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

Abstract

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.

Monitorowanie zapalenia płuc związanego z wentylacją mechaniczną według projektu INICC — doświadczenia jednego ośrodka

“…In one of the studies, the patients diagnosed by BAL had a lower number of confirmed VAP (6.1 vs. 25.5/1000 ventilation days) compared to those diagnosed with non-protective aspiration, which was characterised by 90% sensitivity and only 14% specificity [24]. The literature data indicate that VAP prophylaxis, in the form of the ventilation bundle, can result in notable effects, i.e., decreased incidence [3,15,23,25]; however, studies confirming the lack of infections of this type in a given period are sparse [17,26]. Moreover, the complete elimination of VAP has been questioned [27].…”

An epidemiological study of ventilator-associated pneumonia (VAP) and ventilator-associated events (VAE) surveillance and preventative strategies in critically ill children

“…The increment of overall compliance for VAP preventative strategies as found in the prospective study versus the retrospective study mimics the findings of several other VAP studies (Al-Thaqafy, El-Saed, Arabi, & Balkhy, 2014;Babcock et al, 2004;Bigham et al, 2009;Bouadma, Mourvillier, Deiler, Le Corre, et al, 2010;Brierley et al, 2012;Lawrence & Fulbrook, 2012). Interestingly, differences between individual VAP preventative strategies reported in the retrospective versus the prospective study were statistically significant (oral hygiene, HOB elevation, cuff pressure and ventilator checks).…”

Introducing the Comprehensive Unit-based Safety Program for mechanically ventilated patients in Saudi Arabian Intensive Care Units

“…[42434445464748] All these studies were based on pre- and post-intervention observational designs except for two, which were prospective cohort studies. [4244] The total number of patient ventilator days was 64,414, with the highest number (41,034) reported by Al-Dorzi et al . [42] Cost estimates were mentioned in two studies: Bukhari et al .…”

“…However, some organizations introduced other prevention measures. Four of the seven institutions added oral care with chlorhexidine,[43444748] two implemented the use of endotracheal tubes with subglottic secretion drainage,[4348] and one monitored endotracheal tube cuff pressure. [43] The overall bundle compliance improved from 48.6% to 94.3% (an increase of 49%), with Al-Tawfiq and Abed[46] reporting the greatest improvement (75.6%).…”

“…The average VAP rates decreased from 9.4 to 3.1 cases per 1000 ventilator days, which represents a reduction of 66%, and the biggest change (72%) was described by Al-Thaqafy et al . [44]…”