Adherence to the items in a bundle for the prevention of ventilator-associated pneumonia

Abstract

Objective To assess adherence to a ventilator care bundle in an intensive care unit and to determine the impact of adherence on the rates of ventilatorassociated pneumonia.Methods A total of 198 beds were assessed for 60 days using a checklist that consisted of the following items: bed head elevation to 30 to 45º; position of the humidifier filter; lack of fluid in the ventilator circuit; oral hygiene; cuff pressure; and physical therapy. Next, an educational lecture was delivered, and 235 beds were assessed for the following 60 days. Data were also collected on the incidence of ventilator-acquired pneumonia.Results Adherence to the following ventilator care bundle items increased: bed head elevation from 18.7% to 34.5%; lack of fluid in the ventilator circuit from 55.6% to 72.8%; oral hygiene from 48.5% to 77.8%; and cuff pressure from 29.8% to 51.5%. The incidence of ventilator-associated pneumonia was statistically similar before and after intervention (p=0.389).Conclusion The educational intervention performed in this study increased the adherence to the ventilator care bundle, but the incidence of ventilator-associated pneumonia did not decrease in the small sample that was assessed.

Nursing workload and compliance with non‐pharmacological measures to prevent ventilator‐associated pneumonia: a multicentre study

“…The observed overall compliance with non‐pharmacological preventive measures against VAP in our population was similar to that reported in other studies (Morris et al, ; Resar et al, ; Sachetti et al, ), suggesting that our staff might be representative of other ICUs with similar staffing and workload levels. Nevertheless, additional multicentre studies would be necessary to confirm our results and further analyse contextual and behavioural factors associated with compliance to help ensure more effective implementation of the guidelines and protocols in clinical practice.…”

Boas práticas na prevenção de pneumonia associada à ventilação mecânica

“…(11,13) Care of the ventilator circuit is classified as interventions with an evidence level I, and daily change of this device is not recommended. (10,14) Brazilian studies evaluating compliance with this measure identified high compliance rates ranging from 70% to 100%. (15,16) In this study, this measure was positively highlighted, since it was the second item with the best compliance by the professionals (82.6%).…”

“…Despite the quality of evidence level II in the reduction of VAP, it is still a measure recommended by the guidelines, since commonly the microorganisms of the oral cavity can migrate to the airways, leading to the occurrence of VAP. (10,14,19) Oral hygiene with chlorhexidine is not a risk-free intervention and the indiscriminate use of this antiseptic should be avoided through the divergence of results described in the literature for specific populations. (21) Regarding cuff pressure, it is a measure considered level of evidence III, because results of clinical trials performed did not have an impact on length of stay in the ICU and mortality rates.…”

Ventilator Bundle Compliance and Risk of Ventilator-Associated Events

“…Prior studies examining the impact of ventilator bundles have largely shown reductions in rates of VAP as it was previously defined. [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] A previous study at our institution implementing the same ventilator dashboard utilized in this study showed that VAP rates decreased significantly with the rollout of the ventilator bundle. 28 VAPs and VAEs are different outcomes; however, previous research has shown that the entities often have little overlap.…”

“…11 These practices are commonly deployed together as part of a ventilator bundle, and in many studies ventilator bundles have been associated with a reduction in VAP rates. [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] In 2007, our institution developed a real-time ventilator bundle compliance dashboard that tracks the status of all bundle practices and serves to remind bedside caregivers when a specific practice is due. A major advantage of this approach is that it captures compliance over the entire duration of ventilation in real time as opposed to other methods such as spot audits.…”