Efficacy of a ventilator bundle for the prevention of the ventilator-associated pneumonia

Introduction: Several specific and general strategies have proven effectiveness for prevention of ventilator-associated pneumonia (VAP). Objective: To evaluate the impact of a ventilator bundle and the control of process measures on the rate of VAP in our Intensive Care Unit. Methods: A prospectively ventilator bundle have applied to every patient who received mechanical ventilation (MV). Daily control of the application of ventilator bundle was registered and weekly control of ventilator bundle compliance was registered. We compare the VAP rate of two periods, 25 months before the implementation of the bundle and 11 months after. The Poisson regression test was used. The methodology of the NHSN (National Healthcare Safety Network) was used for infection surveillance and the methodology of IHI (Institute of Healthcare Improvement) was used for compliance control. Results: The MV use rate was (ventilator day/patients day) higher during the bundle period compare to the previous period (1381/2253 = 0.61 vs. 2840/5262 = 0.54 p<0.0001), the MV average days was also higher during the bundle period (8.52±2.07 vs. 7.03±1.61 p<0.0001). The VAP rate was lower during the bundle period compare with the previous one (3.62‰ MV days vs. 12.32‰ MV days p=0.001) with a reduction of the VAP of 70.61%. The compliance to the ventilator bundle was 97.91% and the fulfillment of the ventilator bundle was 90.13%. Conclusion: The application of a ventilator bundle and control of ventilator bundle compliance was associated with a diminishment of the VAP rate.