacy. We implemented a six-item VAP care bundle modified from that of the Institute for Healthcare Improvement at five surgical ICUs (SICUs) in the National Taiwan University Hospital. A multidisciplinary teamwork was involved in this bundle care. This study analyses the SICU utilization, ventilator utilization, and VAP incidence between January 2006 and March 2013 to assess the impact of VAP bundle in a clinical setting. A total of 28,454 SICU patients were analyzed in this study and patients under the age of 18 were excluded (n = 1329); eventually, 27,125 patients were enrolled, with 12,913 patients from the pre-VAP bundle phase and 14,212 from the post-VAP bundle phase. Patients from the post-VAP phase tended to be older (p = 0.024) and with shorter SICU stay (p = 0.006), and disease severity scores (Therapeutic Intervention Scoring System, Glasgow Coma Scale, and Acute Physiology and Chronic Health Evaluation II score) were lower in the post-VAP bundle phase (p < 0.001), except the Injury Severity Score (p = 0.729). In response to VAP bundle interventions, no difference in SICU utilization (p = 0.982) between the pre-VAP and post-VAP bundle phases was noted, whereas the ventilator utilization was significantly decreased, from 1148.5 ventilator days to 956.1 ventilator days (p < 0.001) monthly; the VAP density had remarkably decreased from 3.3 to 1.4 cases per 1000 ventilator days (p < 0.001). Implementation of VAP bundle care decreases the incidence of VAP at SICU. Multidisciplinary teamwork, education, and a comprehensive checklist to improve health-care workers' compliance are the keys to success.

Impact of Enhanced Ventilator Care Bundle Checklist on Nursing Documentation in an Intensive Care Unit

Ventilator-associated pneumonia is a hospital-acquired infection that may develop in patients 48 hours after mechanical ventilation. The project goal was to determine whether a ventilator-associated pneumonia care bundle checklist embedded into an existing electronic health record would increase completeness of nursing documentation in an intensive care unit setting. With the embedded checklist, there were significant improvements in nursing documentation and a decreased incidence of ventilator-associated pneumonia.